Effects Of Pulmonary Rehabilitation Program Research Articles

Effectiveness of Pulmonary Rehabilitation Programme on Exercise Tolerance among Survivors of COVID-19

Effectiveness of Pulmonary Rehabilitation Programme on Exercise Tolerance among Survivors of COVID-19

Effect of pulmonary rehabilitation program on post hospitalization severe COVID-19 patients (Experimental study)

Effect of pulmonary rehabilitation program on post hospitalization severe COVID-19 patients (Experimental study)

Effects of Pulmonary Rehabilitation Program on Patients With Chronic Obstructive Pulmonary Disease

Introduction: Chronic Obstructive Pulmonary Disease (COPD) impairs patients` quality of life and clinical outcomes. Pulmonary rehabilitation (PR) program can improve the functional capacity in patients with chronic lung disease. Thus, the study aimed to evaluate the effect of the PR program on the quality of life, anxiety, depression, and pulmonary function of patients with COPD. Materials and Methods: In this single-group before-and-after clinical trial, adult patients with COPD and recent history of exacerbation were recruited. The intervention was a PR program, including training of breathing exercises at home and aerobic exercise program, twice a week about 30 to 60 min for 8 weeks. The program was prepared according to the patient’s tolerance by a sports medicine specialist in a pulmonary rehabilitation clinic. The primary outcome was quality of life measured by the St. George’s Respiratory Questionnaire (SGRQ). Secondary outcomes were assessing anxiety, depression, pulmonary function, COPD status, the ability to walk, and shortness of breathing. All outcomes were measured before and one week after the program. Results: Twenty-two eligible patients of both genders (68% male and 32% female) with a Mean±SD age of 65.09±9.72 years finished the program. Quality of life was improved significantly following the intervention (51.49 [16.68] vs 4275 [15.63]; P<0.001]. Anxiety and depression (P<0.001), pulmonary function parameters, such as forced expiratory volume in 1 second (FEV1) (P<0.001) and FEV1/ forced vital capacity (FVC) ratio (P=0.015), COPD status (P=0.001), the ability of walk1ing (P<0.05), and shortness of breath (P=0.001) were improved significantly after the intervention. Conclusion: The PR program resulted in clinical improvement in patients with COPD. Thus, we recommend that it be used besides medical management.

Effects of Pulmonary Rehabilitation Program on Patients With Chronic Obstructive Pulmonary Disease

Effects of Pulmonary Rehabilitation Program on Patients With Chronic Obstructive Pulmonary Disease

Effects of pulmonary rehabilitation program on amyotrophic lateral sclerosis: A meta-analysis of randomized controlled trials.

Patients with amyotrophic lateral sclerosis (ALS) develop respiratory failure and progressive muscle weakness. The effects of pulmonary rehabilitation on the lung function of patients with ALS are unclear. Through this meta-analysis of randomized controlled trials (RCTs), we evaluated the effects of pulmonary rehabilitation, such as type of treatment, on patients with ALS and compared the effectiveness of this treatment. PubMed, EMBASE, Web of Science, and Cochrane databases were searched until December 2020. The methodological quality of each study was assessed using the updated Cochrane Risk of Bias tool (RoB 2.0). Data were analyzed using Review Manager version 5.4 (Cochrane Collaboration, Oxford, England), and the meta-analysis was performed in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Of 2168 articles, 10 trials were reviewed; among these trials, two focused on respiratory training and eight on physical exercise, three of which involved a combination of aerobic and resistance training. Our meta-analysis demonstrated no difference in the ALSFRS-R score and % FVC among patients with ALS. Respiratory training or physical exercise did not significantly affect the ALSFRS-R score and % FVC of patients with ALS. At 12 months after intervention, the ALSFRS-R score in the physical exercise group was higher than that in the usual care group. Further clinical trials are warranted to develop approaches for improving the lung function of patients with ALS.

Effect of pulmonary rehabilitation in an allergen safe outdoor environment on children and adolescents with mild to moderate persistent allergic asthma

