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The relationship between exercise capacity and different functional markers in pulmonary rehabilitation for COPD.
Int J Chron Obstruct Pulmon Dis. 2018; 13:717-724.IJ

Abstract

Rationale

The relationship of functional parameters such as lung mechanics, chest kinematics, metabolism and peripheral and respiratory muscle function with the level of exercise tolerance remains a controversial subject. While it has been previously shown that pulmonary rehabilitation is capable of improving exercise tolerance in patients afflicted by COPD, as expressed by values of 6-minute walking test (6MWT), the degree of contribution to this change by each of the aforementioned parameters remains unclear.

Aims

To investigate the correlation between changes in exercise capacity and other functional markers following pulmonary rehabilitation in COPD and to determine which parameters are more closely related to improvements of exercise tolerance.

Materials and methods

Three hundred and twenty-seven patients with COPD (with average, 95% CI for forced expiratory volume in the first second [FEV1]: 45% [25%-83%] predicted, age: 64 [48-80] years, and BMI: 27 [13.5-40.4] kg/m2) participated in this study. Thirty percent of the patients had pulmonary hypertension as comorbidity. Patients underwent a pulmonary rehabilitation program with 20-30 minutes sessions two to three times per day for 4 weeks. The program was composed of chest wall-stretching, controlled breathing exercises, and a personalized training schedule for cycling and treadmill use. Measurements of 6MWT, lung function, chest wall expansion, grip strength, maximal inspiratory pressure, and breath holding time were taken. The Body mass index, airflow Obstruction, Dyspnea and Exercise capacity (BODE-index), body mass index [BMI], FEV1, 6MWT, modified Medical Research Dyspnea Scale score, and an alternative scale score (for BMI, FEV1, 6MWT, and COPD Assessment Test) were calculated.

Results

Rehabilitation resulted in a generalized improvement in 6MWT among patients (average: 360 [95% CI: 178-543 m] vs average: 420 [95% CI: 238-601 m], p<0.05). Improvements in exercise tolerance were found to be most closely associated with changes in composite BODE-index (R2=-0.6), Alternative Scale (R2=-0.56), dyspnea score (modified Medical Research Dyspnea Scale R2=-0.54), and health status (COPD Assessment Test R2=-0.4, p<0.05). In addition, improvements in exercise tolerance were found to moderately correlate with improvements in inspiratory vital capacity (IVC, R2=0.34, p<0.05). Post-rehabilitation changes in IVC displayed a connection with grip strength (R2=0.6) and chest expansion (R2=0.48).

Conclusion

Enhancements in exercise tolerance had correlation with changes in IVC, BODE-index, and the new Alternative Scale. However, comprehensive assessment needs to include considerations of chest kinematics and peripheral and respiratory muscle function as well.

Authors+Show Affiliations

Department of Pulmonary Rehabilitation, National Koranyi Institute for Pulmonology, Budapest, Hungary.Department of Pulmonary Rehabilitation, National Koranyi Institute for Pulmonology, Budapest, Hungary.Department of Pulmonary Rehabilitation, National Koranyi Institute for Pulmonology, Budapest, Hungary.Department of Pulmonary Rehabilitation, National Koranyi Institute for Pulmonology, Budapest, Hungary.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29535512

Citation

Kerti, Maria, et al. "The Relationship Between Exercise Capacity and Different Functional Markers in Pulmonary Rehabilitation for COPD." International Journal of Chronic Obstructive Pulmonary Disease, vol. 13, 2018, pp. 717-724.
Kerti M, Balogh Z, Kelemen K, et al. The relationship between exercise capacity and different functional markers in pulmonary rehabilitation for COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:717-724.
Kerti, M., Balogh, Z., Kelemen, K., & Varga, J. T. (2018). The relationship between exercise capacity and different functional markers in pulmonary rehabilitation for COPD. International Journal of Chronic Obstructive Pulmonary Disease, 13, 717-724. https://doi.org/10.2147/COPD.S153525
Kerti M, et al. The Relationship Between Exercise Capacity and Different Functional Markers in Pulmonary Rehabilitation for COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:717-724. PubMed PMID: 29535512.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The relationship between exercise capacity and different functional markers in pulmonary rehabilitation for COPD. AU - Kerti,Maria, AU - Balogh,Zsuzsanna, AU - Kelemen,Krisztina, AU - Varga,Janos T, Y1 - 2018/02/28/ PY - 2018/3/15/entrez PY - 2018/3/15/pubmed PY - 2018/9/18/medline KW - breath holding time KW - exercise tolerance KW - health status KW - lung mechanics KW - respiratory and peripheral muscle function SP - 717 EP - 724 JF - International journal of chronic obstructive pulmonary disease JO - Int J Chron Obstruct Pulmon Dis VL - 13 N2 - Rationale: The relationship of functional parameters such as lung mechanics, chest kinematics, metabolism and peripheral and respiratory muscle function with the level of exercise tolerance remains a controversial subject. While it has been previously shown that pulmonary rehabilitation is capable of improving exercise tolerance in patients afflicted by COPD, as expressed by values of 6-minute walking test (6MWT), the degree of contribution to this change by each of the aforementioned parameters remains unclear. Aims: To investigate the correlation between changes in exercise capacity and other functional markers following pulmonary rehabilitation in COPD and to determine which parameters are more closely related to improvements of exercise tolerance. Materials and methods: Three hundred and twenty-seven patients with COPD (with average, 95% CI for forced expiratory volume in the first second [FEV1]: 45% [25%-83%] predicted, age: 64 [48-80] years, and BMI: 27 [13.5-40.4] kg/m2) participated in this study. Thirty percent of the patients had pulmonary hypertension as comorbidity. Patients underwent a pulmonary rehabilitation program with 20-30 minutes sessions two to three times per day for 4 weeks. The program was composed of chest wall-stretching, controlled breathing exercises, and a personalized training schedule for cycling and treadmill use. Measurements of 6MWT, lung function, chest wall expansion, grip strength, maximal inspiratory pressure, and breath holding time were taken. The Body mass index, airflow Obstruction, Dyspnea and Exercise capacity (BODE-index), body mass index [BMI], FEV1, 6MWT, modified Medical Research Dyspnea Scale score, and an alternative scale score (for BMI, FEV1, 6MWT, and COPD Assessment Test) were calculated. Results: Rehabilitation resulted in a generalized improvement in 6MWT among patients (average: 360 [95% CI: 178-543 m] vs average: 420 [95% CI: 238-601 m], p<0.05). Improvements in exercise tolerance were found to be most closely associated with changes in composite BODE-index (R2=-0.6), Alternative Scale (R2=-0.56), dyspnea score (modified Medical Research Dyspnea Scale R2=-0.54), and health status (COPD Assessment Test R2=-0.4, p<0.05). In addition, improvements in exercise tolerance were found to moderately correlate with improvements in inspiratory vital capacity (IVC, R2=0.34, p<0.05). Post-rehabilitation changes in IVC displayed a connection with grip strength (R2=0.6) and chest expansion (R2=0.48). Conclusion: Enhancements in exercise tolerance had correlation with changes in IVC, BODE-index, and the new Alternative Scale. However, comprehensive assessment needs to include considerations of chest kinematics and peripheral and respiratory muscle function as well. SN - 1178-2005 UR - https://www.unboundmedicine.com/medline/citation/29535512/The_relationship_between_exercise_capacity_and_different_functional_markers_in_pulmonary_rehabilitation_for_COPD_ DB - PRIME DP - Unbound Medicine ER -