To evaluate the effect of pulmonary rehabilitation (PR) on exercise performance and quality of life in patients with chronic obstructive pulmonary disease (COPD) with different degrees of static lung hyperinflation (LH).
Retrospective cohort study.
A cohort of 1981 patients with COPD (55% men; age: 66.8±9.3y; forced expiratory volume in the first second%: 50.7±19.5; residual volume [RV]%: 163.0±49.7).
An interdisciplinary PR program for patients with COPD consisting of 40 sessions.
Main Outcome Measures
Participants were stratified into 5 quintiles according to baseline RV and were evaluated on the basis of pre- and post-PR 6-minute walk distance (6MWD), constant work rate test (CWRT), and Saint George’s Respiratory Questionnaire (SGRQ), among other clinical parameters.
With increasing RV quintile, patients were younger, more frequently women, had lower forced expiratory volume in the first second%, lower body mass index and fat-free mass index, shorter 6MWD, shorter CWRT, and worse SGRQ scores (P<.01). All RV strata improved after PR in all 3 outcomes (P<.001). Nevertheless, higher, compared to lower RV categories, had lower ΔCWRT (P<.01) but similar Δ6MWD (P=.948) and ΔSGRQ (P=.086) after PR.
LH in COPD is related to younger age, female sex, lower body weight, worse exercise capacity and health status, but did not prevent patients from benefitting from PR. LH, however, influences walking and cycling response after PR differently.
List of abbreviations:BMI (body mass index), COPD (chronic obstructive pulmonary disease), CIRO (Center of Expertise for Chronic Organ Failure), CWRT (constant work rate test), FFMI (fat-free mass index), LH (lung hyperinflation), MCID (minimal clinically important difference), PR (pulmonary rehabilitation), 6MWD (6-minute walk distance), SGRQ (Saint George’s Respiratory Questionnaire), RV (residual volume)
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- Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD executive summary.Am J Respir Crit Care Med. 2017; 195: 557-582
- Dyspnea and activity limitation in COPD: mechanical factors.COPD. 2007; 4: 225-236
- Physiology and consequences of lung hyperinflation in COPD.Eur Respir Rev. 2006; 15: 61-67
- Mechanisms, assessment and therapeutic implications of lung hyperinflation in COPD.Respir Med. 2015; 109: 785-802
- Decline of resting inspiratory capacity in COPD: the impact on breathing pattern, dyspnea, and ventilatory capacity during exercise.Chest. 2012; 141: 753-762
- Daily physical activity in patients with chronic obstructive pulmonary disease is mainly associated with dynamic hyperinflation.Am J Respir Crit Care Med. 2009; 180: 506-512
- The effects of pulmonary rehabilitation in the national emphysema treatment trial.Chest. 2005; 128: 3799-3809
- The National Emphysema Treatment Trial (NETT): part I: lessons learned about emphysema.Am J Respir Crit Care Med. 2011; 184: 763-770
- Spirometric correlates of improvement in exercise performance after anticholinergic therapy in chronic obstructive pulmonary disease.Am J Respir Crit Care Med. 1999; 160: 542-549
- Lung hyperinflation in chronic obstructive pulmonary disease: mechanisms, clinical implications and treatment.Expert Rev Respir Med. 2014; 8: 731-749
- An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation.Am J Respir Crit Care Med. 2013; 188: e13-e64
- Exercise performance after standard rehabilitation in COPD patients with lung hyperinflation.Intern Emerg Med. 2014; 9: 23-31
- Integration of pulmonary rehabilitation in COPD.Lancet. 2008; 371: 12-13
- General considerations for lung function testing.Eur Respir J. 2005; 26: 153-161
- Constant-load cycle endurance performance: test-retest reliability and validity in patients with COPD.J Cardiopulm Rehabil. 2003; 23: 143-150
- Reproducibility of 6-minute walking test in patients with COPD.Eur Respir J. 2011; 38: 261-267
- An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease.Eur Respir J. 2014; 44: 1428-1446
- An official systematic review of the European Respiratory Society/American Thoracic Society: measurement properties of field walking tests in chronic respiratory disease.Eur Respir J. 2014; 44: 1447-1478
- A self-complete measure of health status for chronic airflow limitation. The St. George’s Respiratory Questionnaire.Am Rev Respir Dis. 1992; 145: 1321-1327
- Assessing the impact of pulmonary rehabilitation on functional status in COPD.Thorax. 2008; 63: 115-121
- Interpreting thresholds for a clinically significant change in health status in asthma and COPD.Eur Respir J. 2002; 19: 398-404
- Arterial stiffness in patients with COPD: the role of systemic inflammation and the effects of pulmonary rehabilitation.Eur Respir J. 2014; 43: 1306-1315
- Efficacy of lower-limb muscle training modalities in severely dyspnoeic individuals with COPD and quadriceps muscle weakness: results from the DICES trial.Thorax. 2014; 69: 525-531
- Treatment of emphysema using bronchoscopic lung volume reduction coil technology: an update on efficacy and safety.Ther Adv Respir Dis. 2015; 9: 251-259
- Endobronchial valves for emphysema without interlobar collateral ventilation.N Engl J Med. 2015; 373: 2325-2335
- Activity limitation and quality of life in COPD.COPD. 2007; 4: 273-278
- Pathophysiology of muscle dysfunction in COPD.J Appl Physiol (1985). 2013; 114: 1222-1234
- Respiratory and limb muscle dysfunction in COPD.COPD. 2015; 12: 413-426
- Muscle function in COPD: a complex interplay.Int J Chron Obstruct Pulmon Dis. 2012; 7: 523-535
- Muscle dysfunction in patients with lung diseases: a growing epidemic.Am J Respir Crit Care Med. 2015; 191: 616-619
- Early-onset chronic obstructive pulmonary disease is associated with female sex, maternal factors, and African American race in the COPDGene Study.Am J Respir Crit Care Med. 2011; 184: 414-420
- Pulmonary rehabilitation: the next steps.Lancet Respir Med. 2016; 4: 172-173
- Differential response to pulmonary rehabilitation in COPD: multidimensional profiling.Eur Respir J. 2015; 46: 1625-1635
- Characteristics and determinants of endurance cycle ergometry and six-minute walk distance in patients with COPD.BMC Pulm Med. 2014; 14: 97
- Determinants of the exercise endurance capacity in patients with chronic obstructive pulmonary disease. The power-duration relationship.Am J Respir Crit Care Med. 2000; 162: 497-504
- Quantifying intervention-related improvements in exercise tolerance.Eur Respir J. 2009; 33: 1254-1260
- Selecting constant work rates for endurance testing in COPD: the role of the power-duration relationship.COPD. 2014; 11: 267-276
- Effects of obesity on weight-bearing versus weight-supported exercise testing in patients with COPD.Respirology. 2016; 21: 483-488
- The impact of obesity on walking and cycling performance and response to pulmonary rehabilitation in COPD.BMC Pulm Med. 2010; 10: 55
- Ventilatory and perceptual responses to cycle exercise in obese women.J Appl Physiol (1985). 2007; 102: 2217-2226
- Symptoms and quadriceps fatigability after walking and cycling in chronic obstructive pulmonary disease.Am J Respir Crit Care Med. 2003; 168: 562-567
- Differences in content and organisational aspects of pulmonary rehabilitation programmes.Eur Respir J. 2014; 43: 1326-1337
Published online: June 12, 2018
© 2018 by the American Congress of Rehabilitation Medicine