Rehabilitation of patients with chronic obstructive pulmonary disease. Exercise twice a week is not sufficient!

Medical department I, Copenhagen University Hospital, Bispebjerg, Denmark.
Respiratory Medicine (Impact Factor: 2.92). 03/2000; 94(2):150-4. DOI: 10.1053/rmed.1999.0704
Source: PubMed

ABSTRACT Several studies of chronic obstructive pulmonary disease (COPD) have shown that pulmonary rehabilitation, consisting of at least three training sessions a week, improves exercise performance and health status. This study investigates feasibility, effect and economic aspects of a rehabilitation programme consisting of two sessions a week for 8 weeks. Twenty-four patients with moderate COPD were randomized to rehabilitation and 21 to placebo. Patients were assigned to an 8-week programme of exercise plus education (Exercise group) or conventional community care (Placebo group). The rehabilitation program was carried out in a hospital outpatient setting and consisted of 16 h exercise and 13.5 h of education. The exercise group received physiotherapy and education twice a week. Seven patients did not complete the programme. The characteristics of the 38 COPD-patients at baseline were the following: (mean +/- SD) forced expiratory volume in 1 sec (FEV1) 1.1+/-0.4 1 (47% of predicted), 6-min walking distance (6MWD) 413+/-75 m, score of St. George's Respiratory Questionnaire (SGRQ) 44+/-21. Health-status, assessed by SGRQ and The Psychological General Well-being (PGWB) Index, did not improve. Rehabilitation resulted in an insignificant improvement in the 6MWD [29 m (95% confidence interval: -8 -66 m)]. We conclude that a rehabilitation program consisting of exercise and education twice a week for 8 weeks had no effect on exercise performance and well being in patients with moderate COPD.

