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Intensive rehabilitation brings benefits to COPD patients
ARTICLE IN PRESS R E S P I R AT O RY M E D I C I N E : C O P D U P DAT E
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Intensive rehabilitation brings benefits to COPD patients A 4-week programme of in-patient pulmonary rehabilitation for people with moderate COPD resulted in significant improvements in quality of life, particularly among the male patients. Abstract of Original Article Changes in health according to World Health Organization’s International Classification of Functioning, Disability and Health (ICF) after four weeks of pulmonary rehabilitation (PR) were investigated. Gender differences in the response to PR, and the correlation between improvements in the two components of ICF (Body functions and Activities and Participation) were examined. Twenty-two men and 18 women with chronic obstructive pulmonary disease in Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage II-IV attended in-patient, multidisciplinary PR consisting of endurance training four to five times/week at 70% of peak work rate (WRpeak), resistance training three to four times/ week at 72% of 15 repetitions maximum, educational sessions and individual counselling. The results were compared to those of 20 Chronic Obstructive Pulmonary Disease (COPD) patients included after the same criteria and investigated while waiting for admission to PR. In the rehabilitation group, we found significant improvements in health related quality
of life (HRQoL) ( 7 units, St. George’s Respiratory Questionnaire), arm (6%) and leg (15%) maximal voluntary contraction, peak oxygen uptake (6%), WRpeak (60%) and treadmill endurance time (93%). At iso-WR, ventilation and dyspnoea were significantly lower, but inspiratory capacity remained unchanged. Improvements in HRQoL correlated with increases in peak ventilation, but not in muscle strength or exercise capacity. Men improved their six-minute walking distance significantly in contrast to women. Clinically important improvements in HRQoL were found in two out of three of the men, and one out of three of the women. Four weeks of intensive PR generated significant health effects comparable to longer lasting programmes. Changes in exercise capacity and muscle strength were not related to improvements in HRQoL. The gender differences in the response to PR deserve attention in future studies. Reproduced with permission from Sage Publications Ltd. Abstract available online at http://crd.sagepub.com/cgi/ content/abstract/4/1/5
Commentary by Kathy Pye Aintree Chest Centre, University Hospital Aintree, Liverpool, UK The benefits of pulmonary rehabilitation (PR) programmes are well documented. However, there is little evidence to suggest patient response to pulmonary rehabilitation. The components of the programmes vary, duration can range from 4 to 12 weeks, with the location being hospital outpatient or community setting and less commonly in-patient programmes. This 4-week controlled trial recruited 60 patients with moderate COPD, of which 40 were admitted for a 4 week in-patient rehabilitation programme. Smokers and those on LTOT were excluded. The programme consisted of the usual exercise and education with a weekly chest physician review and one to one consultations with individual members of the multidisciplinary team where required. Gender response to the effects of PR was examined. The authors also wanted to ascertain whether the effects of PR related to changes in the World Health Organization’s International Classification of Functioning, and if these changes were linked. Although no association was found between components, as expected there were improvements in quality of life. These changes, together with improvements in exercise distance, were more significant in men. When Celli’s1 group compared gender differences in COPD patients they reported a worse quality of life and poorer walking distance in women, despite a better FEV1, PaO2 and PaCO2. When comparing a 3-month to an 18-month programme, Foy and Rejeski2 reported that men derived significant benefit from an extended exercise training programme compared to women. This study and others have shown that gender related differences in COPD patients warrant further investigation in order to fully understand response to exercise.
1. de Torres J, Casanova C, Hernandez C, Abreu J, Aguirre-Jaime A, Celli B. Gender and COPD in patients attending a pulmonary clinic. Chest 2005;128:2012–16. 2. Foy C, Rejeski W, Berry M, Zaccaro D, Woodward C. Gender moderates the effect of exercise therapy on health related quality of life among COPD patients. Chest 2001;119:70–6.
