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Purpose: The aim of this systematic review was to investigate the effectiveness of physiotherapy interventions on chest mobility in obstructive lung diseases., Methods: Searches were performed in PEDro, Pubmed and Cochrane Central Register of Controlled Trials databases without language restrictions between 2010 and 25th December 2020. Randomized controlled trials (RCTs) investigating physiotherapy interventions on chest wall mobility were included. Two independent reviewers screened studies, extracted data, and assessed methodological quality of included studies. The assessment of risk of bias was conducted using the PEDro scale for RCTs. The articles were excluded if they have less than 5 out of 10 score., Results: Five studies included had good to excellent quality. A total of 139 patients were included in all RCTs. Intervention duration ranged from a single session to 12 weeks and the intervention schedules varied, consisting of 1-24 sessions, lasting 5-45 min per sessions. Three studies used respiratory muscle stretching and releasing techniques, one study combined respiratory muscle stretching with aerobic training, and one study planned diaphragmatic breathing. Four studies assessed chest wall mobility with optoelectronic plethysmography, whereas one study used measuring tape., Conclusions: The result of this first systematic review that investigates the effects of physiotherapy interventions on chest wall mobility in obstructive lung diseases suggests that more and better quality RCTs with objective measurement tools are required., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Pulmonary rehabilitation has become a standard of care for patients with chronic lung disease. It has been clearly demonstrated that pulmonary rehabilitation improves exercise capacity and quality of life in patients with chronic lung disease and reduces the number of hospital days and other measures of health-care utilization in patients with chronic obstructive pulmonary disease (COPD). This is an update of the guidelines in outpatient pulmonary rehabilitation in Austria, closely related to the official American Thoracic Society and European Respiratory Society Statement published in 2013.The guidelines represent standards of quality for requirements of structural and personal qualifications.

Objective: To evaluate self-esteem and self-image of respiratory diseases patients in a Pulmonary Rehabilitation Program, who participated in socialization and physical fitness activities, and of patients who participated only in physical fitness sessions., Methods: A descriptive cross-sectional exploratory study. Out of a total of 60 patients analyzed, all enrolled in the Pulmonary Rehabilitation Program, 42 participated in at least one of the proposed activities, 10 did not participate in any activity and 8 were excluded (7 were discharged and 1 died)., Results: When the two groups were compared, despite the fact that both demonstrated low self-esteem and self-image, the difference between them was relevant (p<0.05) regarding self-esteem, indicating that those who participated in the proposed socialization activities had better self-esteem than the individuals who only did the physical fitness sessions. Regarding self-image, the difference between the groups was not relevant (p>0.05)., Conclusion: The Pulmonary Rehabilitation Program patients evaluated presented low self-esteem and self-image; however, those carrying out some socialization activity proposed had better self-esteem as compared to the individuals who did only the physical fitness sessions.

Background and Objective: Pulmonary rehabilitation (PR) is a cornerstone of care in chronic respiratory diseases; yet its benefits diminish over time. Repeating PR may be beneficial; however, little is known about the characteristics and outcomes of repeaters. This study aimed to establish the proportion of repeaters, identify characteristics that predict repetition and compare the magnitude of benefits achieved between initial and subsequent programmes., Methods: Patients with stable chronic respiratory diseases who attended PR over a 9-year period were included. Outcome measures included the 6-min walk distance (6MWD) and the Chronic Respiratory Disease Questionnaire-Self-Reported (CRDQ-SR). Independent predictors of repeating were identified., Results: Of 296 patients, 59 (20%) repeated PR, most within 1-3 years. Following the initial programme, repeaters had significant decline in 6MWD (-96.1 ± 84.6 m; P < 0.001) and CRDQ-SR scores (mean decline -3.6 points, range -0.1 to -7.9 points; P < 0.005). The improvement in 6MWD was less in the repeat programme compared with the first (38.4 ± 50.7 m vs 67 ± 40.4 m; P = 0.005), while the change in CRDQ-SR was similar in all domains. A chronic obstructive pulmonary disease diagnosis increased the odds of repeating PR (odds ratio (OR) 4.8; P = 0.005) while improved mastery in the initial programme reduced the odds (OR 0.9; P = 0.033)., Conclusions: One in five patients repeated PR, achieving clinically significant improvements in exercise tolerance and quality of life. Patients with small improvements in disease mastery after initial PR were more likely to repeat the programme and may benefit from earlier intervention or longer duration PR., (© 2014 Asian Pacific Society of Respirology.)

