Rehabilitation In COPD Research Articles

Impact of Resistance Training in Subjects With COPD: A Systematic Review and Meta-Analysis.

The goal of this study was to evaluate the effects of resistance training on subjects with COPD. We performed a systematic search in MEDLINE, PubMed, Embase, CINAHL, Elsevier ScienceDirect, EBM Reviews, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov and also of leading respiratory journals for randomized controlled trials on COPD treatment for ≥ 4 weeks with resistance training compared with non-exercise control or with combined resistance and endurance training compared with endurance training alone. Data from these studies were pooled to calculate odds ratio and weighted mean differences (WMDs) with 95% CI. Eighteen trials with 750 subjects with advanced COPD met the inclusion criteria. There were 2 primary and 5 secondary outcomes. Compared with non-exercise control, resistance training led to significant improvements in the dyspnea domain of the Chronic Respiratory Disease Questionnaire (WMD of 0.59, 95% CI 0.26-0.93, I2 = 0%, P < .001), skeletal muscle strength, and percent-of-predicted FEV1 (WMD of 6.88%, 95% CI 0.41-13.35%, I2 = 0%, P = .04). The combination of resistance and endurance training significantly improved the St George Respiratory Questionnaire total score (WMD of -7.44, 95% CI -12.62 to -2.25, I2 = 0%, P = .005), each domain score, and skeletal muscle strength. There were no significant differences in 6-min walk distance, 6-min pegboard and ring test, maximum exercise work load, and maximum oxygen consumption between the 2 groups. There were no reports of adverse events related to resistance-training intervention. Resistance training can be successfully performed alone or in conjunction with endurance training without increased adverse events during pulmonary rehabilitation in COPD.

Family-Based Psychosocial Support and Education as Part of Pulmonary Rehabilitation in COPD: A Randomized Controlled Trial

Involving family as part of the patient's rehabilitation plan of care might enhance the management of COPD. The primary aim of this study was to investigate the impact of a family-based pulmonary rehabilitation (PR) program on patients and family members' coping strategies to manage COPD. Family dyads (patient and family member) were randomly assigned to family-based (experimental) or conventional (control) PR. Patients from both groups underwent exercise training three times a week and psychosocial support and education once a week, during 12 weeks. Family members of the family-based PR attended the psychosocial support and education sessions together with patients. In the conventional PR, family members did not participate. Family coping and psychosocial adjustment to illness were assessed in patients and family members of both groups. Patients' exercise tolerance, functional balance, muscle strength, and health-related quality of life were also measured. All measures were collected pre/post-program. Forty-two dyads participated (patients: FEV1, 70.4% ± 22.1% predicted). Patients (P = .048) and family members (P = .004) in the family-based PR had significantly greater improvements in family coping than the control group. Family members of the family-based PR had significantly greater changes in sexual relationships (P = .026) and in psychologic distress (P = .033) compared with the control group. Patients from both groups experienced significant improvements in exercise tolerance, functional balance, knee extensors strength, and health-related quality of life after intervention (P < .001). This research supports family-based PR programs to enhance coping and psychosocial adjustment to illness of the family system. ClinicalTrials.gov; No.: NCT02048306; URL: www.clinicaltrials.gov.

Changes in the endurance shuttle walk test in COPD patients with chronic respiratory failure after pulmonary rehabilitation: the minimal important difference obtained with anchor- and distribution-based method.

BackgroundAlthough the endurance shuttle walk test (ESWT) has proven to be responsive to change in exercise capacity after pulmonary rehabilitation (PR) for COPD, the minimally important difference (MID) has not yet been established. We aimed to establish the MID of the ESWT in patients with severe COPD and chronic hypercapnic respiratory failure following PR.MethodsData were derived from a randomized controlled trial, investigating the value of noninvasive positive pressure ventilation added to PR. Fifty-five patients with stable COPD, GOLD stage IV, with chronic respiratory failure were included (mean (SD) FEV1 31.1 (12.0) % pred, age 62 (9) y). MID estimates of the ESWT in seconds, percentage and meters change were calculated with anchor based and distribution based methods. Six minute walking distance (6MWD), peak work rate on bicycle ergometry (Wpeak) and Chronic Respiratory Questionnaire (CRQ) were used as anchors and Cohen’s effect size was used as distribution based method.ResultsThe estimated MID of the ESWT with the different anchors ranged from 186–199 s, 76–82% and 154–164 m. Using the distribution based method the MID was 144 s, 61% and 137 m.ConclusionsEstimates of the MID for the ESWT after PR showed only small differences using different anchors in patients with COPD and chronic respiratory failure. Therefore we recommend using a range of 186–199 s, 76–82% or 154–164 m as MID of the ESWT in COPD patients with chronic respiratory failure. Further research in larger populations should elucidate whether this cut-off value is also valid in other COPD populations and with other interventions.Trial registrationClinicalTrials.Gov (ID NCT00135538).Electronic supplementary materialThe online version of this article (doi:10.1186/s12931-015-0182-x) contains supplementary material, which is available to authorized users.

