Impact Of Pulmonary Rehabilitation Research Articles

Impact of Pulmonary Rehabilitation on Exercise Tolerance and Quality of Life in Patients With Idiopathic Pulmonary Fibrosis: A SYSTEMATIC REVIEW AND META-ANALYSIS.

Patients with pulmonary fibrosis are living longer and present with an increasing number of comorbidities over time. Pulmonary rehabilitation, as a nonpharmacological approach, may be promising in these patients, although there is limited information on the impact of pulmonary rehabilitation on exercise tolerance and quality of life. Thus, conducting a systematic review and meta-analysis, the purpose of this study was to determine the effects of pulmonary rehabilitation on exercise tolerance and quality of life in patients with idiopathic pulmonary fibrosis. We searched MEDLINE, Cochrane Library, Embase, Scielo, PEDro, and CINAHL (from the earliest date available to June 2016) for trials. Study selection included randomized controlled trials (RCTs) that examined the effects of pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis. Two reviewers selected studies independently. Data were extracted from published RCTs. Study quality was evaluated using the PEDro scale. Weighted mean differences, standard mean differences, and 95% CIs were calculated. We analyzed data from 5 RCTs comparing a pulmonary rehabilitation group with a control group. Pulmonary rehabilitation improved exercise tolerance weighted mean differences (44 m; 95% CI, 5.3-82.8) compared with no exercise. The meta-analyses also showed significant improvement in symptoms, impact, and total score from the St George's Respiratory Questionnaire for participants in pulmonary rehabilitation compared with control. No serious adverse events were reported. Pulmonary rehabilitation is effective in increasing exercise tolerance and improving quality of life in patients with idiopathic pulmonary fibrosis.

Impact of pulmonary rehabilitation on postoperative complications in patients with lung cancer and chronic obstructive pulmonary disease.

BackgroundGiven the extent of the surgical indications for pulmonary lobectomy in breathless patients, preoperative care and evaluation of pulmonary function are increasingly necessary. The aim of this study was to assess the contribution of preoperative pulmonary rehabilitation (PR) for reducing the incidence of postoperative pulmonary complications in non‐small cell lung cancer (NSCLC) patients with chronic obstructive pulmonary disease (COPD).MethodsThe records of 116 patients with COPD, including 51 patients who received PR, were retrospectively analyzed. Pulmonary function testing, including slow vital capacity (VC) and forced expiratory volume in one second (FEV 1), was obtained preoperatively, after PR, and at one and six months postoperatively. The recovery rate of postoperative pulmonary function was standardized for functional loss associated with the different resected lung volumes. Propensity score analysis generated matched pairs of 31 patients divided into PR and non‐PR groups.ResultsThe PR period was 18.7 ± 12.7 days in COPD patients. Preoperative pulmonary function was significantly improved after PR (VC 5.3%, FEV 1 5.5%; P < 0.05). The FEV 1 recovery rate one month after surgery was significantly better in the PR (101.6%; P < 0.001) than in the non‐PR group (93.9%). In logistic regression analysis, predicted postoperative FEV 1, predicted postoperative %FEV 1, and PR were independent factors related to postoperative pulmonary complications after pulmonary lobectomy (odds ratio 18.9, 16.1, and 13.9, respectively; P < 0.05).Conclusions PR improved the recovery rate of pulmonary function after lobectomy in the early period, and may decrease postoperative pulmonary complications.

Respiratory Function and the Influence of Inspiratory Muscle in Vital Capacity in Parkinsons Disease

Background: Pulmonary disorders have been identified in Parkinson's disease (PD) since its description. They are associated with high mortality. However, there have been limited investigations on respiratory function in the patients with PD. The mechanisms mediating this association need to be better clarified. The relationship between maximal inspiratory pressure (MIP) and the forced vital capacity (FVC) in these individuals has not been investigated yet. Objective: The objective was to assess and compare the respiratory function in older elderly with and without PD in order to determine the prevalence of respiratory dysfunction and the influence of MIP in FCV. Methodological design: Cross-sectional study which evaluated 41 elderly with PD and 41 elderly without (control group). Inclusion criteria: For patients with PD: level of disability 0-3 Hoehn and Yahr scale and levodopa substitution therapy. For all participants: more than 60 years, no smoking, and no diagnosis of respiratory dysfunction and have physical and cognitive conditions to perform the tests. Pulmonary function was investigated by spirometry and MIP through manovacuometry. For the comparison between the groups was used the Student's t test and Mann Whitney and the correlation between the variables of interest was investigated by linear regression model. Results: There was a higher prevalence of respiratory disorder in patients with PD, whose major ventilation dysfunction was restrictive. There were significantly lower values % FVC and forced expiratory volume in the first minute (FEV1) in patients with PD and a direct association between FVC and MIP. This association can only be observed in the control group in the elderly who presented restrictive disturbance. Conclusion: Patients with PD showed important modifications of pulmonary function even in the early stages of the disease. Thus, the pulmonary evaluation must be systematically performed in subjects with PD and the impact of pulmonary rehabilitation on these dysfunctions should be the focus of further research.