Purpose: This study aimed to validate the Activities and Participation component of the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Obstructive Pulmonary Diseases (OPD) from the patient's perspective., Methods: A cross-sectional qualitative study was conducted with a convenience sample of outpatients with Chronic Obstructive Pulmonary Disease (COPD). Individual interviews were performed and analysed according to the meaning condensation procedure., Results: Fifty-one participants (70.6% male) with a mean age of 69.5 ± 10.8 years old were included. Twenty-one of the 24 categories contained in the Activities and Participation component of the Comprehensive ICF Core Set for OPD were identified by the participants. Additionally, seven second-level categories that are not covered by the Core Set were reported: complex interpersonal interactions, informal social relationships, family relationships, conversation, maintaining a body position, eating and preparing meals., Conclusions: The activities and participation component of the ICF Core Set for OPD was largely supported by the patient's perspective. The categories included in the ICF Core Set that were not confirmed by the participants and the additional categories that were raised need to be further investigated in order to develop an instrument according to the patient's perspective. This will promote a more patient-centred assessments and rehabilitation interventions. Implications for Rehabilitation The Activities and Participation component of the Comprehensive ICF Core Set for OPD is largely supported by the perspective of patients with COPD and therefore could be used in the assessment of patients' individual and social life. The information collected through the Activities and Participation component of the Comprehensive ICF Core Set for OPD could be used to plan and assess rehabilitation interventions for patients with COPD.

Aim: The aim of this literature review was to describe and discuss the available evidence about different modalities of physical therapy treatment and pulmonary rehabilitation (PR) involving exercise training in patients with chronic obstructive pulmonary disease (COPD), asthma, bronchiectasis and interstitial lung disease (ILD)., Methods: The search was performed by using the Cochrane Library and PubMed databases. We selected studies published between 2001 and 2012 which involved physiotherapy treatment and included patients with COPD, asthma, bronchiectasis or ILD, aged 18 years or more, in stable or unstable disease condition., Results and Conclusion: PR involving exercise training was effective in improving exercise capacity, muscle force, quality of life and reducing symptoms in patients with COPD and asthma. Although there are few studies published about exercise training in patients with bronchiectasis, improvement in exercise capacity and quality of life in those patients was also observed. Patients with ILD also respond to exercise training; however, the response is less pronounced than in COPD and they lose the gains more quickly. Non-exercise-based interventions, such as bronchial hygiene techniques and inspiratory muscle training, also present positive results when applied to patients with COPD, asthma and bronchiectasis. In some cases it is recommended that these interventions are combined with exercise training. Studies about non-exercise based interventions applied to patients with ILD are still necessary.

Introduction: The comprehensive care and personalized pulmonary rehabilitation (PR) of patients with chronic respiratory disease is effective regardless of the place of performance. The objective of this prospective observational study was to compare two types of care in an outpatient rehabilitation center, versus a home-based PR., Methods: Two hundred and eighty-six patients were supported : 137 patients were included in outpatients (age : 61.2±10.8years, BMI: 28.7±7.1), 149 in home-based PR (age: 62.9±12years, BMI: 26.1±6.6). The choice between outpatient and home was a function of distance from the center and the patient's wishes. The outpatient care was done in groups of six, four times a week for 6weeks. At home she was single, once a week for 8weeks with continued physical activity independently of the other days a week depending on individual action plan. The therapeutic education programs and psycho-social support were identical in both structures. The assessment included assessment of exercise tolerance test in 6minutes stepper (TS6), anxiety and depression and quality of life., Results: There were no incidents or accidents during the PR in the two structures. The exercise intolerance was significantly higher in patients TS6 home (332.9±154.8 versus 460.2±137.9 counts, P<0.01). All the parameters studied, except for HAD score in the center, were improved significantly (P<0.001) after the course. The evolution of the different scores was not significantly different between the ambulatory versus home., Conclusion: The PR of chronic respiratory unselected patients is as safe and effective at home or in outpatient center on exercise tolerance and quality of life. Home-based PR is an alternative to outpatient care as long as all activities, physical training, therapeutic education and psychosocial support, are achieved., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Background: Chronic obstructive pulmonary disease (COPD) is characterised by progressive airflow obstruction, worsening exercise performance and health deterioration. It is associated with significant morbidity, mortality and health system burden., Objectives: To evaluate the effectiveness of outreach respiratory health care worker programmes for COPD patients in terms of improving lung function, exercise tolerance and health related quality of life (HRQL) of patient and carer, and reducing mortality and medical service utilisation., Search Methods: The Cochrane Airways Group Specialised Register of Trials was searched (November 2011). Study references were hand-searched for additional studies we contacted study authors to identify other unpublished studies., Selection Criteria: We included only randomised controlled trials of COPD patients. We included interventions involving an outreach nurse visiting patients in their homes, providing support, education, monitoring health and liaising with physicians. Studies in which the therapeutic intervention under test was physical training were not included., Data Collection and Analysis: Two reviewers independently assessed trial quality and extracted data. We contacted study authors for additional information., Main Results: We pooled mortality data from eight studies and found a non-significant reduction in mortality at 12 months (OR 0.72, 95% CI 0.45 to, 1.15).We pooled four studies that assessed disease-specific heath-related quality of life (HRQL) and found a statistically significant improvement in HRQL (mean difference -2.61, 95% CI -4.82 to -0.40).Hospitalisations were reported in five studies. Although there was no statistically significant difference in the number of hospitalisations (OR 1.01, 95% CI 0.71 to 1.44), there was significant heterogeneity. Although this heterogeneity appeared to be caused by one outlying study with a statistically significant decrease in hospitalisations in patients receiving home care, whereas the other studies showed a non-significant increase in hospitalisations, we could not draw firm conclusions about why this heterogeneity exists. Data on GP visits and emergency department presentations were available, however no consistent effect in these was observed with the intervention. The intervention also incurred higher health care costs than standard care as reported in a single study.Very few studies provided data on lung function or exercise performance, so there was insufficient evidence to assess impact on these outcomes., Authors' Conclusions: Outreach nursing programmes for COPD improved disease-specific HRQL. However the effect on hospitalisations was heterogeneous, reducing admissions in one study, but increasing them in others, therefore we could not draw firm conclusions for this outcome.