The overall impact of COPD (CAT) and BODE index on COPD male patients: correlation?

BackgroundChronic Obstructive Pulmonary Disease (COPD) will be the 5th leading cause of disability (DALYs) and the 4th leading cause of death by 2030. Measuring the real impact of COPD using CAT (“COPD Assessment Test”) can complement BODE index, an indicator of mortality. AimsTo assess correlation between CAT and BODE index in COPD patients. Materials and methodsA retrospective study was conducted in a population of patients with COPD in a Respiratory Rehabilitation program. We analyzed demographic variables, variables in respiratory function – 6min walking test (6MWT), post-BD forced expiratory volume in 1st second (FEV1%); dyspnea by mMRC scale; BODE Index and CAT. ResultsThe study included 50 patients – GOLD stage I (7), II (25), III (14) and IV (4), 48 men; mean age 62.6 years (±9.5), average BMI 25.8kg/m2 (±4.8) and FEV1 57.1% (±19.6); 6MWT of 443.3m (±61.6); 46% patients in classes 2 and 3 of mMRC scale; 84% were class 2 in BODE Index. About 80% reported slight to medium impact in CAT. CAT score and impact were correlated with BODE index score: R=0.475, p<0.01, and R=0.377, p=0.004, and BODE index class: R=0.357, p=0.011, and R=0.326, p=0.021. ConclusionAs pre-existent data in the literature (exacerbations and benefit of rehabilitation in COPD), the positive correlations found with BODE index reinforce the discriminative validity of CAT as a complement in the evaluation of what the true impact of COPD is on a patient's daily life.

A controlled study of community-based exercise training in patients with moderate COPD.

BackgroundThe effectiveness of clinic-based pulmonary rehabilitation in advanced COPD is well established, but few data exist for less severe patients treated in alternative settings. The purpose of this study was to investigate whether a novel, community-based exercise program (CBE) was feasible and effective for patients with moderate COPD.MethodsNineteen patients with moderate COPD (mean FEV1 62%) and self-reported exercise impairment were randomized to 12-weeks of progressive endurance and strength training at a local health club under the guidance of a certified personal trainer, or to continuation of unsupervised habitual physical activity. Outcomes assessed at baseline and 12 weeks included session compliance, intensity adherence, treadmill endurance time, muscle strength, dyspnea, and health status.ResultsCompliance was 94% and adherence was 83%. Comparisons between CBE and control groups yielded the following mean (SEM) differences in favor of CBE: endurance time 134 (74) seconds versus -59 (49) seconds (P = 0.041) and TDI 5.1 (0.8) versus -0.2 (0.5) (P < 0.001). The CBE group increased muscle strength (weight lifted) by 11.8 kilograms per subject per week of training (P < 0.001). SGRQ was not significantly changed.ConclusionsWe demonstrated the feasibility and effectiveness of a novel community-based exercise program involving health clubs and personal trainers for patients with moderate COPD.Trial registrationClinicalTrials.gov Identifier NCT01985529.

Prof. Denis E. O'Donnell: personalized treatment of COPD.

Denis E. O’Donnell, MB, BCh., (NUI), MD (NUI), FRCP(I), FRCP(C) is a professor of Medicine, with cross appointments to the Departments of Biomedical & Molecular Sciences (Physiology), Rehabilitation Medicine and Kinesiology & Health Studies, Queen’s University, Kingston, Ontario, Canada (Figure 1). Dr. O’Donnell’s main research focus is clinical integrative physiology and specifically, exercise pathophysiology and mechanisms and management of dyspnea in respiratory disorders. His main clinical focus is COPD and pulmonary rehabilitation (PR).