Impact of pulmonary rehabilitation on hospitalizations for chronic obstructive pulmonary disease among members of an integrated health care system.

The evidence regarding the effects of pulmonary rehabilitation (PR) on health care resource use remains limited. This retrospective study evaluated the effects of PR on the primary outcome of all-cause hospitalizations and secondary outcomes of other health care use, exercise capacity, health-related quality of life (HRQOL), and body weight in patients with chronic obstructive pulmonary disease (COPD) in a large integrated health care system. The PR cohort included 558 patients with a COPD diagnosis, age ≥ 40 years, who were treated with a bronchodilator or steroid inhaler, participated in 1 of 13 PR programs between January 1, 2008, and August 1, 2013, and were continuously enrolled in the health plan ≥ 12 months prior to and after PR. Two non-PR control cohorts were assembled for comparison. Data were extracted from electronic health records. The 6-minute walk test and St. George's Respiratory Questionnaire results were available for a subset. The proportion of patients who were hospitalized 12 months post-PR was lower compared with the 12 months prior (37% vs 45%, P = .001) while emergency department use was not different (52% vs 54%). Patients who declined PR for logistical reasons had a 40% higher risk of hospitalization than PR participants (relative risk = 1.40, 95% CI: 0.96-2.06, P = .08). There were significant improvements in the 6-minute walk test distance (+43 m) and the St. George's Respiratory Questionnaire total score (-9.6 points) but minimal changes in weight. Our finding that participation in PR is associated with reductions in hospitalizations corroborates previous studies. A notable strength of this study is the capture of complete utilization data.

Impact of pulmonary rehabilitation in subjects with mild COPD.

Pulmonary rehabilitation (PR) is a core component of the management of patients with moderate-to-very-severe COPD. However, as impairments in quadriceps muscle strength and health-related quality of life (HRQOL) are already present in patients with mild COPD, there is a need to investigate whether PR could also be beneficial to these patients. Thus, this study assessed the impact of PR on patients with mild COPD. A quasi-experimental study was conducted. Twenty-six participants (67.8 ± 10.3 years old; FEV1 83.8 ± 6.4% of predicted) enrolled in a 12-week PR program with exercise training and psychoeducation. Lung function was assessed by spirometry, dyspnea with the Modified Medical Research Council questionnaire, functional balance with the Timed Up and Go test, muscle strength with 10-repetition maximum testing, exercise tolerance with the 6-min walk test, emotional state with the Depression Anxiety Stress Scales, and HRQOL with the St George Respiratory Questionnaire (SGRQ). Significant effects were observed on participants' dyspnea (P = .003, effect size [ES] = 0.7), functional balance (P < .001, ES = 0.8), shoulder flexor/knee extensor strength (P < .001, ES = 1.2-1.3), and exercise tolerance (P < .001, ES = 0.5). With the exception of the SGRQ impact score, the symptom (P < .001, ES = 0.6), activity (P = .02, ES = 0.4), and total (P = .005, ES = 0.3) scores improved significantly after PR. The PR program had no significant effect on participants' lung function and emotional state. Patients with mild COPD benefit from PR and could therefore be routinely included in these programs. Studies with more robust designs and with long-term follow-ups are needed to inform guidelines for PR in mild COPD.