Purpose: : The independent contribution of physical inactivity to disability in obstructive lung disease (OLD) is difficult to study, partly because inactivity may reflect disease severity. We examined the relationship of physical inactivity to disability progression over a 1-year period among a group of older adults with OLD., Methods: : A population-based cohort with self-reported physician-diagnosed emphysema, chronic obstructive pulmonary disease, or chronic bronchitis (n = 206) completed baseline interviews and in-person spirometry, with 1-year followup interviews. The Community Health Activities Model Program for Seniors physical activity questionnaire provided estimates of energy expenditure; we defined inactivity as no expenditure in moderate- or vigorous-intensity activities. Disability was measured with the Valued Life Activity (VLA) disability scale; increased disability was defined as a 10% or greater increase in VLA disability score over 1-year followup. Logistic regression tested the relationship between baseline inactivity and disability increase, controlling for age, sex, baseline VLA disability, comorbidities, smoking, and pulmonary function (forced expiratory volume in 1 second, % predicted)., Results: : Of 206 subjects, 48 (27%) were physically inactive at baseline; 42.9% of individuals whose disability increased were inactive at baseline compared with 23.4% of those who did not experience a disability increase. With adjustment for covariates, increased disability after 1 year was significantly (P = .04) more likely among individuals who were inactive at baseline (Odds Ratio =2.4; 95% confidence interval, 1.02-5.9)., Conclusions: : Physically inactive individuals with OLD had more than double the odds of an increase in disability, even after controlling for baseline disability, lung function, and other covariates. These results provide strong support for the importance of maintaining physical activity among individuals with OLD.

Background: Chronic obstructive pulmonary disease (COPD) is characterised by progressive airflow obstruction, worsening exercise performance and health deterioration. It is associated with significant morbidity, mortality and health system burden., Objectives: To evaluate the effectiveness of outreach respiratory health care worker programmes for COPD patients in terms of improving lung function, exercise tolerance and health related quality of life (HRQL) of patient and carer, and reducing mortality and medical service utilisation., Search Strategy: The Cochrane Airways Group Specialised Register of Trials was searched (November 2009). Study references were hand-searched for additional studies we contacted study authors to identify other unpublished studies., Selection Criteria: We included only randomised controlled trials of COPD patients. We included interventions involving an outreach nurse visiting patients in their homes, providing support, education, monitoring health and liaising with physicians. Studies in which the therapeutic intervention under test was physical training were not included., Data Collection and Analysis: Two reviewers independently assessed trial quality and extracted data. We contacted study authors for additional information., Main Results: We included five new studies in this update, resulting in a total of nine included studies.We pooled mortality data from eight studies and found a non-significant reduction in mortality at 12 months (OR 0.72, 95% CI 0.45 to, 1.15).We pooled four studies that assessed disease-specific heath-related quality of life (HRQL) and found a statistically significant improvement in HRQL (mean difference -2.61, 95% CI -4.82 to -0.40).Hospitalisations were reported in five studies. Although there was no statistically significant difference in the number of hospitalisations (OR 1.01, 95% CI 0.71 to 1.44), there was significant heterogeneity. Although this heterogeneity appeared to be caused by one outlying study with a statistically significant decrease in hospitalisations in patients receiving home care, whereas the other studies showed a non-significant increase in hospitalisations, we could not draw firm conclusions about why this heterogeneity exists. Data on GP visits and emergency department presentations were available, however no consistent effect in these was observed with the intervention. The intervention also incurred higher health care costs than standard care as reported in a single study.Very few studies provided data on lung function or exercise performance, so there was insufficient evidence to assess impact on these outcomes., Authors' Conclusions: Outreach nursing programmes for COPD improved disease-specific HRQL. However the effect on hospitalisations was heterogeneous, reducing admissions in one study, but increasing them in others, therefore we could not draw firm conclusions for this outcome.

Purpose: To date, there are no studies that have investigated the role of alexithymia in respiratory rehabilitation. We aimed to observe the prevalence of alexithymia in patients attending respiratory rehabilitation and to verify the presence of a difference between alexithymics and non-alexithymics responsiveness to the respiratory rehabilitation standard protocol., Methods: A prospective cohort study evaluating the influence of alexithymia on functional recovery of in-patients afferent to the Respiratory Rehabilitation Unit of IRCCS San Raffaele Pisana. Sixty patients were consecutively enrolled into the study and evaluated for alexithymia, anxiety and depression. Functional recovery was assessed with the six-minute walking test (6MWT). Prior and post-completion of this test dyspnoea, oxygen saturation and cardiac frequency were recorded., Results: Alexithymia was not found to be significantly affecting the functional recovery of participants in respiratory rehabilitation. The distance walked at the 6MWT (6MWD) increased in both alexithymics and non-alexithymics (p(alexithymics) = 0.014; p(non-alexithymics) < 0.0001). Dyspnoea strongly improved among non-alexithymics, although a signal for improvement was also found in alexithymics (p(alexithymics) = 0.046; p(non-alexithymics) = 0.0001)., Conclusions: These findings suggest that alexithymia did not have a significant impact on functional recovery of patients in respiratory rehabilitation.

