Effects of 3-week outpatient pulmonary rehabilitation on exercise capacity, dyspnea, and quality of life in COPD

Handheld fans for dyspnoea in respiratory failure: randomised controlled trial

OBJECTIVE

Fan therapy is widely acknowledged as an essential component in the management of dyspnoea with numerous studies supporting its efficacy in alleviating dyspnoea among patients with chronic illnesses. However, there is limited evidence regarding the effectiveness of fan therapy in reducing dyspnoea in patients with respiratory failure undergoing continuous oxygen therapy. This study aimed to assess the efficacy of fan therapy in mitigating dyspnoea in this specific patient population through a randomised controlled trial.

METHODS

Participants meeting the inclusion criteria were randomly assigned to either an experimental group or a control group. In the experimental group, a handheld fan (HHF) was directed at the face, while in the control group the fan was aimed at the legs. Both interventions were conducted at a distance of 15-30 cm for 10 min. Key physiological and subjective measures, including heart rate, respiratory rate, blood pressure, blood oxygen saturation, facial skin temperature and Visual Analogue Scale (VAS) scores, were recorded immediately after fan therapy.

RESULTS

The experimental group demonstrated a statistically significant reduction in VAS scores (p<0.05) compared with the control group indicating that fan therapy effectively alleviates dyspnoea in patients with respiratory failure receiving continuous oxygen therapy.

CONCLUSION

HHFs are affordable, widely accessible and highly effective in relieving dyspnoea with minimal risk. Therefore, fan therapy should be considered as a complementary treatment for patients with respiratory failure and incorporated alongside standard therapeutic interventions for the condition.

[Effects of gender on pulmonary rehabilitation outcomes in patients with COPD]

INTRODUCTION

COPD has become more prevalent among women, revealing a specific feminine phenotype. Women experience greater dyspnea and a more impaired quality of life. The main objective of this study was to assess the effect of gender on dyspnea during a pulmonary rehabilitation program (PRP).

METHODS

Retrospective study including COPD patients having participated in PRPs. The following data were analyzed according to gender before and after a PRP: dyspnea, quality of life, anxiety and depression, exercise capacity, muscle function (quadriceps and inspiratory muscles).

RESULTS

More than 500 patients (252 men and 252 women) were included. We did not find a significant effect of gender on the evolution of dyspnea, anxiety or depressive disorders, exercise capacity, inspiratory muscle strength, or overall quality of life score. That said, we found a possible effect on the sub-scores of the quality of life questionnaire, and regarding quadriceps strength. All criteria improved during the program in both groups.

CONCLUSIONS

During a PRP, gender does not impact the evolution of dyspnea. While women may nonetheless benefit to a greater extent in terms of quality of life sub-scores (impact, activities, symptoms) and quadriceps strength, these results still require confirmation.

Combined Lifestyle Interventions in the Prevention and Management of Asthma and COPD: A Systematic Review

(1) Background: A healthy lifestyle has a protective role against the onset and management of asthma and chronic obstructive pulmonary disease (COPD). Therefore, combined lifestyle interventions (CLIs) are a potentially valuable prevention approach. This review aims to provide an overview of existing CLIs for the prevention and management of asthma or COPD. (2) Methods: A systematic literature search was conducted using PubMed, EMBASE, and PsycInfo. Studies were included if CLIs targeted at least two lifestyle factors. (3) Results: Among the 56 included studies, 9 addressed asthma and 47 addressed COPD management, with no studies focusing on prevention. For both conditions, the most prevalent combination of lifestyle targets was diet and physical activity (PA), often combined with smoking cessation in COPD. The studied CLIs led to improvements in quality of life, respiratory symptoms, body mass index/weight, and exercise capacity. Behavioural changes were only measured in a limited number of studies and mainly showed improvements in dietary intake and PA level. (4) Conclusions: CLIs are effective within asthma and COPD management. Next to optimising the content and implementation of CLIs, these positive results warrant paying more attention to CLIs for persons with an increased risk profile for these chronic respiratory diseases.

