Search

Background: Current guidelines on pulmonary rehabilitation (PR) recommend upper extremity exercise training (UEET) in patients with COPD. However, the literature still questions the effectiveness of systematic UEET in this population. We studied the effects of 15 sessions of unsupported UEET on functional exercise capacity, the ability to perform activities of daily living (ADL), and symptoms perceived during activities involving arms in patients with COPD.Methods: We conducted a randomized trial that consisted of 3 weeks of inpatient PR, comparing the short-term effects of unsupported UEET plus PR (intervention group) to those of PR alone (control group). A change in the 6-min ring test (6MRT) was the primary outcome; the ADL field test (four shuttle stations), the dyspnea score as assessed by the Medical Research Council scale, the London Chest Activity of Daily Living scale (LCADL), and the distance walked in 6 min served as secondary outcomes of the study. At the 6-month follow-up, we repeated the 6MRT and the LCADL.Results: Fifty patients with COPD were randomly assigned to the two groups and completed the study. At the end of the study period, patients in the intervention group improved in the 6MRT and ADL field test compared with those patients in the control group (p = 0.018 and p = 0.010, respectively) with reduced perception of fatigue (p Conclusions: Our trial corroborates the effectiveness of unsupported UEET in specifically improving functional exercise capacity of patients with COPD. Moreover, it also provides evidence that this training modality may ameliorate and maintain the patients' autonomy over and above standard PR.Trial Registration: ClinicalTrials.gov Identifier: NCT00825032. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD( is often associated with other chronic diseases. These patients are often admitted to hospital based rehabilitation programmes. Objectives: To determine the prevalence of chronic comorbidities in patients with COPD undergoing pulmonary rehabilitation and to assess their influence on outcome. Design: Observational retrospective cohort study. Setting: A single rehabilitation centre. Patients: 2962 inpatients and outpatients with COPD (73% male, aged 71 (SD 8) years, forced expiratory volume in 1 s (FEV1( 49.3 (SD 14.8)% of predicted), graded 0, 1 or ⩾2 according to the comorbidity categories and included in a pulmonary rehabilitation programme. Measurements: The authors analysed the number of self-reported comorbidities and recorded the Charlson Index. They then calculated the percentage of patients with a predefined positive response to pulmonary rehabilitation (minimum clinically important difference (MCID((, as measured by improvement in exercise tolerance (6 mm walking distance test (6MWD)), dyspnoea (Medical Research Council scale( and/or health related quality of life (St George's Respiratory Questionnaire (SGRQ((. Results: 51% of the patients reported at least one chronic comorbidity added to COPD. Metabolic (systemic hypertension, diabetes and/or dyslipidaemia) and heart diseases (chronic heart failure and/or coronary heart disease( were the most frequently reported comorbid combinations (61% and 24%, respectively( among the overall diseases associated with COPD. The prevalence of patients with MCID was different across the comorbidity categories and outcomes. In a multiple categorical logistic regression model, the Charlson Index (OR 0.72 (96% CI 0.54 to 0.98) and 0.51 (96% Cl 0.38 to 0.68( vs 6MWD and SGRQ, respectively(, metabolic diseases (OR 0.57 (96% CI 0.49 to 0.67) vs 6MWD) and heart diseases (OR 0.67 (96% Cl 0.55 to 0.83( vs SGRQ) reduced the probability to improve outcomes of rehabilitation. Conclusions: Most patients with COPD undergoing pulmonary rehabilitation have one or more comorbidities. Despite the fact that the presence of comorbidities does not preclude access to rehabilitation, the improvement in exercise tolerance and quality of life after rehabilitation may be reduced depending on the comorbidity. [ABSTRACT FROM AUTHOR]