Background and Purpose: The 'Comprehensive ICF Core Set for obstructive pulmonary diseases' (OPD) is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in functioning of patients with OPD. To optimize a multidisciplinary and patient-oriented approach in pulmonary rehabilitation, in which physiotherapy plays an important role, the ICF offers a standardized language and understanding of functioning. For it to be a useful tool for physiotherapists in rehabilitation of patients with OPD, the objective of this study was to validate this Comprehensive ICF Core Set for OPD from the perspective of physiotherapists., Method: A three-round survey based on the Delphi technique of physiotherapists who are experienced in the treatment of OPD asked about the problems, resources and aspects of environment of patients with OPD that physiotherapists treat in clinical practice (physiotherapy intervention categories). Responses were linked to the ICF and compared with the existing Comprehensive ICF Core Set for OPD., Results: Fifty-one physiotherapists from 18 countries named 904 single terms that were linked to 124 ICF categories, 9 personal factors and 16 'not classified' concepts. The identified ICF categories were mainly third-level categories compared with mainly second-level categories of the Comprehensive ICF Core Set for OPD. Seventy of the ICF categories, all personal factors and 15 'not classified' concepts gained more than 75% agreement among the physiotherapists. Of these ICF categories, 55 (78.5%) were covered by the Comprehensive ICF Core Set for OPD., Conclusion: The validity of the Comprehensive ICF Core Set for OPD was largely supported by the physiotherapists. Nevertheless, ICF categories that were not covered, personal factors and not classified terms offer opportunities towards the final ICF Core Set for OPD and further research to strengthen physiotherapists' perspective in pulmonary rehabilitation.

Today, a growing number of people, some of them suffering from lung diseases, travel to high altitude resorts. It is sometimes not easy for the general practitioner to adequately counsel these patients. Based on our knowledge of physiopathology and clinical studies, the present paper addresses the effects of high altitude in patients with preexisting lung diseases and provides recommendations in order to optimize the sojourn at high altitude.

High-frequency airway clearance assist devices generate either positive or negative transrespiratory pressure excursions to produce high-frequency, small-volume oscillations in the airways. Intrapulmonary percussive ventilation creates a positive transrespiratory pressure by injecting short, rapid inspiratory flow pulses into the airway opening and relies on chest wall elastic recoil for passive exhalation. High-frequency chest wall compression generates a negative transrespiratory pressure by compressing the chest externally to cause short, rapid expiratory flow pulses, and relies on chest wall elastic recoil to return the lungs to functional residual capacity. High-frequency chest wall oscillation uses a chest cuirass to generate biphasic changes in transrespiratory pressure. In any case (positive or negative pressure pulses or both), the general idea is get air behind secretions and move them toward the larger airways, where they can be coughed up and expectorated. These techniques have become ubiquitous enough to constitute a standard of care. Yet, despite over 20 years of research, clinical evidence of efficacy for them is still lacking. Indeed, there is insufficient evidence to support the use of any single airway clearance technique, let alone judge any one of them superior. Aside from patient preference and capability, cost-effectiveness studies based on existing clinical data are necessary to determine when a given technique is most practical.

In health, secretions produced in the respiratory tract are cleared by mucociliary transport, cephalad airflow bias, and cough. In disease, increased secretion viscosity and volume, dyskinesia of the cilia, and ineffective cough combine to reduce secretion clearance, leading to increased risk of infection. In obstructive lung disease these conditions are further complicated by early collapse of airways, due to airway compression, which traps both gas and secretions. Techniques have been developed to optimize expiratory flow and promote airway clearance. Directed cough, forced expiratory technique, active cycle of breathing, and autogenic drainage are all more effective than placebo and comparable in therapeutic effects to postural drainage; they require no special equipment or care-provider assistance for routine use. Researchers have suggested that standard chest physical therapy with active cycle of breathing and forced expiratory technique is more effective than chest physical therapy alone. Evidence-based reviews have suggested that, though successful adoption of techniques such as autogenic drainage may require greater control and training, patients with long-term secretion management problems should be taught as many of these techniques as they can master for adoption in their therapeutic routines.

