Role of Exercise in Testing and in Therapy of COPD

Pulmonary and Critical Care Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
The Medical clinics of North America (Impact Factor: 2.61). 07/2012; 96(4):753-66. DOI: 10.1016/j.mcna.2012.05.004
Source: PubMed


The stair-climbing test, 6MWT, and shuttle test are exercise tests that requires less technical support than the CPET and are more available to any physician. The 6MWT is the simplest and most likely to be cost effective, as it provides useful information regarding prognosis, ADLs, and health care use at a very low cost. In addition, the 6MWT can be used to evaluate response to several interventions, including physical rehabilitation, medications, lung volume reduction interventions, and transplantation. The 6MWT has also been useful in and has become an integral part of the evaluation and response to treatment in other medical conditions, including congestive heart failure, pulmonary hypertension, and pulmonary fibrosis. The stair-climbing test seems to be most useful for preoperative evaluations when a CPET is not available. We have also used it on patients unable to perform a good CPET because of lack of familiarity with bicycle pedaling. The shuttle walk test may be used to better determine a maximal exercise capacity when a CPET is not available and to measure the effects of pulmonary rehabilitation in patients unfamiliar with a CPET. The role of exercise as a therapeutic tool is central to the concept of pulmonary rehabilitation. Exercise training improves not only functional dyspnea and health-related quality of life, but also has been shown to decrease health care resource use. As part of a comprehensive pulmonary rehabilitation initiated after a hospitalization for exacerbation, it has been shown to decrease readmission rates.

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    • "Maximal cardiopulmonary testing including peak VO2 has been shown to predict exercise capacity but has its limitations because the very sick are unable to undergo this testing. In several examples, a primary outcome of functional capacity has been adequately demonstrated using the 6MWT in several instances whereby the study population that was unable to complete other means of maximal cardiopulmonary testing [10-13,15,16,18]. The 6-min walk test is simpler than full cardiopulmonary testing, and in this study, we demonstrate its simplicity in epidemiological studies to compare functional capacity of two healthy populations at different altitudes. "
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    ABSTRACT: We sought to determine if adult residents living at high altitude have developed sufficient adaptation to a hypoxic environment to match the functional capacity of a similar population at sea level. To test this hypothesis, we compared the 6-min walk test distance (6MWD) in 334 residents living at sea level vs. at high altitude. We enrolled 168 healthy adults aged ≥35 years residing at sea level in Lima and 166 individuals residing at 3,825 m above sea level in Puno, Peru. Participants completed a 6-min walk test, answered a sociodemographics and clinical questionnaire, underwent spirometry, and a blood test. Average age was 54.0 vs. 53.8 years, 48% vs. 43% were male, average height was 155 vs. 158 cm, average blood oxygen saturation was 98% vs. 90%, and average resting heart rate was 67 vs. 72 beats/min in Lima vs. Puno. In multivariable regression, participants in Puno walked 47.6 m less (95% CI -81.7 to -13.6 m; p < 0.01) than those in Lima. Other variables besides age and height that were associated with 6MWD include change in heart rate (4.0 m per beats/min increase above resting heart rate; p < 0.001) and percent body fat (-1.4 m per % increase; p = 0.02). The 6-min walk test predicted a lowered functional capacity among Andean high altitude vs. sea level natives at their altitude of residence, which could be explained by an incomplete adaptation or a protective mechanism favoring neuro- and cardioprotection over psychomotor activity.
    Full-text · Article · Feb 2014
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    ABSTRACT: Pulmonary hypertension (PH) presented in the last decade, significant progress in terms of their interpretation pathophysiological, clinical practice, and especially for diagnosis and treatment, which results in a significant improvement in the quality and life expectancy of patients even those who are in the later stages of the disease. These developments are reflected in the development of clinical guidelines based on evidence that has been developed by scientific societies and working groups of national and international, constituting the current reference for the diagnosis and treatment of this disease. However, these guidelines and recommendations are not addressed some issues that affect the daily clinical practice and how to contribute to this pathology. And, in addition, require technical and personal with solid experience in disease management for proper diagnosis and treatment of PH, especially in its more severe forms. The creation of interdisciplinary teams for early detection and early treatment of patients with PH of different etiologies contribute to better management of this disease which until very recently had no specific treatment. Creating models to educate the population to agree an early warning of disease, a rare and devastating, contribute significantly to this purpose. The working groups should work not only program of health care need, but also in a social educational task, to achieve the ultimate goal: a better quality of life and longer survival.
    Full-text · Article · Jan 2012 · Insuficiencia Cardiaca
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    ABSTRACT: Introdução:Os broncodilatadores são fundamentais para o tratamento da doença pulmonar obstrutiva crônica (DPOC). O indacaterol é broncodilatador beta-2-agonista de longa ação recentemente aprovado para utilização na DPOC, que tem como principal característica referida pelos fabricantes um rápido início de ação. Objetivo: Avaliar o efeito agudo do indacaterol em portadores de DPOC. Métodos: Foi realizado um ensaio clínico randomizado, duplo cego, controlado com placebo utilizando indacaterol 150 mcg inalado em portadores de DPOC. Os desfechos avaliados foram o VEF1 e a CVF (obtidos da espirometria), frequência cardíaca e respiratória, pressão arterial, SpO2, sensação de dispneia e o teste do degrau. Resultados: Quarenta pacientes foram selecionados. Observou-se que não foi notada broncodilatação significante entre os grupos indacaterol e Placebo aos 5, 15 e 30 minutos seja em relação ao VEF1 ou a CVF. Diferenças estatísticas também não foram notadas para as variáveis secundárias como SpO2 ( p=0,89), FR (p=0,88), FC(p=0,31), pressão arterial (p=0,85), dispneia (p=0,60) e número de degraus subido ao final de 6 minutos (0,72). Conclusão: Em portadores de DPOC estáveis o indacaterol não produziu modificações nos desfechos avaliados em até 30 minutos após a sua utilização.
    Preview · Article · Jan 2013
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