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      The likelihood of improving physical activity after pulmonary rehabilitation is increased in patients with COPD who have better exercise tolerance

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          Pulmonary rehabilitation (PR) enhances exercise tolerance in patients with COPD; however, improvements in physical activity (PA) are not guaranteed. This study explored the relationship between baseline exercise tolerance and changes in PA after PR.

          Materials and methods

          Patient data from prospective clinical trials in the PR settings of Athens and Leuven (2008–2016) were analyzed. Validated PA monitors were worn for 1 week before and after a 12-week program. The proportion of patients who improved PA levels ≥1,000 steps/day (“PA responders”) after PR was compared between those with initial 6-minute walk distance [6MWDi] <350 m and ≥350 m. Baseline predictors of PA change were evaluated via univariate and multivariate logistic regression analyses.


          Two hundred thirty-six patients with COPD (median [IQR] FEV 1 44 [33–59] % predicted, age 65±8 years, 6MWDi 416 [332–486] m) were included. The proportion of “PA responders” after PR was significantly greater in those with higher vs lower 6MWDi (37.9% vs 16.4%, respectively; P<0.001). 6MWDi group classification was the strongest baseline independent predictor of PA improvement (univariate OR 3.10, 95% CI 1.51–6.36).


          The likelihood of improving PA after PR is increased with greater 6MWDi. Baseline exercise tolerance appears as an important stratification metric for future research in this field.

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          Most cited references 21

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          Short- and long-term effects of outpatient rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial.

          Pulmonary rehabilitation programs are effective in patients with severe chronic obstructive pulmonary disease (COPD) in the short term, but their long-term effects are not known. We investigated the short- and long-term effects of a 6-month outpatient rehabilitation program in patients with severe COPD. One hundred patients were randomly assigned to receive either an exercise training program that included cycling, walking, and strength training (n = 50) or usual medical care (n = 50). Thirty-four patients in the training group were evaluated after 6 months (end of training), and 26 were evaluated after 18 months of follow-up. In the control group, 28 patients were evaluated at 6 months and 23 after 18 months. We measured pulmonary function, 6-minute walking distance, maximal exercise capacity, peripheral and respiratory muscle strength, and quality of life (on a 20 to 140-point scale), and estimated the cost-effectiveness of the program. At 6 months, the training group showed improvement in 6-minute walking distance [mean difference (training - control) of 52 m; 95% confidence interval (CI), 15 to 89 m], maximal work load (12 W; 95% CI, 6 to 19 W), maximal oxygen uptake (0.26 liters/min; 95% CI, 0.07 to 0.45 liters/min), quadriceps force (18 Nm; 95% CI, 7 to 29 Nm), inspiratory muscle force (11 cm H(2)O; 95% CI, 3 to 20 cm H(2)O), and quality of life (14 points; 95% CI, 6 to 21 points; all P <0.05). At 18 months all these differences persisted (P <0.05), except for inspiratory muscle strength. For 6-minute walking distance and quality of life, the differences between the training group and controls at 18 months exceeded the minimal clinically-important difference. Among patients who completed the 6-month program, outpatient training resulted in significant and clinically relevant changes in 6-minute walking distance, maximal exercise performance, peripheral and respiratory muscle strength, and quality of life. Most of these effects persisted 18 months after starting the program.
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            Does exercise training change physical activity in people with COPD? A systematic review and meta-analysis.

            A systematic review and meta-analysis was conducted to examine the effect of exercise training on daily physical activity (PA) in people with chronic obstructive pulmonary disease (COPD). MEDLINE, PubMed, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro) and Cochrane Central Register of Controlled Trials were searched from their inception to week 27 of 2010, using the keywords 'COPD,' 'exercise,' 'therapy' and 'physical activity.' All studies except case reports were eligible for inclusion provided they investigated the effects of ≥4 weeks of supervised exercise training on PA in patients with COPD. Study quality for the randomised trials (RTs) and single-group interventional studies was rated using the PEDro scale and Downs and Black Tool, respectively. No randomised controlled trials met our study criteria. The two RTs had a mean PEDro score of 5. The 5 single-group studies had a mean Downs and Black score of 19 ± 3. When combined, a small effect on PA outcomes was demonstrated (overall mean effect = 0.12; p = 0.01). Taken together, the RTs and single-group studies demonstrate that exercise training may confer a significant but small increase in PA.
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              Disease Progression and Changes in Physical Activity in Patients with Chronic Obstructive Pulmonary Disease.

              Little is known about the role of physical activity in the course of chronic obstructive pulmonary disease (COPD).

                Author and article information

                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                24 October 2018
                : 13
                : 3515-3527
                [1 ]Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium, thierry.troosters@
                [2 ]Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia
                [3 ]Monash Lung and Sleep, Monash Health, Melbourne, Victoria, Australia
                [4 ]Institute for Breathing and Sleep, Melbourne, Victoria, Australia
                [5 ]Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg
                [6 ]Respiratory Division, University Hospitals, KU Leuven, Leuven, Belgium, thierry.troosters@
                [7 ]Faculty of Physical Education and Sports Sciences, National and Kapodistrian University of Athens, Athens, Greece
                [8 ]Department of Chronic Disease, Metabolism and Aging, KU Leuven, Leuven, Belgium
                [9 ]Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK
                Author notes
                Correspondence: Thierry Troosters, Department of Rehabilitation Sciences, KU Leuven, Herestraat 49 bus 706, Onderwijs & Navorsing I, Labo Pneumologie, 3000, Leuven, Belgium, Tel +32 1 633 0798, Fax +32 1 633 0805, Email thierry.troosters@

                These authors contributed equally to this work

                © 2018 Osadnik et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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