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      Home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized clinical trial

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          Abstract

          Introduction

          Pulmonary rehabilitation (PR) is a multidisciplinary program of care for patients with chronic obstructive pulmonary disease (COPD) with the goal of improving the functional capacity and quality of life, as well as maintaining the clinical stability of COPD sufferers. However, not all patients are available for such a program despite discomfort with their condition. The aim of this study was to evaluate the effects of a home-based PR (HBPR) program on functional ability, quality of life, and respiratory muscle strength and endurance.

          Patients and methods

          Patients with COPD according to the Global Initiative of Chronic Obstructive Lung Disease were randomized (double-blind) into two groups. One group performed a protocol at home with aerobic and muscle strength exercises and was called the intervention group; the other group received only instructions to perform breathing and stretching exercises, characterizing it as the control group (CG). We assessed the following variables at baseline and 2 months: exercise tolerance (incremental shuttle walk test and upper limb test), respiratory muscle (strength and endurance test), and health-related quality of life (Airways Questionnaire 20).

          Results

          There were no significant changes after the intervention in either of the two groups in exercise tolerance and quality of life. However, the intervention group had improved respiratory endurance compared with the CG, while the CG presented a decrease in the load sustained by the respiratory muscles after the HBPR.

          Conclusion

          A program of HBPR with biweekly supervision (although not enough to provide significant improvements in physical capacity or quality of life) played an important role in maintaining the stability of the clinical features of patients with COPD; the patients had no worsening of symptoms during the intervention period according to the daily log.

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          Most cited references 15

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          [Benefits of a home-based pulmonary rehabilitation program for patients with severe chronic obstructive pulmonary disease].

          The benefits of a domiciliary program of pulmonary rehabilitation for patients with severe to very severe chronic obstructive pulmonary disease (COPD) are uncertain. We aimed to assess the short- and medium-term efficacy of such a program in this clinical setting. Patients with severe COPD (stages III-IV, classification of the Global Initiative for Chronic Obstructive Lung Disease) and incapacitating dyspnea (scores 3-5, Medical Research Council [MRC] scale) were randomized to a control or domiciliary rehabilitation group. The 9-week supervised pulmonary rehabilitation program included educational sessions, respiratory physiotherapy, and muscle training in weekly sessions in the patient's home. We assessed the following variables at baseline, 9 weeks, and 6 months: lung function, exercise tolerance (3-minute walk test), dyspnea (MRC score), and health-related quality of life with the Chronic Respiratory Questionnaire (CRQ). Thirty-eight patients with a mean (SD) age of 68 (6) years were enrolled. The mean MRC score was 4 (0.8) and mean forced expiratory volume in 1 second was 29% of reference. Twenty-nine patients completed the study (6 months). Distance covered on the walk test increased significantly in the rehabilitation group (P=.001) and the difference was maintained at 6 months. Dyspnea also improved significantly with rehabilitation (P<.05), but the reduction was not evident at 6 months. Statistically significant improvements in symptoms related to 2 CRQ domains were detected between baseline and 9 weeks: dyspnea (3.1 [0.8] vs 3.6 [0.7]; P=.02) and fatigue (3.7 [0.8] vs 4.2 [0.9]; P=.002). A clinically relevant but not statistically significant change in mastery over disease was detected (from 4.3 to 4.9). All improvements were maintained at 6 months. Home-based pulmonary rehabilitation for patients with severe to very severe COPD and severe functional incapacity leads to improvements in exercise tolerance and health-related quality of life that are maintained at 6 months.
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            Position Paper of the American Association of Cardiovascular and Pulmonary Rehabilitation Scientific Basis of Pulmonary Rehabilitation

             Andrew Ries (1990)
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              Dyspnea ratings for prescription of cross-modal exercise in patients with COPD.

               M Horowitz,  D Mahler (1997)
              To investigate the ability of patients with COPD to reproduce an exercise intensity accurately on the treadmill using dyspnea ratings obtained during incremental exercise on the cycle ergometer (cross-modal exercise prescription). Five visits over an 8-week period. Thirteen symptomatic patients with stable COPD. Age was 67+/-6 years (mean+/-SD). FEV1 was 1.15+/-0.22 L (45+/-7% predicted). At each visit, patients performed spirometry and exercise. Visit 1 was a practice incremental exercise test on the cycle ergometer. At visit 2 (1 week later), patients estimated the intensity of dyspnea using the 0 to 10 category-ratio scale during an incremental exercise test on the cycle ergometer (cycle estimation trial). Visit 3, 5 weeks later, was a practice session on the treadmill. At visit 4, 1 week later, patients were instructed to produce specific intensities of dyspnea (ie, dyspnea targets) at 50% and at anaerobic threshold (AT) or 80% of peak oxygen consumption (VO2) as calculated from results at visit 2 (treadmill production trial). Visit 5, 1 week later, was the treadmill estimation trial. Lung function was stable at all visits. Dyspnea ratings were 1.9+/-0.9 at 50% of VO2 and 5.6+/-1.5 at AT/80% of peak VO2 (17.5+/-3.3 mL/kg/min). The VO2 at the treadmill production trial (761+/-185 mL/min) was significantly higher than at the cycle estimation trial (612+/-159 mL/min) at the low dyspnea target (p 0.5; 0+/-11% bias). Patients with COPD can use dyspnea ratings from an incremental cycle ergometry test to regulate exercise on the treadmill without systematic bias at an intensity of 80% of peak VO2, but exceed the desired VO2 when using the dyspnea rating at an intensity of 50% of peak VO2.
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                Author and article information

                Journal
                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
                1176-9106
                1178-2005
                2013
                2013
                05 November 2013
                : 8
                : 537-544
                Affiliations
                [1 ]Post Graduate Program in Rehabilitation Sciences, Nove de Julho University – UNINOVE, São Paulo, Brazil
                [2 ]Pneumology Clinic at Santa Casa de Misericórdia de São Paulo (AME), São Paulo, Brazil
                Author notes
                Correspondence: Dirceu Costa, Post Graduate Program in Rehabilitation Sciences, Nove de Julho University, UNINOVE, LARESP, 109 Barra Funda, São Paulo - SP 01156-050, Brazil, Tel +55 113 665 9871, Email dcosta@ 123456uninove.br
                Article
                copd-8-537
                10.2147/COPD.S50213
                3821544
                24235824
                © 2013 Dias et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Original Research

                Respiratory medicine

                copd, home-based pulmonary rehabilitation, shuttle walk test

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