Background Environmental interactions are very complex in childhood asthma, and we hypothesized that even a short-term exposure to an allergy safe outdoor environment (AllSOE) combined with pulmonary rehabilitation program (PRP) could exert significant beneficial effects. Our aim was to test the effects of 2-week PRP provided in an AllSOE in children with mild to moderate asthma. Methods 110 children (aged 7.5–17 years, 46% girls), with partially or totally controlled asthma, attended the PRP at the Island of Lošinj (Croatia) supervised by a multidisciplinary team (pediatric pulmonologist, sports medicine specialist, physiotherapist and kinesiologist). Each child had an adjusted intensity of physical activity with at least 2 h of exercise per day. Body height and weight, spirometry, fraction of exhaled nitric oxide (FeNO), running distance during free running test (FRT) and the decline in lung function after FRT (exercise-induced bronchoconstriction- EIB) were measured at baseline and after PRP. Results A significant improvement in running distance (from 903 ± 272 m to 968 ± 289 m; p < 0.001), a decrease of FeNO (from 37 ± 32 ppb to 25 ± 17 ppb; p < 0.001) were determined after PRP. There were no significant changes in lung function and EIB, except EIB in the fourth quartile (significant EIB at baseline) where EIB significantly decreased (p < 0.001) after PRP. Conclusion Two weeks of PRP in an AllSOE significantly improved exercise capacity and reduced airway inflammation and airway hyperreactivity showing that even a short-term PRP within a proper environment could be effective and affordable management strategy for children and adolescents with mild to moderate asthma.

Pulmonary rehabilitation outcome in chronic obstructive pulmonary disease patients with a different body composition

ContextChange in body composition is commonly present in chronic obstructive pulmonary disease (COPD) patients.AimThe aim of this study was to investigate the effects of pulmonary rehabilitation program (PRP) on COPD patients who have a different body composition.Materials and methodsIn this study, we measure;Deg;BM; Deg;I and fat-free mass index (FFMI) using a single-frequency bioelectrical impedance analysis apparatus to classify patients into three categories: Group 1 nonmuscle depleted;Deg;BM;Deg;I greater than or equal to 21 kg/m2 and FFMI greater than or equal to 16. Group 2 muscle depleted; Deg;BM;Deg;I greater than or equal to 21 kg/m2 and FFMI less than 16 in men or FFMI less than 15 in women. Group 3 muscle depleted with cachexia;Deg;BM;Deg;I less than 21 kg/m2 and FFMI less than 16 in men or FFMI less than 15 in women. PRP outcomes were assessed by the improvement in pulmonary function severity, exercise capacity by 6-min walk test, dyspnea score by modified-British Medical Research Council, and health status by combined assessment test score and arterial blood gas improvements.ResultsForty-four patients with FFMI were measured by bioelectrical impedance analysis. The patients were mainly elderly men (N=35; 79%), who have a mean age of 65 years with different global initiative obstructive lung disease stage I–IV. In the nonmuscle depleted group, there were statistically significant improvements in the mean values of FFMI (kg/m2) while in the muscle depleted group there were improvements as regards the mean values of dyspnea score by modified-British Medical Research Council; in the cachectic group there were statistically significant improvements in the mean values of BMI (kg/m2), forced expiratory volume in the first second (FEV1), forced expiratory volume in first second divided by forced vital capacity ratio, combined assessment test score after PRP.ConclusionsA comprehensive PRP outcome change in COPD patients with different body compositions.

EFFECTIVENESS OF THE PULMONARY REHABILITATION PROGRAMME IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND OBESITY

Aim. To evaluate the effectiveness of pulmonary rehabilitation programme in patients with chronic obstructive pulmonary disease (COPD) and obesity. Materials and methods. The study included two groups of patients. The first group consisted of 44 patients with COPD and obesity (23 men and 21 women; median age — 57.47±0.76 years; average body mass index (BMI) — 34.1±1.24 kg/m2) who were receiving only standard medical treatment for COPD. The second group consisted of 44 patients (22 men, 22 women; median age — 56.07±0.83 years, average BMI — 33.4±1.62 kg/m2) who were undergoing pulmonary rehabilitation along with the standard medical treatment for COPD. Pulmonary rehabilitation programme involved group training of COPD patients including dietary recommendations, graduated exercise, as well as recommendations on smoking cessation. At the initial stage and 12 months after the study, the severity of COPD symptoms was assessed using a visual analogue scale, the frequency of exacerbations and hospitalisations, spirometry parameters, as well as quality of life data obtained via the SF-36 questionnaire. Results. At 12 months into the study, patients from the second group showed a significant decrease in the number of COPD exacerbations and related hospitalisations; a decrease in the shortness of breath, cough, sputum production; as well as an improvement of the SF-36 questionnaire with respect to a number of points. At the same time, spirometry parameters did not improve significantly. Conclusion. Inclusion of pulmonary rehabilitation programmes in the standard treatment of patients with COPD and obesity contributes to providing higher effcacy of medical treatment, decreasing the load of main COPD clinical symptoms, as well as to reducing their impact on the patients’ health status and improving life quality.