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Available from: Thomas J Ringbaek, Mar 26, 2014
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    • "60.0% 80.0%100.0% Howland 1986 Cockcroft 1987 Littlejohn 1991 Goldstein 1994 Ries 1995 Sassi-Dambron 1995 Strijbos 1996 Emery 1998 Guell 2000 Ringbaek 2000 Finnerty 2001 White 2002 Bourbeau 2003 de Godoy 2003 Monninkhof 2003 Oh 2003 Kara 2004 Man 2004 Rea 2004 Coultas 2005 Lindsay 2005 Na 2005 Casas 2006 Resqueti 2007 Barakat 2008 Efraimsson 2008 Kheirabadi 2008 Nyugen 2008 Sridhar 2008 Carr 2009 Effing 2009 Khdour 2009 Moore 2009 Taylor 2009 Theander 2009 van Wetering 2009 Ghanem 2010 Hill 2010 Lemmens 2010 Liddell 2010 Rice 2010 Ninot 2011 Zakrisson 2011 Participation rate SM HE PR Figure 4 Participation rates in different studies ordered by year of publication, and according to type of intervention: self management (SM), health education (HE), and pulmonary rehabilitation (PR). Error bars show 95% confidence interval. "
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    ABSTRACT: Background Pulmonary rehabilitation (PR) and self-management (SM) support programmes are effective in the management of patients with chronic obstructive pulmonary disease (COPD), but these interventions are not widely implemented in routine care. One reason may be poor patient participation and retention. We conducted a systematic review to determine a true estimate of participation and dropout rates in research studies of these interventions. Methods Studies were identified from eight electronic databases including MEDLINE, UK Clinical Trial Register, Cochrane library, and reference lists of identified studies. Controlled clinical trial studies of structured SM, PR and health education (HE) programmes for COPD were included. Data extraction included ‘participant flow’ data using the Consolidated Standards of Reporting Trials (CONSORT) statement and its extension to pragmatic trials. Patient ‘participation rates’ (study participation rate (SPR), study dropout rate (SDR) and intervention dropout rate (IDR)) were calculated using prior participation definitions consistent with CONSORT. Random effects logistic regression analysis was conducted to examine effects of four key study characteristics (group vs. individual treatment, year of publication, study quality and exercise vs. non-exercise) on participation rates. Results Fifty-six quantitative studies (51 randomised controlled trials, three quasi-experimental and two before-after studies) evaluated PR (n = 31), SM (n = 21) and HE (n = 4). Reports of participant flow were generally incomplete; ‘numbers of potential participants identified’ were only available for 16%, and ‘numbers assessed for eligibility’ for only 39% of studies. Although ‘numbers eligible’ were better reported (77%), we were unable to calculate SPR for 23% of studies. Overall we found ‘participation rates’ for studies (n = 43) were higher than previous reports; only 19% of studies had less than 50% SPR and just over one-third (34%) had a SPR of 100%; SDR and IDR were less than or equal to 30% for around 93% of studies. There was no evidence of effects of study characteristics on participation rates. Conclusion Unlike previous reports, we found high participation and low dropout rates in studies of PR or SM support for COPD. Previous studies adopted different participation definitions; some reported proportions without stating definitions clearly, obscuring whether proportions referred to the study or the intervention. Clear, uniform definitions of patient participation in studies are needed to better inform the wider implementation of effective interventions.
    12/2012; 1(1):66. DOI:10.1186/2046-4053-1-66
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    • "A 2003 meta-analysis found that physical training improved maximal exercise capacity and walking distance (Salman et al., 2003). A systematic review (Chavannes et al., 2002) aimed specifically at patients with mild to moderate COPD (FEV450% of expected ) identified five original studies suitable for evaluation (Clark et al., 1996; Cambach et al., 1997; Grosbois et al., 1999; Clark et al., 2000; Ringbaek et al., 2000) and found that exercise training can improve fitness in this patient group but not the feeling of dyspnea. The maximal exercise capacity was investigated in 15 trials encompassing 508 patients, 265 of whom received active rehabilitation, while the remaining 243 patients served as controls. "
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    ABSTRACT: Considerable knowledge has accumulated in recent decades concerning the significance of physical activity in the treatment of a number of diseases, including diseases that do not primarily manifest as disorders of the locomotive apparatus. In this review we present the evidence for prescribing exercise therapy in the treatment of metabolic syndrome-related disorders (insulin resistance, type 2 diabetes, dyslipidemia, hypertension, obesity), heart and pulmonary diseases (chronic obstructive pulmonary disease, coronary heart disease, chronic heart failure, intermittent claudication), muscle, bone and joint diseases (osteoarthritis, rheumatoid arthritis, osteoporosis, fibromyalgia, chronic fatigue syndrome) and cancer, depression, asthma and type 1 diabetes. For each disease, we review the effect of exercise therapy on disease pathogenesis, on symptoms specific to the diagnosis, on physical fitness or strength and on quality of life. The possible mechanisms of action are briefly examined and the principles for prescribing exercise therapy are discussed, focusing on the type and amount of exercise and possible contraindications.
    Scandinavian Journal of Medicine and Science in Sports 03/2006; 16 Suppl 1(S1):3-63. DOI:10.1111/j.1600-0838.2006.00520.x · 3.17 Impact Factor
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    ABSTRACT: Exercise and activity limitation are characteristic features of chronic obstructive pulmonary disease (COPD). Exercise intolerance may result from ventilatory limitation, cardiovascular impairment, and/or skeletal muscle dysfunction. Exercise training, a core component of pulmonary rehabilitation, improves the exercise capacity (endurance and, to a lesser degree, maximal work capacity) of patients with COPD in spite of the irreversible abnormalities in lung function. Dyspnea and health-related quality of life also improve following pulmonary rehabilitation. The clinical benefits of exercise rehabilitation last up to 2 years following 8 to 12 weeks of training. Existing evidence-based guidelines recommend that exercise training/pulmonary rehabilitation be included routinely in the management of patients with moderate to severe COPD. Exercise training/ pulmonary rehabilitation may be undertaken in an inpatient, outpatient, or home-based setting, depending on the individual needs of the patient and available resources. The type and intensity of training and muscle groups trained determine the expected outcomes of exercise training. Both high- and low-intensity exercise lead to increased exercise endurance, but only high-intensity training also leads to physiologic gains in aerobic fitness. The rationale for and outcomes of lower- and upper-limb training, as well as ventilatory muscle training, are reviewed, and the potential for anabolic hormone supplementation to optimize the benefits of exercise training is discussed.
    The Journal of Rehabilitation Research and Development 01/2003; 40(5 Suppl 2):59-80. DOI:10.1682/JRRD.2003.10.0059 · 1.69 Impact Factor
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