Purpose: To evaluate the ability of the Seattle Obstructive Lung Disease Questionnaire (SOLDQ) to detect change in health-related quality of life (HRQOL) following a pulmonary rehabilitation program (PRP) and to determine associations with other functional indicators., Methods: A prospective pre- and post-test design. A PRP was offered for 60 minutes, 2 times per week for 8 weeks. Measured at entry and exit to the PRP: the SOLDQ (physical, emotional, and coping skills), 6-minute walk, Medical Outcomes Study Short Form Health Survey-36 Veterans (SF-36V) (physical and mental), Lareau Functional Status and Dyspnea Questionnaire, and the Multidimensional Assessment of Fatigue (MAF) scale. Setting was an outpatient PRP in a VA Medical Center., Results: Participants included 58 adults who completed the PRP (age mean = 66, SD +/- 9.8; FEV1% predicted mean = 39, SD +/- 15.9). At baseline, significant correlations were found between SOLDQ physical functioning and SF-36V physical, dyspnea, fatigue, 6-minute walk distance, SF-36V mental, and spirometry. SOLDQ emotional functioning significantly correlated with fatigue, dyspnea, and SF-36V mental and physical. SOLDQ coping skills significantly correlated with fatigue, dyspnea, and SF-36V mental and physical. Paired, 2-tailed, t tests comparing the SOLDQ subscales pre- and post-program were significant, with the biggest treatment effect seen with emotional functioning. Other measures showing significant improvement included 6-minute walk, SF-36V physical, dyspnea, and fatigue., Conclusions: After participation in a PRP, all 3 SOLDQ subscales improved significantly and were associated with other indicators of function. These findings validate the SOLDQ as a measure sensitive to functional changes associated with participation in pulmonary rehabilitation.

Background: The development and validation study of the Clinical Chronic Obstructive Disease (COPD) Questionnaire (CCQ) has recently been published in this journal. The CCQ is the first questionnaire that incorporates both clinician and patient guideline goals in the clinical control evaluation of patients with COPD in general clinical practice. The aim of this study is the validation of the CCQ questionnaire in Italian, in specific pulmonary disease clinical practice., Methods: Validity was tested on a population of healthy subjects and patients with COPD, using the Italian validated version of the Short Form Health Survey (SF-36) and guideline recommended routine measurement in COPD patients (FEV1, FVC, BMI and functional dyspnoea). Test-retest reliability was tested by re-administering the CCQ after 2 weeks. Responsiveness was tested by re-administering the CCQ after three weeks of hospital pulmonary rehabilitation. Distance walked and Borg breathlessness rating were measured at the end of the six-minute walking test (6 MWT), before and after rehabilitation., Results: Cross-sectional data were collected from 175 subjects (55 healthy; 40 mild-moderate, 50 severe and 25 very severe COPD). Cronbach's alpha was high (0.89). The CCQ scores in patients were significantly worse than in healthy subjects. The CCQ total score in patients with COPD was significantly worse in those with BMI < or = 21. Significant correlations were found between the CCQ total score and domains of the SF-36 (rho = -0.43 to rho = -0.72). The correlation between the CCQ and FEV1 % predicted was rho = -0.57. The correlation between the CCQ and MRC was rho = 0.63. Test-retest reliability was determined in 112 subjects over a period of two weeks (Intra Class Coefficient = 0.99). Forty-six patients with COPD showed significant improvement in CCQ scores, distance-walked and Borg breathlessness rating after 3 weeks of pulmonary rehabilitation, indicating CCQ responsiveness., Conclusions: The CCQ is self-administered and has been specially developed to measure clinical control in patients with COPD. Data support its validity, reliability and responsiveness in Italian and in specific pulmonary disease clinical practice.

Objectives: There is limited evidence that pulmonary rehabilitation improves exercise capacity in older patients with chronic respiratory disease. The objective of the present study was to determine whether patients 80 years of age or older gain similar benefits from pulmonary rehabilitation as do younger patients., Design: Outcomes were compared in 230 consecutive inpatients with moderate to severe lung disease who participated in a comprehensive pulmonary rehabilitation program during a one-year period. Outcomes included 6 min walk test distance (6MWT), the number of stairs completed in 2 min (2MST), Borg dyspnea scores after exertion and objective functional scores., Results: There were no differences between older (80 to 91 years, n=43) and younger patients (n=187) with respect to sex, forced expiratory volume in 1 s (mean 0.77 L versus 0.72 L) or number of chronic medical diagnoses (2.4 versus 2.7). Older patients were less frequently survivors of mechanical ventilation (2.3% versus 16%). Baseline 6MWT (133 m versus 144 m; P=0.48) and 2MST (5.2 laps versus 6.5 laps; P=0.067) were similar but global function was lower (85 versus 89; P=0.040) in older patients than in younger patients, respectively. After pulmonary rehabilitation, all outcomes improved significantly regardless of age (all before-after comparisons P<0.0001). Younger patients improved with a higher discharge 6MWT (231 m versus 185 m; P=0.004) and similar discharge 2MST (9.3 laps versus 7.9 laps; P=0.070) compared with older patients. Global function at discharge remained lower in older patients than younger patients (91 versus 94; P=0.002). The duration of rehabilitation and length of stay were similar between the two groups., Conclusion: A comprehensive inpatient pulmonary rehabilitation program is beneficial in selected patients 80 years of age or older.