The Short-Term Efficacy of a Three-Week Pulmonary Rehabilitation Program among Patients with Obstructive Lung Diseases

Introduction: The recommended duration for pulmonary rehabilitation stands at a minimum of six weeks; however, this stipulation may pose constraints in various countries due to financial limitations imposed by insurance companies and/or national health funds, as is the case in Poland. Consequently, our study endeavors to analyze the short-term outcomes stemming from a condensed three-week PR regimen administered to patients diagnosed with chronic obstructive pulmonary disease (COPD), asthma, and the concomitance of these conditions (COPD-A)-this is an approach that is standard in the rehabilitation protocols endorsed by our national health fund. Methods: Patients diagnosed with COPD, asthma, and COPD-A, referred to the PR program, underwent retrospective analysis to evaluate the short-term efficacy of a three-week PR program. Patients underwent comprehensive assessment by respiratory physicians and rehabilitation consultants, leading to individualized PR programs. Clinical evaluations occurred at program onset and completion. Results: 125 patients participated: 37 COPD, 61 asthma, and 27 COPD-A. Significant improvements were observed in the COPD Assessment Test (CAT), the consensus-based GINA symptom control tool (GINA-SCT), the Modified Medical Research Council (mMRC) scale, forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and the 6-min walk test (6 MWT) distance, as well as in the St. George's Respiratory Questionnaire (SGRQ) scores. All groups experienced reduced dyspnea severity and improved exercise tolerance. FEV1 and FVC improved in asthma and COPD-A, but not significantly in COPD. Multivariable logistic regression identified predictive factors for PR response. Conclusions: The study supports the short-term efficacy of the three-week PR program in improving clinical outcomes, exercise tolerance, and quality of life in COPD and asthma patients. Tailoring interventions based on predictors of PR response can optimize outcomes. Further research, particularly of the COPD-A group, is needed for individualized approaches. Larger sample sizes are necessary to confirm our findings.

Effectiveness of a 3-Week Rehabilitation Program Combining Muscle Strengthening and Endurance Exercises Prior to Total Knee Arthroplasty: A Non-Randomized Controlled Trial

We evaluated the effectiveness of a high-intensity preoperative resistance and endurance training program in improving physical function among patients scheduled for total knee arthroplasty. This non-randomized controlled trial included 33 knee osteoarthritis patients scheduled to undergo total knee arthroplasty at a tertiary public medical university hospital. Fourteen and nineteen patients were non-randomly assigned to intervention and control groups, respectively. All patients underwent total knee arthroplasty and a postoperative rehabilitation program. The intervention group participated in a preoperative rehabilitation program comprising high-intensity resistance and endurance training exercises to increase lower limb muscle strength and endurance capacity. The control group received only exercise instruction. The primary outcome was the 6-min walking distance, which was significantly higher in the intervention group (399 ± 59.8 m) than in the control group (348 ± 75.1 m) 3 months post-surgery. There were no significant differences between the groups 3 months post-surgery in muscle strength, visual analog scale, WOMAC-Pain, range of motion of knee flexion, and extension. A 3-week preoperative rehabilitation program combining muscle strengthening and endurance training improved endurance 3 months after total knee arthroplasty. Thus, preoperative rehabilitation is important for improving postoperative activity.

Pulmonary rehabilitation outcomes in individuals with chronic obstructive pulmonary disease: a systematic review

BACKGROUND

The magnitude of response to pulmonary rehabilitation (PR) is influenced by the selection of outcomes and measures.

OBJECTIVES

This systematic review aimed to review all outcomes and measures used in clinical trials of PR for individuals with chronic obstructive pulmonary disease (COPD).

METHODS

The review involved a search of Scopus, Web of Knowledge, Cochrane Library, EBSCO, Science Direct and PubMed databases for studies of stable individuals with COPD undergoing PR. Frequency of reporting for each domain, outcome and measure was synthesized by using Microsoft Excel.

RESULTS

We included 267 studies (43153 individuals with COPD). A broad range of domains (n=22), outcomes (n=163) and measures (n=217) were reported. Several measures were used for the same outcome. The most reported outcomes were exercise capacity (n=218) assessed with the 6-min walk test (n=140), health-related quality of life (n=204) assessed with the Saint George's respiratory questionnaire (n=99), and symptoms (n=158) assessed with the modified Medical Research Council dyspnea scale (n=56). The least reported outcomes were comorbidities, adverse events and knowledge.

CONCLUSIONS

This systematic review reinforces the need for a core outcome set for PR in individuals with COPD because of high heterogeneity in reported outcomes and measures. Future studies should assess the importance of each outcome for PR involving different stakeholders.

PROSPERO ID

CRD42017079935.

