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Jean-Marie Grosbois,1 Axelle Détrée,2 Adeline Pierache,3,4 Nathalie Bautin,5,6 Thierry Pérez,5,6 Benoit Wallaert,5,6 Cécile Chenivesse,5,6 Olivier Le Rouzic5,6 1FormAction Santé, Pérenchies, F-59840, France; 2Groupe Hospitalier Loos Haubourdin, Réhabilitation Respiratoire, Loos, F-59120, France; 3Université de Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, F-59000, France; 4CHU Lille, Department of Biostatistics, Lille, F-59000, France; 5Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, F-59000, France; 6CHU Lille, Pneumologie et Immuno-Allergologie, Centre de référence constitutif pour les maladies pulmonaires rares, Lille, F-59000, FranceCorrespondence: Olivier Le Rouzic, Pneumologie et Immuno-Allergologie, Institut Cœur Poumon, 1 boulevard Jules Leclercq, CHU de Lille, Lille, 59037, France, Tel +33 3 20 44 59 48, Fax +33 3 20 44 57 68, Email olivier.lerouzic@univ-lille.frBackground: Cardiovascular and metabolic comorbidities in chronic obstructive pulmonary disease (COPD) are associated with higher symptoms burden. Few center-based studies have evaluated the impact of these comorbidities on short-term pulmonary rehabilitation outcomes with contrasting results.Research Question: This study aimed to determine whether cardiovascular diseases and metabolic comorbidities impacted long-term outcomes of a home-based PR program in COPD patients.Study Design and methods: Data of 419 consecutive COPD patients addressed to our pulmonary rehabilitation program between January 2010 and June 2016 were retrospectively analyzed. Our program consisted of once-weekly supervised home sessions, including therapeutic education and self-management support, with unsupervised retraining exercises and physical activities the other days for 8 weeks. Exercise capacity (6-min stepper test [6MST]), quality of life (visual simplified respiratory questionnaire), and anxiety and depression (hospital anxiety and depression scale) were assessed respectively, before (M0) and at the end (M2) of the pulmonary rehabilitation program, and at 6 (M8) and 12 months (M14) after its achievement.Results: Patients (mean age 64.1± 11.2 years, 67% males, mean forced expiratory volume in one second (FEV1) 39.2± 17.0% predicted) were classified as having cardiovascular comorbidities (n=195), only metabolic disorders (n=122) or none of these comorbidities (n=102). After adjustment, all outcomes appeared similar between groups at baseline and improved after pulmonary rehabilitation with a greater effect at M14 for patients with only metabolic disorders on anxiety and depression score (− 5.0± 0.7 vs − 2.9± 0.8 and − 2.6± 0.6, p=0.021). Quality of life and exercise capacity improvements were not significantly different between the three groups at M2 and M14.Conclusion: Cardiovascular and metabolic comorbidities do not preclude COPD patients from obtaining clinically meaningful improvements in exercise capacity, quality of life and anxiety-depression up to 1 year after a home-based pulmonary rehabilitation.Keywords: anxiety, exercise tolerance, quality of life, comorbidities, home based pulmonary rehabilitation, COPD

Sarah Gephine,1,2 Olivier Le Rouzic,3,4 François Machuron,5 Benoit Wallaert,3 Cécile Chenivesse,3,4 Didier Saey,2 François Maltais,2 Patrick Mucci,1 Jean-Marie Grosbois6 1Univ. Lille, Univ. Artois, Univ. Littoral Côte d’Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille F-59000, France; 2Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada; 3CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Lille F-59000, France; 4Univ. Lille, Lille F-59000, France; 5Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, Lille F-59000, France; 6FormAction Santé, Pérenchies, FranceCorrespondence: Jean-Marie GrosboisFormAction Santé, Pérenchies, Zone d’Activité du Bois, Rue de Pietralunga, Pérenchies, F-59840, FranceEmail jmgrosbois@formactionsante.comBackground: Long-term effectiveness of pulmonary rehabilitation (PR) is still uncertain in older people with severe chronic obstructive pulmonary disease (COPD). The objective was to compare the effects of home-based PR in people with COPD above and below the age of 70 years.Methods: In this retrospective study, 480 people with COPD were recruited