Purpose: This study evaluated pulmonary rehabilitation as practiced in the general California medical community to determine its effectiveness in improving dyspnea and health-related quality of life and reducing the use of healthcare resources., Methods: For this study, 10 established pulmonary rehabilitation programs agreed to collect common clinical health outcome data on consecutive patients over 2 years. The following three self-administered questionnaires were obtained before and after rehabilitation, then at 3-, 6-, 12-, and 18-month follow-up assessments: Medical Outcomes Survey Short Form (SF-36), University of California, San Diego Shortness of Breath Questionnaire (SOBQ), and Health Care Utilization in the preceding 3 months. Information also was collected on patient demographics, diagnostic categories, use of supplemental oxygen, and available spirometry and 6-minute walk tests., Results: Nine centers enrolled 647 patients that met prespecified inclusion criteria. Of these, 521 completed the rehabilitation program and both the pre- and the postprogram assessment. At least two of the four follow-up assessments were completed by 415 patients in eight centers. The mean age of the patients was 68 years, and 42% were men. Overall, the forced expiratory volume in 1 second was 44% of the predicted value. There were few significant differences between the centers. The baseline outcome measures demonstrated marked symptoms, as evidenced by the mean SOBQ score (56.8) and the mean impaired quality of life results (SF-36 physical component score, 31.2; SF-36 mental component score, 47.5). These measures also showed high utilization of healthcare services over the preceding 3 months in terms of mean hospital stay (2.4 days), urgent care visits (0.4), physician visits (4.4), and telephone calls (2.7). After rehabilitation, there were significant improvements in symptoms and quality of life in all the centers, as evidence by mean changes of -6.8 for the SOBQ, 7.5 for the physical component score, and 3.9 for the mental component score). Over 18 months, benefits gradually declined, but levels remained above baseline values. There also were significant reductions in all measures of healthcare utilization., Conclusions: Pulmonary rehabilitation was effective in improving symptoms and quality of life and reducing the utilization of healthcare resources over 18 months. The results were consistent across participating centers despite variations in practice settings, patient referral patterns, and program structure.

Pulmonary rehabilitation is one of the most important treatment modalities for patients with chronic lung disease. To determine the effects of an outpatient pulmonary rehabilitation program for the older members (aged 77 +/- 3 years; seniors) of an elderly patient group with chronic lung disease, we prospectively compared the degrees of improvement of lung function, dyspnea, daily activities and exercise tolerance (6-minute walking distance) after a 9-week rehabilitation program in 27 seniors with chronic lung disease (COPD 18, post-tuberculosis lung disorders 8, lung fibrosis 1; %FEV1 50.9 +/- 17.1%) with that in disease- and %FEV1-matched younger members (aged 70 +/- 2 years; juniors; %FEV1 49.3 +/- 16.1%) of the elderly patient group. All patients performed supervised weekly outpatient exercise and education activities for 9 weeks and a home exercise regimen. Assessments were made before and after the program. Twenty-three of the seniors and 25 of the juniors completed the program. There was no significant difference in the withdrawal rates between these groups. Although lung function and blood gas data had not changed significantly after rehabilitation, the clinical symptoms and the 6-minute walking exercise improved significantly in both groups (Baseline Dyspnea Index focal score: +1.3 +/- 0.9 in the seniors and +0.6 +/- 0.9 in the juniors: 6-minute walking distance: +/- 52 m and +/- 62 m, respectively) and the improvement of the Baseline Dyspnea Index focal score was significantly greater in the seniors than in the juniors. We observed the patients after they had followed the program for 2,000 days and found that the continuation ratio of rehabilitation in the seniors was far inferior to that in the juniors (continuation ratios for 1.2 and 3 years in the seniors were 50.5, 18.0 and 0%, respectively, and in the juniors, 79.5, 66.2 and 61.5%). We concluded that, although the senior elderly patients could benefit from the pulmonary rehabilitation program, it is difficult to maintain this benefit for many years.

Some children with cerebral palsy and severe feeding impairment experience pulmonary complications from aspiration and gastroesophageal reflux. This exploratory study examined whether pulmonary function would improve following one year of intervention with optimal positioning for feeding, control of gastroesophageal reflux and use of food textures that would minimize aspiration from swallowing. Two children showed a 28% and 45% improvement, respectively, in functional residual capacity. One child experienced a 37% improvement in total respiratory resistance and a 284% improvement in respiratory compliance. All children gained sufficient weight to maintain their growth trajectories but only one who was changed from oral to tube feeding due to aspiration showed catch-up growth in length. One child showed pathological gastroesophageal reflux that was controlled medically throughout the study period. Although all children experienced pulmonary illnesses during the one year of follow up, control of aspiration permitted a clinically significant improvement of their pulmonary obstructive syndrome Further study is needed to more fully determine the effect of this treatment approach on pulmonary function.