Original article reference: Skumlien S, Skogedal EA, Bjotruft O, Ryg MS. Four weeks’ intensive rehabilitation generates significant health effects in COPD patients. Chronic Resp Dis 2007;4:5–13. 10.1016/j.rmedu.2007.05.009
3 ( 200 7) 110 – 1 13
111
Intensive rehabilitation brings benefits to COPD patients A 4-week programme of in-patient pulmonary rehabilitation for people with moderate COPD resulted in significant improvements in quality of life, particularly among the male patients. Abstract of Original Article Changes in health according to World Health Organization’s International Classification of Functioning, Disability and Health (ICF) after four weeks of pulmonary rehabilitation (PR) were investigated. Gender differences in the response to PR, and the correlation between improvements in the two components of ICF (Body functions and Activities and Participation) were examined. Twenty-two men and 18 women with chronic obstructive pulmonary disease in Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage II-IV attended in-patient, multidisciplinary PR consisting of endurance training four to five times/week at 70% of peak work rate (WRpeak), resistance training three to four times/ week at 72% of 15 repetitions maximum, educational sessions and individual counselling. The results were compared to those of 20 Chronic Obstructive Pulmonary Disease (COPD) patients included after the same criteria and investigated while waiting for admission to PR. In the rehabilitation group, we found significant improvements in health related quality
of life (HRQoL) ( 7 units, St. George’s Respiratory Questionnaire), arm (6%) and leg (15%) maximal voluntary contraction, peak oxygen uptake (6%), WRpeak (60%) and treadmill endurance time (93%). At iso-WR, ventilation and dyspnoea were significantly lower, but inspiratory capacity remained unchanged. Improvements in HRQoL correlated with increases in peak ventilation, but not in muscle strength or exercise capacity. Men improved their six-minute walking distance significantly in contrast to women. Clinically important improvements in HRQoL were found in two out of three of the men, and one out of three of the women. Four weeks of intensive PR generated significant health effects comparable to longer lasting programmes. Changes in exercise capacity and muscle strength were not related to improvements in HRQoL. The gender differences in the response to PR deserve attention in future studies. Reproduced with permission from Sage Publications Ltd. Abstract available online at http://crd.sagepub.com/cgi/ content/abstract/4/1/5
Commentary by Kathy Pye Aintree Chest Centre, University Hospital Aintree, Liverpool, UK The benefits of pulmonary rehabilitation (PR) programmes are well documented. However, there is little evidence to suggest patient response to pulmonary rehabilitation. The components of the programmes vary, duration can range from 4 to 12 weeks, with the location being hospital outpatient or community setting and less commonly in-patient programmes. This 4-week controlled trial recruited 60 patients with moderate COPD, of which 40 were admitted for a 4 week in-patient rehabilitation programme. Smokers and those on LTOT were excluded. The programme consisted of the usual exercise and education with a weekly chest physician review and one to one consultations with individual members of the multidisciplinary team where required. Gender response to the effects of PR was examined. The authors also wanted to ascertain whether the effects of PR related to changes in the World Health Organization’s International Classification of Functioning, and if these changes were linked. Although no association was found between components, as expected there were improvements in quality of life. These changes, together with improvements in exercise distance, were more significant in men. When Celli’s1 group compared gender differences in COPD patients they reported a worse quality of life and poorer walking distance in women, despite a better FEV1, PaO2 and PaCO2. When comparing a 3-month to an 18-month programme, Foy and Rejeski2 reported that men derived significant benefit from an extended exercise training programme compared to women. This study and others have shown that gender related differences in COPD patients warrant further investigation in order to fully understand response to exercise.
1. de Torres J, Casanova C, Hernandez C, Abreu J, Aguirre-Jaime A, Celli B. Gender and COPD in patients attending a pulmonary clinic. Chest 2005;128:2012–16. 2. Foy C, Rejeski W, Berry M, Zaccaro D, Woodward C. Gender moderates the effect of exercise therapy on health related quality of life among COPD patients. Chest 2001;119:70–6.
Original article reference: Skumlien S, Skogedal EA, Bjotruft O, Ryg MS. Four weeks’ intensive rehabilitation generates significant health effects in COPD patients. Chronic Resp Dis 2007;4:5–13. 10.1016/j.rmedu.2007.05.009