Outpatient pulmonary rehabilitation for severe asthma with fixed airway obstruction: Comparison with COPD

Background: The benefit of exercise has been demonstrated in asthma, but the role of pulmonary rehabilitation (PR) in people with severe asthma, especially with airway obstruction, has been less investigated. The activity limitation mechanisms differ in asthma and COPD, so the effect of a PR program not specific to asthma is unclear. Methods: We retrospectively compared the effect of an ambulatory PR program in nonsmoking patients with severe asthma and airway obstruction (FEV1/FVC ratio <70% and FEV1 < 80% measured twice, not under an exacerbation) and sex-, age-, FEV1-, and BMI-matched COPD controls. Results: We included 29 patients, each with asthma and COPD. Airway obstruction was moderate (median FEV1 57% [44–64]). VO2 at peak was higher for asthma than COPD patients (19.0 [15.7–22.2] vs 16.1 [15.3–19.6] ml.min−1.kg−1, p = 0.05). After PR, asthma and COPD groups showed a significant and similar increase in constant work cycling test of 378 [114–831] s and 377 [246–702] s. Changes in Hospital Anxiety and Depression Scale (HAD) total score were similar (–2.5 [–7.0 to 0.0] vs –2.0 [–5.0 to 2.0], p > 0.05). Quality of life on the St. George’s Respiratory Questionnaire (SGRQ) was significantly improved in both groups (–14.0 [–17.7 to –2.0], p < 0.005 and –8.3 [–13.0 to –3.6], p < 0.0001). Conclusion: Outpatient PR is feasible and well tolerated in patients with severe asthma with fixed airway obstruction. A nondedicated program strongly improves HAD and SGRQ scores and constant work-rate sub-maximal cycling, with similar amplitude as with COPD.

Effectiveness of a perioperative pulmonary rehabilitation program following coronary artery bypass graft surgery in patients with and without COPD

PurposeIt is unclear whether the effectiveness of pulmonary rehabilitation program (PRP) after cardiac surgery differs between patients with and without COPD. This study aimed to compare the effectiveness of PRP between patients with and without COPD undergoing coronary artery bypass graft (CABG) surgery.Patients and methodsWe retrospectively included patients who underwent CABG surgery and received 3-week PRP from January 2009 to December 2013. We excluded patients who underwent emergency surgery, had an unstable hemodynamic status, were ventilator dependent or did not complete the PRP. Demographics, muscle strength, degree of dyspnea, pulmonary function and postoperative complications were compared.ResultsSeventy-eight patients were enrolled (COPD group, n=40; non-COPD group, n=38). Maximal inspiratory pressure (MIP; −34.52 cmH2O vs −43.25 cmH2O, P<0.01; −34.67 cmH2O vs −48.18 cmH2O, P<0.01), maximal expiratory pressure (MEP; 32.15 cmH2O vs 46.05 cmH2O, P<0.01; 37.78 cmH2O vs 45.72 cmH2O, P<0.01) and respiratory rate (RR; 20.65 breath/minute vs 17.02 breath/minute, P<0.01; 20.65 breath/minute vs 17.34 breath/minute, P<0.01) in COPD and non-COPD groups, respectively, showed significant improvement, but were not significantly different between the two groups. Forced vital capacity (FVC; 0.85 L vs 1.25 L, P<0.01), forced expiratory volume in 1 second (FEV1; 0.75 L vs 1.08 L, P<0.01), peak expiratory flow (PEF; 0.99 L vs 1.79 L, P<0.01) and forced expiratory flow between 25% and 75% of vital capacity (FEF25–75; 0.68 L vs 1.15 L, P<0.01) showed significant improvement between postoperative Days 1 and 14 in the COPD group. FVC (1.11 L vs 1.36 L, P<0.05), FEV1 (96 L vs 1.09 L, P<0.05) and FEF25–75 (1.03 L vs 1.26 L, P<0.05) were significantly improved in the non-COPD group. However, only PEF (80.8% vs 10.1%, P<0.01) and FEF25–75 (67.6% vs 22.3%, P<0.05) were more significantly improved in the COPD group than in the non-COPD group.ConclusionPRP significantly improved respiratory muscle strength and lung function in patients with and without COPD who underwent CABG surgery. However, PRP is more effective in improving PEF and FEF25–75 in COPD patients.