Background: Approaches to interpretation of quality of life changes in clinical trials have fallen into two camps: those that rely on the distribution of changes and the Effect Size (ES), and those that use some external anchor, such as patient judgments of change, which is then used to compute a Minimally Important Difference (MID), the proportion benefiting from treatment, p(B), and the Number Needed to Treat (NNT)., Objective: To examine the relationship between the ES and p(B), and the impact of the MID on this relationship., Methods: Simulation was used based on a normal distribution to compute the proportion of patients benefiting in both parallel group and crossover designs, for various values of the ES and the MID. The agreement of the simulation with empirical data from four studies of asthma and respiratory disease was assessed. The effect of skewness in the distributions of change scores on the relationship between ES and p(B) was also examined., Results: The simulation showed a near-linear relationship between ES and p(B), which was nearly independent of the value of the MID. Agreement of the simulation with the empirical data were excellent. Although the curves differed for crossover and parallel group designs, the general form was similar. Introducing moderate skew into the distributions had minimal impact on the relationship., Conclusions: The proportion of patients who will benefit from treatment can be directly estimated from the ES, and is nearly independent of the choice of MID. Effect size and anchor based approaches provide equivalent information in this situation.

Background: Pulmonary rehabilitation programmes improve the health of patients disabled by lung disease but their cost effectiveness is unproved. We undertook a cost/utility analysis in conjunction with a randomised controlled clinical trial of pulmonary rehabilitation versus standard care., Methods: Two hundred patients, mainly with chronic obstructive pulmonary disease, were randomly assigned to either an 18 visit, 6 week rehabilitation programme or standard medical management. The difference between the mean cost of 12 months of care for patients in the rehabilitation and control groups (incremental cost) and the difference between the two groups in quality adjusted life years (QALYs) gained (incremental utility) were determined. The ratio between incremental cost and utility (incremental cost/utility ratio) was calculated., Results: Each rehabilitation programme for up to 20 patients cost pound 12,120. The mean incremental cost of adding rehabilitation to standard care was pound -152 (95% CI -881 to 577) per patient, p=NS. The incremental utility of adding rehabilitation was 0.030 (95% CI 0.002 to 0.058) QALYs per patient, p=0.03. The point estimate of the incremental cost/utility ratio was therefore negative. The bootstrapping technique was used to model the distribution of cost/utility estimates possible from the data. A high likelihood of generating QALYs at negative or relatively low cost was indicated. The probability of the cost per QALY generated being below pound 0 was 0.64., Conclusions: This outpatient pulmonary rehabilitation programme produces cost per QALY ratios within bounds considered to be cost effective and is likely to result in financial benefits to the health service.

Objective: The aim of the study was to assess the effect of target-flow inspiratory muscle training (IMT) on respiratory muscle function, exercise performance, dyspnea, and health-related quality of life (HRQL) in patients with COPD., Patients and Methods: Twenty patients with severe COPD were randomly assigned to a training group (group T) or to a control group (group C) following a double-blind procedure. Patients in group T (n = 10) trained with 60 to 70% maximal sustained inspiratory pressure (SIPmax) as a training load, and those in group C (n = 10) received no training. Group T trained at home for 30 min daily, 6 days a week for 6 months., Measurements: The measurements performed included spirometry, SIPmax, inspiratory muscle strength, and exercise capacity, which included maximal oxygen uptake (VO(2)), and minute ventilation (VE). Exercise performance was evaluated by the distance walked in the shuttle walking test (SWT). Changes in dyspnea and HRQL also were measured., Results: Results showed significant increases in SIPmax, maximal inspiratory pressure, and SWT only in group T (p < 0.003, p < 0.003, and p < 0.001, respectively), with significant differences after 6 months between the two groups (p < 0.003, p < 0.003, and p < 0.05, respectively). The levels of VO(2) and VE did not change in either group. The values for transitional dyspnea index and HRQL improved in group T at 6 months in comparison with group C (p < 0.003 and p < 0.003, respectively)., Conclusions: We conclude that targeted IMT relieves dyspnea, increases the capacity to walk, and improves HRQL in COPD patients.

Study/principles: Pulmonary rehabilitation programmes are often costly and dependent on the infrastructure of specialised centres. We developed a modular, outpatient-based rehabilitation programme, which is inexpensive and can be implemented in a variety of settings. The aim of this study was to determine the effects and feasibility of this programme., Methods: Thirteen patients with COPD and 7 patients with asthma were enrolled by their primary care physician because of dyspnoea. Initial assessment included cardiopulmonary exercise testing, six-minute walking distance, lung function testing and multiple questionnaires addressing dyspnoea, depression and quality of life issues. The training consisted of 36 sessions of high intensity training of 2 hours duration to improve exercise tolerance, including 30 minutes of stationary cycling at the anaerobic threshold. Another complete assessment was done on completion of the study at 3 months., Results: The six-minute walking distance improved significantly from 401 to 551 m (p < 0.0001). The maximal exercise capacity increased significantly from 85 W to 99 W (p < 0.001). The anaerobic threshold remained unchanged despite the high intensity training. There was a reduction of dyspnoea and an improvement of quality of life., Conclusion: This study shows that our outpatient rehabilitation programme leads to a benefit in exercise tolerance and health related quality of life comparable to other programmes published in the literature. The rehabilitation programme was very well accepted among patients, primary care physicians and health insurers.