Gender does not impact the short- or long-term outcomes of home-based pulmonary rehabilitation in patients with COPD

Pulmonary rehabilitation, whether performed at home or in a specialised centre, is effective in the management of COPD. As gender-related differences in COPD were previously reported, we aimed to evaluate the impact of gender on pulmonary rehabilitation outcomes in the short, medium and long term.

In this retrospective observational study of 170 women and 310 men with COPD, we compared the outcomes of an 8-week home-based pulmonary rehabilitation programme including an individualised plan of retraining exercises, physical activities, therapeutic education, and psychosocial and self-management support. Exercise tolerance, anxiety, depression, and quality of life (QOL) were assessed using the 6-min stepper test (6MST), Hospital Anxiety and Depression Scale (HADS) and Visual Simplified Respiratory Questionnaire (VSRQ), respectively. Assessments were carried out before, immediately after the pulmonary rehabilitation programme (T2) and at 8 (T8) and 14 months (T14).

At baseline, women were younger (mean 62.1 versus 65.3 years), more often nonsmokers (24.7% versus 7.7%) and had a higher body mass index (28 versus 26.4 kg·m⁻²). They more often lived alone (50.6% versus 24.5%) and experienced social deprivation (66.7% versus 56.4%). They had significantly lower exercise tolerance (−34 strokes, 6MST) and higher anxiety and depression (+3.2 HADS total score), but there were no between gender differences in QOL (VSRQ). Both groups showed similar improvements in all outcome measures at T2, T8 and T14 with a tendency for men to lose QOL profits over time.

Despite some differences in baseline characteristics, women and men with COPD had similar short-, medium- and long-term benefits of a home-based pulmonary rehabilitation programme.

Despite some differences in baseline characteristics, women and men with COPD had similar short-, medium- and long-term benefits of a home-based pulmonary rehabilitation programmehttps://bit.ly/2XfFakK

Pulmonary rehabilitation for chronic obstructive pulmonary disease: effects of a high versus low intensity programme

Background/Aims

Pulmonary rehabilitation is known to facilitate improvements in chronic obstructive pulmonary disease symptoms, exercise tolerance and quality of life. Despite this, there is no consensus on the ideal programme intensity. This article aims to explore and compare the benefits of a high intensity and low intensity pulmonary rehabilitation programme.

Methods

A total of 30 patients with a diagnosis of chronic obstructive pulmonary disease were randomly and blindly allocated to either a high intensity or low intensity 12-week pulmonary rehabilitation programme.

Results

Significant improvements in functional and health-related quality of life measures were obtained in both groups. Most of the significant changes for the high intensity group were achieved by week 8. The low intensity group required a further 4 weeks of rehabilitation in order to reach a significant difference.

Conclusions

Results show that both low and high intensity pulmonary rehabilitation programmes were beneficial. However, the high intensity programme was more efficient in achieving these improvements than the low intensity group.

Effects of Water-Based Aerobic Interval Training in Patients With COPD: A RANDOMIZED CONTROLLED TRIAL

PURPOSE

Chronic obstructive pulmonary disease promotes systemic repercussions, which can be minimized with physical exercise. This study investigated the effects of a water-based aerobic interval training program on the autonomic modulation of heart rate (HR), quality of life (QoL), and functional capacity (FC) of patients with chronic obstructive pulmonary disease.

METHODS

Nineteen patients with chronic obstructive pulmonary disease were enrolled in this randomized clinical trial and allocated to either the usual care group (n = 9) or training group (n = 10). Before and after 24 sessions of water-based physical training, the patients underwent evaluation of autonomic modulation of HR by analyzing the HR variability, QoL using the St George's Respiratory Questionnaire, and FC using 6-min walk test distance.

RESULTS

The results showed significant improvement when comparing the variables of HR variability, QoL, and FC in the training group in the pre- and post-training conditions (P < .05). In the usual care group, there was no significant difference for any of the variables. Negative correlations were found between HR variability and QoL (r =-0. 55; P = .01) and 6-min walk test distance and QoL (r =-0.49; P = .02).

CONCLUSION

Water-based physical training promoted beneficial adaptations in the autonomic modulation of HR, QoL, and FC of patients with chronic obstructive pulmonary disease.

