Exercise Rehabilitation and Chronic Obstructive Pulmonary Disease Stage

Abstract

Exercise Rehabilitation and Chronic Obstructive Pulmonary Disease StageBerry MJ, Rejeski WJ, Adair NF, Zaccaro D Am J Respir Crit Care Med 1999;160:1248-1253 Background. Staging of chronic obstructive pulmonary disease (COPD) (by the use of forced expiratory volume in 1 second [FEV1] measurement) has been shown to correlate with disability and death. The effects of pulmonary rehabilitation have been assessed in patients with moderate to severe COPD. Purpose. To determine if patients with mild COPD experience improvements in physical performance and health-related quality of life as a result of exercise training. Materials and Methods. One hundred fifty one patients with COPD (defined as an FEV1/forced vital capacity [FVC] less than 70% and without airflow reversibility) who had difficulty in performing daily activity tasks due to dyspnea underwent 12 weeks of facility-based exercise training. Staging of COPD was made with those patients who had an FEV1 greater than 49% predicted classified as Stage 1, those with 35-49% classified as Stage 2, and those with less than 35% classified as Stage 3. Exercise duration on a treadmill and 6-minute walk test and quality of life measures by the Chronic Respiratory Questionnaire (CRQ) were assessed before and after training. Results. Six-minute walk distance increased significantly in patients with Stage 1 (200.5 ft; 95% confidence interval [CI] 165.4, 235.7), Stage 2 (233.3 ft; 95% CI 143.3, 333.3), and Stage 3 (112.1 ft; 95% CI 34.6, 189.6). Treadmill time increased significantly in patients with Stage 1 (0.42 min; 95% CI 0.20, 0.64) and Stage 2 (0.64 min; 95% CI 0.14, 1.4). Participants in Stages 1, 2, and 3 all experienced improvements in the CRQ domains of dyspnea and fatigue. Conclusion. Patients with mild, moderate, and severe COPD appear to benefit from pulmonary rehabilitation with improvements in exercise capacity and quality of life. Comment. Despite the fact that patients with mild COPD have a reduced quality of life and physical work capacity, the studies to date have evaluated the effects of rehabilitation on patients with Stage 2 and 3 disease (moderate to severe disease). This is the first study to show that patients with more mild COPD also experience significant benefits in exercise tolerance and improvements in quality of life. Rehabilitation services should be offered to those patients with mild COPD.