Effect of pulmonary rehabilitation program on patients admitted to ICU:a comparative cross sectional study

Generally ICU patients are in critical status and need long stay in ICU. Pulmonary rehabilitation program (PRP) is considered as an important tool to improve outcome and shorten the length of stay in ICU. The aim of this study was to investigate whether PRP can affect outcome and duration of hospitalization in ICU patients. This study was performed in medical ICU of Labafi Nejad hospital, Tehran, Iran during 2012 and 2013. All of patients who had more than one day stay in ICU were included in the study. They underwent PRP. We compared length of stay, mortality rate and number of hospitalized patients within 2 years in patients with PRP and patients without PRP. In 2012, 155 patients and in 2013, 173 patients were admitted in ICU. Admission period was 15 ± 2.7 and 11 ± 2.1 days, respectively (p< 0.001). Pulmonary physiotherapy showed no effect on patients’ outcome in which during 2012, 94 patients were discharged and 61 patients were died and in 2013, 98 patients were discharged and 64 patients were died (p=0.9). Our study shows that PRP can shorten hospitalization time which can indirectly decrease hospitalization costs but there is no effect on overall survival.

The usefulness of pedometry in patients with chronic obstructive pulmonary disease.

BackgroundEffort tolerance and daily physical activity (DPA) are predictive of quality of life and survival in COPD patients, but still remain difficult to assess based on their daily life.The aim of this study was: how to relate pedometry to other classic parameters commonly used in pulmonary rehabilitation (PR).MethodsDPA was evaluated through pedometry. 74 patients with COPD, aged 63.55 ± 8.73 (12 stage II, FEV1 = 60.16 ± 7.78%), (29 stage III, FEV1 = 39.07 ± 6.30%), (33 stage IV, FEV1 = 23.1 ± 7.18%). The monitoring was conducted for a period of 7 days before and 6 months after a pulmonary rehabilitation program (PRP) of 3 weeks. A control group consisting of 21 patients with stable COPD was evaluated initially, but they did not undergo Pulmonary Rehabilitation Program (PRP). After 6 months the patients were re-evaluated using the same parameters.Results and discussionThe values are widely dispersed, with a maximum of 17,420 and minimum of 964 steps/24hrs. The average values acquired were: the lowest in COPD stage IV (2476→3112 steps/24 hrs, p < 0.0001), still with the highest increase over 6 months of PR + 636steps/24hrs; in COPD stage III the increase of DPA was + 597steps/24hrs over 6 months (5627→6224, p < 0.0001), COPD stage II registered the lowest increase + 540steps/24hrs (8724→9264, p < 0.13), probably because the subjects belonging to this stage had the best preserved DPA. The results show moderate correlation between pedometry and the 6MWT and the SGQ. (r = 0.5-0.7). However it demonstrated the positive effects of PRP, even after 6 months.ConclusionsDPA decreases with increasing COPD stage, it is fluctuant with every subject, dependent on clinical status, weather and daily schedule. Wearing pedometers is very easy and motivational, provided that patients realize that they are being “watched”.

The usefulness of pedometry in patients with chronic obstructive pulmonary disease

Background: Effort tolerance and daily physical activity (DPA) are predictive of quality of life and survival in COPD patients, but still remain difficult to assess based on their daily life. The aim of this study was: how to relate pedometry to other classic parameters commonly used in pulmonary rehabilitation (PR). Methods: DPA was evaluated through pedometry. 74 patients with COPD, aged 63.55 ± 8.73 (12 stage II, FEV1 = 60.16 ± 7.78%), (29 stage III, FEV1 = 39.07 ± 6.30%), (33 stage IV, FEV1 = 23.1 ± 7.18%). The monitoring was conducted for a period of 7 days before and 6 months after a pulmonary rehabilitation program (PRP) of 3 weeks. A control group consisting of 21 patients with stable COPD was evaluated initially, but they did not undergo Pulmonary Rehabilitation Program (PRP). After 6 months the patients were re-evaluated using the same parameters. Results and discussion: The values are widely dispersed, with a maximum of 17,420 and minimum of 964 steps/24hrs. The average values acquired were: the lowest in COPD stage IV (2476→3112 steps/24 hrs, p &lt; 0.0001), still with the highest increase over 6 months of PR + 636steps/24hrs; in COPD stage III the increase of DPA was + 597steps/24hrs over 6 months (5627→6224, p &lt; 0.0001), COPD stage II registered the lowest increase + 540steps/24hrs (8724→9264, p &lt; 0.13), probably because the subjects belonging to this stage had the best preserved DPA. The results show moderate correlation between pedometry and the 6MWT and the SGQ. (r = 0.5-0.7). However it demonstrated the positive effects of PRP, even after 6 months. Conclusions: DPA decreases with increasing COPD stage, it is fluctuant with every subject, dependent on clinical status, weather and daily schedule. Wearing pedometers is very easy and motivational, provided that patients realize that they are being “watched”.