The Effect of Pulmonary Rehabilitation in Mountain Environment on Exercise Capacity and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease (COPD) and Chronic Bronchitis

BACKGROUND We aimed to test the effectiveness of the pulmonary rehabilitation in a mountain environment on the pulmonary function, physical performance, dyspnea, affective factors, and quality of life (QoL) in patients with chronic obstructive pulmonary disease (COPD) and chronic bronchitis (CB), as well as to determine predictors of clinical improvement. MATERIAL AND METHODS 128 consecutive patients (90 diagnosed with COPD and 38 diagnosed with CB) underwent comprehensive pulmonary rehabilitation for a duration of 3 weeks in one of 3 mountain health resorts in the High Tatras. The examination included spirometry (FEV1 and FEV1/FVC), 6-minute walk test (6MWT), Borg scale of dyspnea, and assessment of depression (Zung score), anxiety (Beck score), and QoL using the SF-36 scales. RESULTS After the study intervention, all patients in both monitored groups demonstrated significant improvements in objective measurements in which large treatment effect was achieved (for FEV1 η²=0.218, for 6MWT η²=0.771). Similarly, in subjective measurements a large effect was achieved (for the Beck score: η²=0.599, for the Zung score: η²=0.536). QoL improved after the intervention in all the monitored SF-36 scales in both groups (P<0.001 for all). In patients with COPD, the improvement of exercise capacity was positively correlated with baseline 6MWT and FEV1, and negatively with the Beck anxiety score and the Borg dyspnea score, whereas, only improvement in the mental summary component of QoL was negatively correlated with baseline 6MWT and FEV1 (P<0.05 for all). CONCLUSIONS Rehabilitation in a mountain environment has proven to be effective in both the reported diagnoses of COPD and CB. Improvements in both functional and subjective indicators were observed. These findings support the use of this treatment modality.

Validity of a Self-administered Questionnaire Version of the Transition Dyspnea Index in Patients with COPD

The transition dyspnea index (TDI) is among the most widely used instruments in chronic obstructive pulmonary disease (COPD) patients to measure changes in dyspnea over time. In its original version it is used as guideline for a structured interview to assess the impact of daily activities on dyspnea in the three subdomains: functional impairment, magnitude of task, and magnitude of effort. However, the TDI is sometimes used as a self-administered paper-and-pencil questionnaire. The validity of this questionnaire format has not been tested, which was the aim of the present study. We tested 190 patients with COPD at start and end of a 3-week inpatient pulmonary rehabilitation program (PR). Dyspnea was assessed with the modified Medical Research Council Scale (mMRC), a questionnaire version of the TDI, and an interview version of the TDI. Group means for the TDI questionnaire and interview version were widely comparable for the TDI summary score and the three TDI subdomains. The scores of both TDI versions were strongly correlated and showed comparable, but only weak, correlations with changes during PR in spirometric lung function and mMRC. Improvement in dyspnea after PR was observed in 89% of patients when using the summary score of the questionnaire TDI, but only in 34% of patients when using the mMRC. The results suggest that a self-administered questionnaire format of the TDI is an adequate instrument for assessing changes in activity-related dyspnea during PR in patients with COPD. The responsiveness of this instrument to effects of PR appears greater than the responsiveness of the mMRC.

Home nursing care with the self-care model improves self-efficacy of patients with chronic obstructive pulmonary disease

AIM

This study was carried out as an intervention study to determine the effect of nursing care provided at home with the self-care model on the self-efficacy of patients with chronic obstructive pulmonary disease in northern Turkey.

METHODS

The study sample totaled 106 patients with chronic obstructive pulmonary disease divided into two groups. The intervention group and the control group each included 53 patients. To collect data, the patient data sheet, Orem's self-care model-based data collection form, symptom evaluation form, Medical Research Council dyspnea scale, and the chronic obstructive pulmonary disease self-efficacy scale (CSES) were used. The nursing care applied for the intervention group consisted of four visits, two during the first month and two for the next 2 months. An educational guidebook was distributed to the intervention group during the first visit, and at all visits, education, care, and supervision were provided according to the care plan. All data were analyzed with the number, percentage, χ(2) -test, Kruskal-Wallis H test, Wilcoxon rank sum test, and Mann-Whitney U-test.

RESULTS

The dyspnea level measured at the last visit for the control group was high compared with the intervention group (P < 0.05). The chronic obstructive pulmonary disease self-efficacy scale scores for subscale dimensions at the last visit and the general score for the intervention group were high compared with the first visit scores (P < 0.05).