Физическая реабилитация больных хобл

Физическая реабилитация больных хобл

Contribution of psychological factors in dropping out from chronic obstructive pulmonary disease rehabilitation programs.

Significant positive effects, particularly on psychological state in patients who completed the follow-up pulmonary rehabilitation programs, are indicated by a large number of studies. Yet, a remarkable proportion of selected patients drop out from these programs. In this study, we investigated existing differences on psychological variables among COPD patients who complete and those who drop out from pulmonary rehabilitation programs. The study included 144 patients, 43 (29.9%) of whom did not complete the program. SCL-90 was used for the assessment of psychological symptoms. On the SCL-90-R scale 55.6% of patients had abnormal findings. Patients who discontinued the program had higher rates of depression and somatization compared to those who completed it. Regarding the psychopathology scales of SCL-90R, we found that patients who discontinued the program showed higher levels of psychopathology on the scales of somatization, depression, paranoid ideation, and psychotism compared to those who completed the program. The final regression model showed that patients with low educational status and psychotism were more likely to leave the program. In conclusion, psychopathology contributes to patients dropping out from a COPD rehabilitation program; thus, psychological assessment prior to inclusion in rehabilitation programs may reduce dropouts.

P118 Post discharge pulmonary rehabilitation for acute exacerbation COPD does not always reduce re-admission rates

IntroductionPost-discharge pulmonary rehabilitation (PR) within 7–10 days after discharge from hospital admission for acute exacerbation of COPD (AECOPD) has been shown not only to result in the well-described benefits of...

Contrasting breathing retraining and helium–oxygen during pulmonary rehabilitation in COPD: A randomized clinical trial

Breathing-retraining and helium-oxygen (heliox) have been used to improve exercise tolerance in COPD. We hypothesized that, in patients with COPD, exercise duration after exercise-training plus breathing-retraining and oxygen would be longer than after exercise-training plus heliox or after exercise-training plus oxygen alone. We also explored the short-term maintenance of gains in exercise duration after using each technique. Of 192 COPD patients recruited, 103 were randomly assigned to exercise-training plus heliox (n=33), exercise-training plus breathing-retraining and oxygen (n=35) and exercise-training and oxygen (n=35). FiO2 was 0.30 during testing and training in all groups. Patients exercised on a treadmill thrice-weekly for eight weeks. Before, at completion of training, and six-weeks later, patients underwent constant-load treadmill testing. At completion of training, improvements in exercise duration in the heliox and breathing-retraining groups were not significantly different. Compared to the exercise-training plus oxygen group, exercise duration improved more in the breathing-retraining group (P=0.008) but not in the heliox group (P=0.142). Hyperinflation was reduced with breathing-retraining plus oxygen compared to the other two groups. Six-weeks later, improvements in exercise duration were still greater with breathing-retraining than with exercise-training (P=0.015). In contrast, improvements in exercise duration with heliox did not differ from those in the other two groups. In moderate-to-severe COPD, exercise-training combined with either heliox or with breathing-retraining yielded not significantly different improvements in exercise duration - with only the latter being superior to exercise-training. Six-weeks after training, these improvements were still greater after exercise-training plus breathing-retraining than after exercise-training. ClinicalTrials.gov; No.: NCT00123422.

The Effect of 6 Week Pulmonary Rehabilitation in COPD - A Randomized Control Study

The Effect of 6 Week Pulmonary Rehabilitation in COPD - A Randomized Control Study

The Editor takes a closer look at some of this month's articles

The Editor takes a closer look at some of this month's articles

Inflammation and COPD rehabilitation – the hen or the egg?

Inflammation and <scp>COPD</scp> rehabilitation – the hen or the egg?

S109 Five-Repetition Sit-To-Stand Test: Reliability, Validity and Response to Pulmonary Rehabilitation in COPD

BackgroundValidated field exercise tests, such as the six minute walk test and incremental/endurance shuttle walks, require space and may be time-consuming as repeat walks are needed due to learning effect....

P102 Post-Hospitalisation Outpatient Pulmonary Rehabilitation: A Translational Gap?