Feasibility and Effectiveness of a Home-Based Exercise Training Program Before Lung Resection Surgery

Patients with lung cancer often experience a reduction in exercise tolerance, muscle weakness and decreased quality of life. Although the effectiveness of pulmonary rehabilitation programs is well recognized in other forms of cancers and in many pulmonary diseases, few researchers have studied its impact in patients with lung cancer, particularly in those awaiting lung resection surgery (LRS). To investigate the feasibility of a short, home-based exercise training program (HBETP) with patients under investigation for non-small cell lung cancer and potential candidates for LRS, and to determine the effectiveness of this program on exercise tolerance, skeletal muscle strength and quality of life. Sixteen patients with lung cancer awaiting LRS participated in a four-week HBETP including moderate aerobic activities (walking and cycling) and muscle training performed three times weekly. Before and after the intervention, a cardiopulmonary exercise test, a 6 min walk test and the assessment of muscle strength and quality of life were performed. Thirteen patients completed the four-week HBETP and all the patients completed >75% of the prescribed exercise sessions. The duration of the cycle endurance test (264±79 s versus 421±241 s; P<0.05) and the 6 min walk test distance (540±98 m versus 568±101 m; P<0.05) were significantly improved. Moreover, the strength of the deltoid, triceps and hamstrings were significantly improved (∆ post-pre training 1.82±2.83 kg, 1.32±1.75 kg and 3.41±3.7 kg; P<0.05, respectively). In patients with lung cancer awaiting LRS, HBETP was feasible and improved exercise tolerance and muscle strength. This may be clinically relevant because poor exercise capacity and muscle weakness are predictors of postoperative complications.

The effects of pulmonary rehabilitation program on oxidative stress biomarker and antioxidant enzymes activities in chronic obstructive pulmonary disease patients and in healthy subjects

Objective: The aim of this study was to evaluate the effects of pulmonary rehabilitation on oxidative stress biomarker (Thiobarbituric acid substances TBARS) and antioxidant enzymes activities (superoxide dismutase SOD, glutathione peroxidise and catalase CAT) in patients with chronic obstructive pulmonary disease (COPD) compared to healthy subjects. Material and Methods: The study included 26 patients with COPD and 12 healthy subjects. The patients were divided into 2 groups (16 trained and 10 untrained). Trained groups performed 45 min individualized exercise training enrolled to an 8 weeks pulmonary rehabilitation program 3 times a week. Prior to and after the programme, exercise testing and pulmonary function were evaluated. Antioxidant enzymes activities were measured by spectrophotometry and spectrofluorimetry was used for plasma levels of thiobarbituric acid substances. Results: After the program, exercise capacity improved significantly in trained groups. At baseline, plasma TBARS were significantly increased in patients with COPD compared to the healthy subjects (p<0.05). Baseline values of SOD and CAT activities were significantly lower in patients with COPD than in healthy subjects. After rehabilitation, there were no significant differences in plasma TBARS between groups. However, SOD activity increased significantly in trained patients and in healthy subjects. GPx activity increased only in trained patients. There was no significant change for CAT activity for all groups. Conclusions: This study suggests that pulmonary rehabilitation program with moderate physical training can activate antioxidant defence and regulate systemic oxidative stress release.

Meta-analysis on the effectiveness of pulmonary rehabilitation program on exercise capacity/tolerance and general health status

This study was conducted to combine the effects of pulmonary rehabilitation program (PRP) on exercise capacity/tolerance and general health status of COPD patients based on the primary research results examined the effects of PRP. Seventeen studies were selected by the sampling criteria established to include the studies that reported enough statistics necessary to conduct meta-analysis. According to the study results, the most effective indicators for exercise capacity/tolerance were exercise time (such as cycling time or treadmill walking time) and ground walking distance within given time (6 minutes or 12 minutes), whereas effects on such indicators as VE and VO2 were not statistically significant. PRP induced significant effect on patients' general health status, frequently measured by physical, psycho-emotional, and holistic indicators, the enhancement on psycho-emotional dimension resulted from PRP was more prominent than those of the other dimensions. From the results, it was noted that the place where PRP was given and the contents of PRP exercised their influence on the outcome variables. Which body part was trained was also one of the important factors that influence on the patients' perception of dyspnea during exercise as well as on exercise capacity/tolerance. PRP including exercise training significantly improved the exercise capacity and general health status of COPD patients.