CONCLUSION

According to the study results, home nursing care based on the Orem's self-care model is effective in improving self-efficacy of patients with chronic obstructive pulmonary disease.

Patient self-management in primary care patients with mild COPD - protocol of a randomised controlled trial of telephone health coaching

Background

The prevalence of diagnosed chronic obstructive pulmonary disease (COPD) in the UK is 1.8%, although it is estimated that this represents less than half of the total disease in the population as much remains undiagnosed. Case finding initiatives in primary care will identify people with mild disease and symptoms. The majority of self-management trials have identified patients from secondary care clinics or following a hospital admission for exacerbation of their condition. This trial will recruit a primary care population with mild symptoms of COPD and use telephone health coaching to encourage self-management.

Methods/Design

In this study, using a multi-centred randomised controlled trial (RCT) across at least 70 general practices in England, we plan to establish the effectiveness of nurse-led telephone health coaching to support self-management in primary care for people who report only mild symptoms of their COPD (MRC grade 1 and 2) compared to usual care. The intervention focuses on taking up smoking cessation services, increasing physical activity, medication management and action planning and is underpinned by behavioural change theory. In total, we aim to recruit 556 patients with COPD confirmed by spirometry with follow up at six and 12 months. The primary outcome is health related quality of life using the St Georges Respiratory Questionnaire (SGRQ). Spirometry and BMI are measured at baseline. Secondary outcomes include self-reported health behaviours (smoking and physical activity), physical activity measured by accelerometery (at 12 months), psychological morbidity, self-efficacy and cost-effectiveness of the intervention. Longitudinal qualitative interviews will explore how engaged participants were with the intervention and how embedded behaviour change was in every day practices.

Discussion

This trial will provide robust evidence about the effectiveness of a novel telephone health coaching intervention to promote behaviour change and prevent disease progression in patients with mild symptoms of dyspnoea in primary care.

Trial registration

Current controlled trials ISRCTN06710391.

Pulmonary rehabilitation improves only some domains of health-related quality of life measured by the Short Form-36 questionnaire

BACKGROUND:

Pulmonary rehabilitation (PR) has inconsistent effects on health-related quality of life (HRQL) in patients with chronic lung diseases. We evaluated the effect of PR on HRQL outcomes using the 36-item short form of the medical outcomes (SF-36).

METHODS:

We retrospectively reviewed the files of all patients who completed PR in 2010, 2011, and first half of 2012. We collected information on demographics, symptoms, pulmonary function tests, 6-minute walk tests (6-MWT), and responses on the SF-36 survey, including the physical component score (PCS) and mental component score (MCS).

RESULTS:

The study included 19 women and 22 men. The mean age was 69.8 ± 8.5 years. The diagnoses included chronic obstructive pulmonary disease (COPD; n = 31), asthma (n = 3), interstitial lung disease (n = 5), and obstructive sleep apnea (OSA; n = 2). The mean forced expiratory volume-one second (FEV1) was 1.16 ± 0.52 L (against 60.5 ± 15.9% of predicted value). There was a significant improvement in 6-MWT (P < 0.0001). The PCS improved post-PR from 33.8 to 34.5 (P = 0.02); the MCS did not change.

CONCLUSION:

These patients had low SF-36 scores compared to the general population; changes in scores after PR were low. These patients may need frequent HRQL assessment during rehabilitation, and PR programs should consider program modification in patients with small changes in mental health.

Evaluation of quality of life with the chronic obstructive pulmonary disease assessment test in chronic obstructive pulmonary disease and the effect of dyspnea on disease-specific quality of life in these patients

PURPOSE

The chronic obstructive pulmonary disease (COPD) assessment test (CAT) was recently introduced for use in assessing disease-specific quality of life and follow-up of patients with COPD. The purpose of this study was to evaluate the effect of the dyspnea on disease-specific quality of life detected by CAT score in patients with COPD.

MATERIALS AND METHODS

In this study, 90 stable patients with COPD as defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria were included. The level of dyspnea was assessed with the Medical Research Council (MRC) dyspnea scale, and disease-specific quality of life was assessed with CAT score.

RESULTS

The mean ± SD age was 68.5 ± 10.9 (range 41-97) years. A significant relationship was established between CAT score, MRC dyspnea scale score and GOLD stage in patients with COPD. There was also a positive correlation between dyspnea scale scores and GOLD stage in the patients (p<0.001), as well as positive correlation between CAT score and dyspnea scale score (p<0.001). CAT score showed a significant correlation with hospitalization and exacerbations (p<0.05).

