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Summary: Background: Although the benefits of comprehensive pulmonary rehabilitation have been demonstrated in patients with COPD, the effects of exercise sessions within self-management programs remain unclear. We hypothesized that 8 supervised exercise sessions incorporated in a 1-month self-management education program in COPD patients would be effective to improve health outcomes and to reduce direct medical costs after one year, compared to usual care. Methods: In this randomized controlled trial, 38 moderate-to-severe COPD patients were assigned either to an intervention group or to a usual care group. The hospital-based intervention program provided a combination of 8 sessions of supervised exercise with 8 self-management education sessions over a 1-month period. The primary end-point was the 6-min walking distance (6MWD), with secondary outcomes being health-related quality of life (HRQoL) – using the St. George’s Respiratory Questionnaire (SGRQ) and Nottingham Health Profile (NHP), maximal exercise capacity and healthcare utilization. Data were collected before and one year after the program. Results: After 12 months, we found statistically significant between-group differences in favor of the intervention group in 6MWD (+50.5 m (95%CI, 2 to 99), in two domains of NHP (energy, −19.8 (−38 to −1); emotional reaction, –10.4 (−20 to 0)); in SGRQ-symptoms (−14.0 (−23 to −5)), and in cost of COPD medication (−480.7 € (CI, −891 to −70) per patient per year). Conclusion: The present hospital-based intervention combining supervised exercise with self-management education provides significant improvements in patient’s exercise tolerance and HRQoL, and significant decrease of COPD medication costs, compared to usual care. [ABSTRACT FROM AUTHOR]

Summary: Although the benefits of pulmonary rehabilitation (PR) have been demonstrated in patients with COPD, most studies suggest that short-term programs are insufficient to maintain the benefits beyond a post-discharge period of 6 months to 1 year. We were interested to evaluate the effects of an innovative maintenance intervention compared with a usual after-care. Forty moderate to severe COPD patients, who had just completed their first inpatient PR, were consecutively included in either a maintenance group (MG) or a standard after-care group. The maintenance program was coordinated within a health-care network including self-help associations, and offered weekly activities. We measured the 6-min walk distance (6MWD), the quality of life using the St George Respiratory Questionnaire (SGRQ), the dyspnea, the maximal workload and the health-care utilization. Data were collected at respiratory clinic admission and discharge, and at 6- and 12-month visits after the PR. After 12 months, we found statistically and clinically significant differences in favor of the MG in 6MWD (74m; p⩽0.01) and in the three domains of SGRQ: symptom (19%; p⩽0.01), activity (27%; p⩽0.01) and impact (32%; p⩽0.01). The results showed no difference between groups in dyspnea and maximal workload. We also found that the number of days spent in hospital for respiratory disorders was significantly lower in the MG after 12 months (p⩽0.03). The multidisciplinary management of COPD patients in the post-rehabilitation period within a health-care network including self-help associations seems to be an effective strategy for maintaining, and even improving, the benefits of a first initial structured program. [Copyright &y& Elsevier]

Summary: Impaired skeletal muscle function has been reported in patients with chronic obstructive disease (COPD), but such impairment is not homogenous and its distribution between the upper and the lower limbs is still unclear. The present study was designed to assess and compare upper and lower limb capacities in patients with moderate to severe COPD during incremental and constant-load exercises. Thirteen COPD patients of similar age with moderate to severe air flow limitation (FEV1: 35%±5% predicted) and 19 healthy subjects were studied. Four sessions were organized: two incremental and two constant-load cycling exercises with arm or leg in randomized order. As observed in a previous study involving incremental and constant tests, power, V˙O2, RER, V˙E, and HR were all significantly lower in the upper and lower limbs of patients with COPD than in healthy controls. In the healthy population, aerobic capacity and mechanical efficiency (ME) were lower in the course of arm exercises than in leg exercises. For the same relative workload, dyspnea and blood lactate production were higher during arm exercise. In contrast, no significant difference was observed between arm and leg capacities for any of these parameters in COPD patients. Conclusion: Although aerobic capacity is impaired in COPD patients, arm aerobic capacity is relatively preserved. Given the lack of significant difference between arm and leg capacities in COPD, we hypothesize that upper limb muscles are less compromised than lower limb muscles in this patient population. [Copyright &y& Elsevier]

Abstract: Aims: This trial was undertaken in order to evaluate the effects of endurance training on health cost in type 2 diabetes. Methods: Thirty-five diabetic patients were randomly assigned to two groups: after 10 dropouts, 13 followed a training program (eight sessions followed by training at home at the level of the ventilatory threshold V T) while 12 had only routine treatment. Both groups were followed over one year with evaluation at 30, 120, 240 and 365 days for health costs, blood pressure, and a standard maximal exercise test, glycemic and lipid equilibrium, six-min, walking test, and exercise (Voorips) and quality of life questionnaires. The effectiveness of training was confirmed in the trained group by an increase in the Voorips score (5.25±3.3 P <0.001) and a lack of decrease in and P max while in the untrained group decreased slightly (−2.16±2.5 P =0.014). Results: Thus, trained subjects at the end of the study reached a higher percentage of the theoretical maximal power (P =0.041). The six-min, walking distance (472.2±98.9 versus 547.6±56.7 P =0.020) was also higher than in the control group. Blood pressure, lipid profile and glycemic control did not significantly improve during this period in either groups, due to decreasing doses in treatments prescribed by their physicians. In the trained group, there was no hospitalization, in contrast (P =0.047) with controls in whom there was 1.27±2.20 (that is, zero to five days) of hospitalization. The total health cost over this period is lowered by 50% in the trained group (P =0.018). Conclusion: Endurance training at the level of the V T significantly prevents the progressive decline in aerobic working capacity evidenced in untrained diabetics over this period of observation and markedly reduces health care costs, due to a decrease in treatment and fewer hospitalizations. [Copyright &y& Elsevier]