and divided into those ≤ 70 (n=341) and those > 70 years of age (n=139). All participants underwent an 8 weeks of home-based PR, consisting of a weekly supervised 90-minute home session. Six-minute stepper test (6MST), timed-up and go test (TUG), Hospital Anxiety and Depression Scale, and Visual Simplified Respiratory Questionnaire (VSRQ) were assessed at baseline (M0), at 2 (M2), 8 (M8), 14 (M14) months after baseline.Results: The older group was described by fewer current smokers (p < 0.001), more long-term oxygen therapy use (p = 0.024), higher prevalence of comorbidities (p< 0.001), lower 6MST score and higher TUG score (p< 0.001), compared to the younger group. Both groups improved every outcome at M2 compared to baseline. At M2, 88% of people ≤ 70 years of age and 79% of those above 70 were considered as responders in at least one evaluated parameter (p = 0.013). Both groups maintained the benefits at M14, except for the VSRQ score and the number of responders to this outcome in the older group.Conclusion: Regardless of the age, personalized home-based PR was effective for people with COPD in the short term. Above 70 years, an ageing effect appeared on the long-term effectiveness of quality of life benefit.Keywords: chronic obstructive pulmonary disease, exercise tolerance, pulmonary rehabilitation, quality of life, older age

Jean-Marie Grosbois,1,2 Justine Heluain-Robiquet,3 François Machuron,4 Gaelle Terce,2 Cécile Chenivesse,3,5,6 Benoit Wallaert,3,5,6 Olivier Le Rouzic3,5 1FormAction Santé, Pérenchies F-59840, France; 2CH Béthune, Service de Pneumologie et Réhabilitation Respiratoire, Béthune F-62400, France; 3CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Department of Heart and Lung Diseases, Lille F-59000, France; 4CHU Lille, Department of Biostatistics, University Lille, EA 2694 - Santé Publique: Epidémiologie Et Qualité Des Soins, Lille F-59000, France; 5University Lille, Lille F-59000, France; 6Inserm, CNRS, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille F-59000, FranceCorrespondence: Jean-Marie Grosbois Email jmgrosbois@formactionsante.comBackground: Pulmonary rehabilitation (PR) improves exercise tolerance and quality of life in patients with chronic obstructive pulmonary disease (COPD), regardless of disease severity. Socioeconomic deprivation has been linked to the incidence of COPD; however, little is known about its impact on PR outcomes.Methods: In this retrospective observational study, 459 COPD patients were enrolled and dichotomized into socially deprived (n=276) and non-socially deprived (n=183) groups based on a cut-off of 30.17 in the EPICES questionnaire (Evaluation of Deprivation and Inequalities in Health Centers), which evaluates socioeconomic disadvantage. The PR program consisted of once-weekly home sessions for 8 weeks, and consisted of an individualized plan of retraining exercises, physical activities, therapeutic education, and psychosocial and motivational support. Exercise tolerance, anxiety and depression, and quality of life were assessed using the 6 min stepper test (6MST), Hospital Anxiety and Depression Scale (HADS), and Visual Simplified Respiratory Questionnaire (VSRQ). Assessments were made before the PR program (baseline) and then at 2 (T2), 8 (T8), and 14 (T14) months after baseline.Results: Compared with the non-socially deprived group, socially deprived patients were younger, more frequently women, active smokers, and living alone, and belonged to lower socioprofessional categories. At baseline, 6MST, VSRQ, and HADS measures were lower for the socially deprived than the non-socially deprived group. At T2, T8, and T14, there were no significant between-group differences in any outcome, and the percentage of patients showing clinically important improvements was the same in both groups.Conclusion: Home-based PR is effective for COPD patients in the short and long term, regardless of socioeconomic status.Keywords: home-based pulmonary rehabilitation, exercise tolerance, quality of life, anxiety, depression, socioeconomic deprivation