CONCLUSION

Dyspnea is an important symptom that may impact quality of life in patients with COPD. CAT was shown to be a simple, fast and intelligible measurement of disease-specific quality of life, and was correlated with levels of dyspnea in patients with COPD.

Distance saturation product predicts health-related quality of life among sarcoidosis patients

BACKGROUND

Sarcoidosis is a chronic disease with different phenotypic manifestations. Health-related quality of life is an important aspect in sarcoidosis, yet difficult to measure. The objective of this study was to identify clinical markers predictive of poor quality of life in sarcoidosis patients that can be followed over time and targeted for intervention.

METHODS

We assessed the quality of life of 162 patients with confirmed sarcoidosis in a prospective, cross-sectional study using the Sarcoidosis Health Questionnaire (SHQ) and Short Form-36 Health Survey (SF-36). We evaluated the validity of these questionnaires and sought to identify variables that would best explain the performance scores of the patients.

RESULTS

On multivariate regression analyses, the very best composite model to predict total scores from both surveys was a model containing the distance-saturation product and Borg Dyspnea Scale score at the end of a 6-min walk test. This model could better predict SF-36 scores (R² = 0.33) than SHQ scores (R² = 0.24). Substitution of distanced walked in 6 min for the distance-saturation product in this model resulted in a lesser ability to predict both scores (R² = 0.26 for SF-36; R² = 0.22 for SHQ).

CONCLUSIONS

Both the SHQ and SF-36 surveys are valuable tools in the assessment of health-related quality of life in sarcoidosis patients. The best model to predict quality of life among these patients, as determined by regression analyses, included the distance-saturation product and Borg score after the 6-min walk test. Both variables represent easily obtainable clinical parameters that can be followed over time and targeted for intervention.

Effects of whole body vibration in patients with chronic obstructive pulmonary disease--a randomized controlled trial

INTRODUCTION

To date endurance and strength training are established and evidence-based exercise methods in patients with chronic obstructive pulmonary disease (COPD). There is an unmet need for further research in new and complementary exercise modalities. Additional whole body vibration training during pulmonary rehabilitation may be such a new approach that has not yet been investigated in patients with COPD.

METHODS

Eighty-two patients (65 ± 9 yrs, FEV(1) pred. 38 ± 11%, female 51%) with COPD in GOLD stage III to IV assessed for a 3-week inpatient multidisciplinary rehabilitation program were on top randomly assigned to one of two intervention groups: (1) 3 × 3 min of bilateral dynamic squat exercises on a side-alternating vibration platform at 24-26 Hz three times per week (WBV) and (2) a control group (CON) with the same amount of exercise time without WBV.

RESULTS

Thirty-six patients completed the study in each group. The improvement in 6-min walking distance was significantly higher in the WBV-group when compared to the CON-group (WBV: 64 ± 59 m, CON: 37 ± 52 m with a between-group difference of 27 m [95% CI, 1-53], p = 0.046). The time required for a sit-to-stand test also decreased more markedly in the WBV-group than in the CON-group (WBV: -4.0 ± 4.8 s, CON: -2.0 ± 3.1 s with a between-group difference of -1.9 s [95% CI, -4.0 to 0.1], p = 0.067). Improvements in health-related quality of life were similar in both groups.

CONCLUSIONS

WBV training seems to be a promising new exercise modality for patients with COPD and may enhance the effects of a multidisciplinary rehabilitation program.

Social comparison and anxious mood in pulmonary rehabilitation: the role of cognitive focus

OBJECTIVES

  Comorbid anxiety is highly prevalent in Chronic Obstructive Pulmonary Disease (COPD), and it is related to increased morbidity and mortality. It has consistently been found that social comparison has substantial impact on mood. However, despite the strong social component of pulmonary rehabilitation, the effect of social comparison processes on anxiety has not been explored in this context.

DESIGN

  Participants were 43 COPD patients enrolled in a 3-week pulmonary rehabilitation programme. We tested in a longitudinal design the relationship between social comparison and assimilation and contrast at the beginning of rehabilitation and anxious mood at the end of the programme.

METHODS

  Using moderator analysis, we tested whether perceived similarities and differences to upward and downward social comparison standards influence the relationship between comparison direction at the beginning of the programme and anxious mood at the end of the programme.