BackgroundRecent trials and meta-analyses of early post-hospitalisation pulmonary rehabilitation (PR) in COPD have demonstrated improvements in exercise capacity, health-related quality of life and a reduction in hospital readmissions (Man et...

Vitamin D supplementation during rehabilitation in COPD: a secondary analysis of a randomized trial.

RationalePulmonary rehabilitation is an important treatment for patients with Chronic Obstructive Pulmonary Disease, who are often vitamin D deficient. As vitamin D status is linked to skeletal muscle function, we aimed to explore if high dose vitamin D supplementation can improve the outcomes of rehabilitation in Chronic Obstructive Pulmonary Disease.Material and methodsThis study is a post-hoc subgroup analysis of a larger randomized trial comparing a monthly dose of 100.000 IU of vitamin D with placebo to reduce exacerbations. 50 Subjects who followed a rehabilitation program during the trial are included in this analysis. We report changes from baseline in muscle strength and exercise performance between both study arms after 3 months of rehabilitation.ResultsVitamin D intervention resulted in significantly higher median vitamin D levels compared to placebo (51 [44-62] ng/ml vs 15 [13-30] ng/ml; p < 0.001). Patients receiving vitamin D had significantly larger improvements in inspiratory muscle strength (-11±12 cmH2O vs 0±14 cmH2O; p = 0.004) and maximal oxygen uptake (110±211 ml/min vs -20±187 ml/min; p = 0.029). Improvements in quadriceps strength (15±16 Nm) or six minutes walking distance (40±55 meter) were not significantly different from the effects in the placebo group (7±19 Nm and 11±74 meter; p>0.050).ConclusionHigh dose vitamin D supplementation during rehabilitation may have mild additional benefits to training.

Pulmonary Rehabilitation in COPD: Effects of Two Aerobic Exercise Intensity in Patient-Centered Outcomes - A Randomized Study

Pulmonary Rehabilitation in COPD: Effects of Two Aerobic Exercise Intensity in Patient-Centered Outcomes - A Randomized Study

Outpatient-Based Pulmonary Rehabilitation for COPD: A Cost of Illness Study

Pulmonary rehabilitation (PR) as recommended by COPD guidelines is a multimodality educational, self-management, supervised exercise program, resulting in improved symptom control, quality of life, and reduction of exacerbations, but there is a need to establish the affordability of PR for healthcare providers. We designed a cost-of-illness study of PR in advanced COPD, with an 8-week hospital-based program, measuring direct healthcare costs for 12 months before and after PR. In 31 patients (female = 16), aged 68 (±8) years, and FEV1% predicted to be 40 (±16.6), there was a reduction in inpatient hospital stay by net 2.35 days (78%; ) and routine primary care visits. Costs were reduced by £1835 per person (base year 2008), with a saving of £791 to 1313 GBP per person, per year. Therefore, PR provision in COPD is likely to be affordable due to reduced direct healthcare costs, even without considering the individual and societal benefits.

Pulmonary Rehabilitation for Moderate COPD (GOLD 2) –Does it Have an Effect?

Background: Although pulmonary rehabilitation is an integrated part of standard care in patients with severe COPD, it is uncertain whether those with less severe COPD benefit from such treatment. The aim of the present survey was to evaluate the effect of rehabilitation in patients with moderate COPD and to determine their willingness to participate in rehabilitation. Material and methods: In a single-centre, randomized, placebo-controlled, unblinded clinical trial, participants comprised 61 of 133 referred subjects with moderate COPD. Of the 61 participants, 35 were randomized to receive rehabilitation and 26 subjects to receive standard COPD care from their GP. After randomization 19 subjects dropped out. Results: Effects of physical training were seen during the period of intervention. Compared with those receiving standard GP care, those receiving rehabilitation showed improvements in walking distance and leg strength as well as improvements in quality of life; however, the effect was temporary, and at 18 months’ follow-up there was no significant difference between the groups. Only 61 subjects of the referred group of 133 with moderate COPD accepted the offer of rehabilitation. Conclusion: Although an effect was found of pulmonary rehabilitation in subjects with moderate COPD, it disappeared over 18 months. Only a minority of patients with moderate COPD referred for rehabilitation accepted and completed the treatment offer.

Occupational therapy intervention for patients with COPD rehabilitation at home

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.