Abstract
BackgroundExercise training is recommended for non-cystic fibrosis (CF) bronchiectasis, but the long-term effects are unclear. This randomised controlled trial aimed to determine the effects of exercise training and review of airway clearance therapy (ACT) on exercise capacity, health related quality of life (HRQOL) and the incidence of acute exacerbations in people with non-CF bronchiectasis.MethodsParticipants were randomly allocated to 8 weeks of supervised exercise training and review of ACT, or control. Primary outcomes of exercise capacity and HRQOL (Chronic respiratory disease questionnaire) and secondary outcomes of cough-related QOL (Leicester cough questionnaire) and psychological symptoms (Hospital anxiety and depression scale) were measured at baseline, following completion of the intervention period and at 6 and 12 months follow up. Secondary outcomes of the exacerbation rate and time to first exacerbation were analysed over 12 months.ResultsEighty-five participants (mean FEV1 74% predicted; median Modified Medical Research Council Dyspnoea grade of 1 (IQR [1–3]) were included. Exercise training increased the incremental shuttle walk distance (mean difference to control 62 m, 95% CI 24 to 101 m) and the 6-minute walking distance (mean difference to control 41 m, 95% CI 19 to 63 m), but these improvements were not sustained at 6 or 12 months. Exercise training reduced dyspnoea (p = 0.009) and fatigue (p = 0.01) but did not impact on cough-related QOL or mood. Exercise training reduced the frequency of acute exacerbations (median 1[IQR 1–3]) compared to the control group (2[1–3]) over 12 months follow up (p = 0.012), with a longer time to first exacerbation with exercise training of 8 months (95% CI 7 to 9 months) compared to the control group (6 months [95% CI 5 to 7 months], p = 0.047).ConclusionsExercise training in bronchiectasis is associated with short term improvement in exercise capacity, dyspnoea and fatigue and fewer exacerbations over 12 months.Trial registryClinicalTrials.gov (NCT00885521).
Highlights
Bronchiectasis unrelated to cystic fibrosis is a chronic respiratory condition characterised by bronchial dilatation secondary to airway inflammation, infection and dysfunction of mucociliary clearance [1]
There is limited evidence of the effects of pulmonary rehabilitation in non-cystic fibrosis (CF) bronchiectasis, with two retrospective studies demonstrating similar benefits in exercise capacity and health related quality of life (HRQOL) as those observed in patients with chronic obstructive pulmonary disease (COPD) [15,16]
The subject flow reflected the recommendations from the Consolidated Standards of Reporting Trials (CONSORT) statement [38]
Summary
Bronchiectasis unrelated to cystic fibrosis (non-CF bronchiectasis) is a chronic respiratory condition characterised by bronchial dilatation secondary to airway inflammation, infection and dysfunction of mucociliary clearance [1]. Common features include persistent cough with chronic sputum production, dyspnoea and fatigue [2,3] This the need for effective medical and physiotherapy treatment approaches. Two prospective studies showed short-term improvements in exercise capacity and HRQOL with a combination of endurance, strength training and inspiratory muscle training [17] or regular airway clearance therapy (ACT) [18]. These studies incorporated formal education as part of the clinical approach and had a follow up period of three months; it is not clear if benefits persist in the longer term. This randomised controlled trial aimed to determine the effects of exercise training and review of airway clearance therapy (ACT) on exercise capacity, health related quality of life (HRQOL) and the incidence of acute exacerbations in people with non-CF bronchiectasis
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