RESULTS

  The relationship between social comparison at the start of rehabilitation and anxious mood at the end of the programme was dependent on assimilation and contrast to upward and downward standards. Downward assimilation and upward contrast were related to a stronger relationship of upward and downward social comparison and anxious mood.

CONCLUSION

  This study demonstrates the important role of social comparison focus in moderating beneficial effects of pulmonary rehabilitation. Downward assimilation and upward contrast might be important targets in reducing anxiety in pulmonary rehabilitation.

Improvement of cognitive function after a three-month pulmonary rehabilitation program for COPD patients

The objective of the study was to evaluate the effect of multidisciplinary pulmonary rehabilitation program on cognitive function in COPD patients, adjusting for potential confounders (gender, age, tobacco consumption, and educational level). In this prospective study, 34 COPD patients were submitted to neuropsychological testing before and after a 3-month pulmonary rehabilitation program. A control group with 18 healthy subjects of similar age, sex, and educational status was used to compare the cognitive function of COPD patients and healthy subjects at baseline. The association between the rehabilitation and change on th scores of cognitive variables, adjusted for each covariate, was estimated by means of linear random-intercept regression models. At baseline, the COPD patients had worse cognitive function with regard to verbal learning, memory, subjective organization, and verbal processing in comparison to the healthy volunteers. The improvement in cognitive performance by the COPD patients was evidenced even after adjusting for the sociodemographic factors that could potentially interfere on cognitive function. Male gender and age less than 65 years old were associated to higher scores in verbal learning and memory at baseline and after the rehabilitation program. The clinical approach to COPD-induced cognitive dysfunction should include participation in pulmonary rehabilitation programs. There were gender- and age-related differences in cognitive scores that persisted after rehabilitation.

Optimal duration of pulmonary rehabilitation for individuals with chronic obstructive pulmonary disease - a systematic review

The purpose of this review was to determine the impact of duration of pulmonary rehabilitation on measures of health-related quality of life and exercise tolerance in individuals with chronic obstructive pulmonary disease (COPD). Randomized controlled trials (RCTs) comparing different lengths of pulmonary rehabilitation in patients with COPD were identified after searches of six electronic databases (MEDLINE, PubMed, CINAHL, EMBASE, Physiotherapy Evidence Database [PEDro] and the Cochrane Library of clinical trials) and reference lists of pertinent articles. Two reviewers performed the searches and assessed trial quality using PEDro and Jadad scales. Five RCTs met inclusion criteria. The mean PEDro score was 6 (range 3-8) and mean Jadad was 2 (range 1-3). Three trials reported a difference in health-related quality of life in favour of the longer duration program; two trials reported a benefit in exercise capacity in favour of longer programs. A meta-analysis of results was not possible due to considerable heterogeneity in program duration and outcomes. Longer duration pulmonary rehabilitation programs appear to have a more favourable effect on health-related quality of life in individuals with COPD; results for exercise capacity are less clear. The limited literature prevents a more definitive conclusion on optimal duration of rehabilitation.

The impact of anxiety and depression on outcomes of pulmonary rehabilitation in patients with COPD

BACKGROUND

Anxiety and depression are prevalent comorbidities in COPD and are related to a worse course of disease. The present study examined the impact of anxiety and depression on functional performance, dyspnea, and quality of life (QoL) in patients with COPD at the start and end of an outpatient pulmonary rehabilitation (PR) program.

METHODS

Before and after PR, 238 patients with COPD (mean FEV(1) % predicted = 54, mean age = 62 years) underwent a 6-min walking test (6MWT). In addition, anxiety, depression, QoL, and dyspnea at rest, after the 6MWT, and during activities were measured.

RESULTS

Except for dyspnea at rest, improvements were observed in all outcome measures after PR. Multiple regression analyses showed that before and after PR, anxiety and depression were significantly associated with greater dyspnea after the 6MWT and during activities and with reduced QoL, even after controlling for the effects of age, sex, lung function, and smoking status. Moreover, before and after PR, anxiety was related to greater dyspnea at rest, whereas depression was significantly associated with reduced functional performance in the 6MWT.

CONCLUSIONS

This study demonstrates that anxiety and depression are significantly associated with increased dyspnea and reduced functional performance and QoL in patients with COPD. These negative associations remain stable over the course of PR, even when improvements in these outcomes are achieved during PR. The results underline the clinical importance of detecting and treating anxiety and depression in patients with COPD.