JM Grosbois,1,2 C Riquier,3 B Chehere,4 J Coquart,5 H Béhal,6 F Bart,2 B Wallaert,2,3 C Chenivesse3 1FormAction Santé, Pérenchies, France; 2Department of Respiratory Medicine, Centre Hospitalier Germon et Gauthier, Béthune, France; 3Department of Respiratory Medicine Immunology and Allergy, Centre Hospitalier Universitaire de Lille, Competence Center for rare lung diseases, University Lille 2, Lille, France; 4EA 7369, URePSSS, Multidisciplinary Research Unit in Sport Health Society, University Lille 2, Lille, France; 5Faculty of Sport Sciences, Sports and Physical Activity, Center for Ecology and Transformation, University of Rouen, Mont Saint Aignan, France; 6Department of Statistical Methods and Biostatistics, Centre Hospitalier Universitaire de Lille, University of Lille Nord, Lille, France Introduction: Exercise tolerance testing is an integral part of the pulmonary rehabilitation (PR) management of patients with chronic obstructive pulmonary disease (COPD). The 6-minute stepper test (6MST) is a new, well-tolerated, reproducible exercise test, which can be performed without any spatial constraints.Objective: The aim of this study was to compare the results of the 6MST to those obtained during a 6-minute walk test (6MWT) and cardiopulmonary exercise testing (CPET) in a cohort of COPD patients.Methods: Ninety-one COPD patients managed by outpatient PR and assessed by 6MST, 6MWT, and CPET were retrospectively included in this study. Correlations between the number of steps on the 6MST, the distance covered on the 6MWT, oxygen consumption, and power at the ventilatory threshold and at maximum effort during CPET were analyzed before starting PR, and the improvement on the 6MST and 6MWT was compared after PR.Results: The number of steps on the 6MST was significantly correlated with the distance covered on the 6MWT (r=0.56; P

Jean Marie Grosbois,1,2 Alice Gicquello,3 Carole Langlois,4 Olivier Le Rouzic,3 Frédéric Bart,2 Benoit Wallaert,2,3 Cécile Chenivesse5 1FormAction Santé, rue Pietralunga, Pérenchies, 2Service de Pneumologie, CH Béthune, 3Service de Pneumologie et Immunoallergologie, Centre des Compétences des Maladies Pulmonaires Rares, Hôpital Calmette, CHRU Lille, 4Unité de Biostatistiques, CHRU Lille, 5AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale, Boulevard de l’Hôpital, Paris, France Introduction: Personalized, global pulmonary rehabilitation (PR) management of patients with COPD is effective, regardless of the place in which this rehabilitation is provided. The objective of this retrospective observational study was to study the long-term outcome of exercise capacity and quality of life during management of patients with COPD treated by home-based PR.Methods: Home-based PR was administered to 211 patients with COPD (mean age, 62.3±11.1 years; mean forced expiratory volume in 1 second, 41.5%±17.7%). Home-based PR was chosen because of the distance of the patient’s home from the PR center and the patient’s preference. Each patient was individually managed by a team member once a week for 8 weeks with unsupervised continuation of physical exercises on the other days of the week according to an individual action plan. Exercise conditioning, therapeutic patient education, and self-management were included in the PR program. The home assessment comprised evaluation of the patient’s exercise capacity by a 6-minute stepper test, Timed Up and Go test, ten times sit-to-stand test, Hospital Anxiety and Depression score, and quality of life (Visual Simplified Respiratory Questionnaire, VQ11, Maugeri Respiratory Failure 28).Results: No incidents or accidents were observed during the course of home-based PR. The 6-minute stepper test was significantly improved after completion of the program, at 6 months and 12 months, whereas the Timed Up and Go and ten times sit-to-stand test were improved after PR and at 6 months but not at 12 months. Hospital Anxiety and Depression and quality of life scores improved after PR, and this improvement persisted at 6 months and 12 months.Conclusion: Home-based PR for unselected patients with COPD is effective in the short term, and this effectiveness is maintained in the medium term (6 months) and long term (12 months). Home-based PR is an alternative to outpatient management provided all activities, such as exercise conditioning, therapeutic education, and self-management are performed. Keywords: pulmonary rehabilitation, home, COPD, quality of life, anxiety, depression, self-management