Impact of Pulmonary Rehabilitation on the Major Dimensions of Dyspnea in COPD

The evaluation of dyspnea and its responsiveness to therapy in COPD should consider the multidimensional nature of this symptom in each of its sensory-perceptual (intensity, quality), affective and impact domains. To gain new insights into mechanisms of dyspnea relief following pulmonary rehabilitation (PR), we examined effects on the major domains of dyspnea and their interaction with physiological training effects. This randomized, controlled study was conducted in 48 subjects with COPD. Subjects received either 8-weeks of PR or usual care (CTRL). Pre- and post-intervention assessments included: sensory-perceptual (i.e., exertional dyspnea intensity, dyspnea descriptors at end-exercise), affective (i.e., intensity of breathing-related anxiety during exercise, COPD self-efficacy, walking self-efficacy) and impact (i.e., activity-related dyspnea measured by the Baseline/Transition Dyspnea Index, Chronic Respiratory Questionnaire dyspnea component, St. George's Respiratory Disease Questionnaire activity component) domains of dyspnea; functional performance (i.e., 6-minute walk, endurance shuttle walk); pulmonary function; and physiological measurements during constant work rate cycle exercise at 75% of the peak incremental work rate. Forty-one subjects completed the study: PR (n = 17) and CTRL (n = 24) groups were well matched for age, sex, body size and pulmonary function. There were no significant between-group differences in pre- to post-intervention changes in pulmonary function or physiological parameters during exercise. After PR versus CTRL, significant improvements were found in the affective and impact domains but not in the sensory-perceptual domain of dyspnea. In conclusion, clinically meaningful improvements in the affective and impact domains of dyspnea occurred in response to PR in the absence of consistent physiological training effects.

Impact of Pulmonary Rehabilitation on Psychosocial Morbidity in Patients with Severe COPD.

Guell, R; Resqueti, V; Sangenis, M; Morante, F; Martorell, B; Casan, P; Guyatt, G H.; Swisher, Anne K. PT, PhD, CCS Author Information

Impact of Pulmonary Rehabilitation on Psychosocial Morbidity in Patients With Severe COPD

To assess the effect of pulmonary rehabilitation (PR) on psychosocial morbidity, functional exercise capacity, and health-related quality of life (HRQL) in patients with severe COPD. A prospective, randomized, controlled trial with blinding of outcome assessment and data analysis. A tertiary-care respiratory service. Forty patients (mean age, 65 +/- 8 years [+/- SD]) with severe chronic flow limitation (FEV(1), 35 +/- 13%) without respiratory failure (Pao(2), 72 +/- 9 mm Hg; Paco(2), 42 +/- 5 mm Hg) were randomized either to a control group or to a PR group (PRG). Sixteen weeks of PR that included breathing retraining and exercise. At baseline and 16 weeks, we evaluated psychosocial morbidity using two questionnaires (the Millon Behavior Health Inventory [MBHI] and the Revised Symptom Checklist [SCL-90-R]) and measured 6-min walk distance (6WMD) and HRQL using the Chronic Respiratory Questionnaire (CRQ). We found differences in favor of the PRG in the following MBHI domains: introversive, forceful, and sensitive personality styles (all p </= 0.05) and chronic tension (p </= 0.01). Results of the depression, hostility, global severity, positive symptom distress index (all p </= 0.01), somatization, anxiety, psychoticism, and positive symptom (all p </= 0.05) domains of the SCL-90-R favored the PRG. We also found statistically and clinically significant differences between groups in 6MWD (85 m; p < 0.01) and in two domains of the CRQ: dyspnea (1.0; p < 0.01) and mastery (0.6; p < 0.05). The other two domains of CRQ showed strong trends in favor of PRG: 0.7 for both fatigue and emotional function (minimal important difference, 0.5). PR may decrease psychosocial morbidity in COPD patients even when no specific psychological intervention is performed. Findings from this study also confirm the positive impact of PR on functional exercise capacity and HRQL.

Mood disorders and chronic obstructive pulmonary disease: current research and future needs.

The following review examines the interrelationships between chronic obstructive pulmonary disease (COPD), psychiatric illness, and tobacco use. The influence that these three entities have is very unclear, and this article attempts to address the current knowledge of how each contributes to the other and postulates future directions to explore regarding diagnosis, treatment, and predictive values. Other issues discussed include the pharmacologic treatment of patients with COPD and depression, and an overview of the clinical trial data regarding several different classes of antidepressants. Also reviewed is the impact of pulmonary rehabilitation on psychologic status and quality of life issues in the daily functioning of the COPD patient.

Impact of pulmonary rehabilitation on self-efficacy, quality of life, and exercise tolerance.

Impact of pulmonary rehabilitation on self-efficacy, quality of life, and exercise tolerance.

Impact of pulmonary rehabilitation on self-efficacy, quality of life, and exercise tolerance.

Impact of pulmonary rehabilitation on self-efficacy, quality of life, and exercise tolerance.