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: 3.09). 03/2000; 94(2):150-4. DOI: 10.1053/rmed.1999.0704
Source: PubMed


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.
    Full-text · Article · Dec 2012 · Systematic Reviews
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    • "Changes were greater among those patients who attended a health care centre for the intervention, where, unlike the individually counselled patients, they also participated in a physical training programme. Thus, physical training certainly has an impact on changes in exercise capacity among DM2 patients as well as other patients with chronic condition [39]. "
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    ABSTRACT: The main aim of the study was to identify predictors of the effects of lifestyle intervention on diabetes mellitus type 2 patients by means of multivariate analysis. Data from a previously published randomised clinical trial, which compared the effects of a rehabilitation programme including standardised education and physical training sessions in the municipality's health care centre with the same duration of individual counseling in the diabetes outpatient clinic, were used. Data from 143 diabetes patients were analysed. The merged lifestyle intervention resulted in statistically significant improvements in patients' systolic blood pressure, waist circumference, exercise capacity, glycaemic control, and some aspects of general health-related quality of life. The linear multivariate regression models explained 45% to 80% of the variance in these improvements. The baseline outcomes in accordance to the logic of the regression to the mean phenomenon were the only statistically significant and robust predictors in all regression models. These results are important from a clinical point of view as they highlight the more urgent need for and better outcomes following lifestyle intervention for those patients who have worse general and disease-specific health.
    Full-text · Article · Apr 2012 · The Scientific World Journal
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    • "Details regarding the circumstances under which the studies were carried out revealed that Jones and colleagues28 searched computerized records to identify regular attenders at their clinic. Bendstrup and colleagues27 invited patients who were chosen from hospital records, however, the total number of relevant records was not described. "
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    ABSTRACT: To analyze randomized controlled trials (RCTs) on pulmonary rehabilitation (PR) to determine whether the patients who complete PR form a representative subset of the chronic obstructive pulmonary disease (COPD) target population and to discuss what impact this may have for the generalizability and implementation of PR in practice. A review of 26 RCTs included in a Cochrane Review 2007. We analyzed the selection at three different levels: 1) sampling; 2) inclusion and exclusion; 3) and dropout. Of 26 studies only 3 (12%) described the sampling as the number of patients contacted. In these studies 28% completed PR. In all we found, that 75% of the patients suitable for PR programs were omitted due to sampling exclusion and dropout. Most of the study populations are not representative of the target population. The RCTs selected for the Cochrane review gave sparse information about the sampling procedure. The demand for high internal validity in studies on PR reduced their external validity. The patients completing PR programs in RCTs were not drawn from a representative subset of the target population. The ability to draw conclusions relevant to clinical practice from the results of the RCTs on PR is impaired.
    Full-text · Article · Aug 2010 · Clinical Epidemiology
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