Resistance exercise training has received relatively little attention as a means to reduce the muscle dysfunction and ensuing exercise intolerance seen in chronic pulmonary diseases. To date, only a few studies have examined the characteristics of skeletal muscle function or its responsiveness to strength training in patients with chronic respiratory diseases. It is clear from these studies, however, that peripheral muscle, particularly muscles of ambulation, are weak in patients with lung disease, exhibiting effort-dependent strength scores that are 70--80% of these measures in age-matched healthy subjects. The degree to which this dysfunction is accounted for by deconditioning, disease-related myopathy, or other causes is unclear. It is evident, however, that patients with chronic respiratory diseases can acquire and maintain substantial improvements in skeletal muscle function, physical function, and quality of life through participation in a well-structured program of resistance exercise training. Despite the positive, albeit limited, evidence that skeletal muscle dysfunction may be improved with resistance training, no clear guidelines are available for this purpose. This review discusses the skeletal muscle dysfunction that accompanies chronic respiratory disease and presents strategies for resistance exercise training that may be considered as part of pulmonary rehabilitation. These strategies are derived from the successful outcomes noted in studies using resistance training in patients with COPD as well as on extrapolations from extant guidelines used to develop strength, power, and endurance in healthy individuals.

Endurance exercise training (EXT) is singly the most important aspect of rehabilitation for patients with chronic pulmonary disease. When effective, this modality of physical reconditioning leads to improved functional exercise capacity and reduced breathlessness. Early implementation is desirable to obtain more meaningful responses (e.g., when FEV1 falls below 50% of the predicted value in patients with chronic obstructive disease). Preparation for effective EXT requires optimization of respiratory system mechanics (e.g., using bronchodilator therapy), prevention of gas exchange failure (i.e., using supplemental oxygen), nutritional guidance, and psychological support (e.g., to overcome stigmata of disability, fear, and inclination to panic). EXT should be applied using a rigorous, scientifically based aerobic exercise prescription (AXRx) that recognizes basic principles of the human response to exercise prescription while considering individual pathophysiological limitations and identifying safety thresholds for exercise participation. The mode of aerobic exercise should use large muscle groups of the legs (e.g., treadmill or cycle ergometer). The recommended duration is an accumulation of 30 min of exercise per session at the target intensity, achieved by continuous or interval training. EXT should be supervised with a recommended frequency of at least three times per week for 6--8 wk. Target exercise intensity can be monitored by oxygen uptake, work rate, heart rate, or perceived exertion. Target intensity can be determined initially on the basis of 40% of a reference value for maximum oxygen uptake and linked to other variables through predictable interrelationships. All aspects of the AXRx must be reviewed with regard to progression during training. Pulmonary rehabilitation must recognize the importance of achieving clinically meaningful responses (e.g., increased 6-min walking distance of 54 m) as well as the need for maintenance exercise program to sustain the benefits.

Chronic pulmonary disease is common in the community and increasing in prevalence. Although numerous etiologies exist, chronic obstructive pulmonary disease secondary to tobacco smoking, and asthma constitute the majority of cases. The important impact of these diseases on patients is disabling breathlessness and impairment of functional exercise capacity. The symptoms set up a vicious cycle leading to physical deconditioning and worsening exercise performance. The discipline of pulmonary rehabilitation has been conclusively shown to reverse this process, resulting in improved functional capacity and reduced breathlessness. Pulmonary rehabilitation, therefore, should be viewed as essential secondary preventative care for the majority of patients with chronic pulmonary disease. As such, early disease recognition and implementation of exercise reconditioning is important. In order to be maximally effective, pulmonary rehabilitation must recognize the complex underlying pathophysiology in chronic pulmonary disease and be customized to the individual patient. The chosen mode of exercise training should recognize that in order to be truly beneficial, any physiological responses need to translate readily into improvements in activities of daily living. Therefore, sessions in pulmonary rehabilitation should concentrate on exercises that have proven useful in this regard. Aerobic and resistance exercise prescriptions should be rigorous, scientifically based, and derived from an understanding of the basic principles of the human response to exercise prescription. Each of these exercise prescriptions should encompass the basic principles of intensity, frequency, duration, and progression suitably modified for the individual patient with chronic pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a major health care problem. Formerly mainly a disease of men, women are increasingly frequently afflicted. In many of these patients, exercise intolerance is the chief complaint. Few effective therapies are available. In recent years, dysfunction of the muscles of ambulation has been identified as a source of a portion of the exercise intolerance these patients experience, and this dysfunction has been shown to be, at least in part, remediable. Mechanisms inducing muscle dysfunction include disuse atrophy, malnutrition, low levels of anabolic steroids, and myopathy from corticosteroid use. Endurance exercise training has been conclusively demonstrated to improve exercise tolerance in COPD. Recent studies suggest that strength training is beneficial as well. A new frontier of therapy for muscle dysfunction in COPD is the use of anabolic hormones. Testosterone supplementation has been shown to increase muscle mass and strength in both hypogonadal and eugonadal healthy men. Low-dose testosterone supplementation is being considered for use in postmenopausal women. Though short-term administration of testosterone in moderate doses seems to be well tolerated in both men and women, further studies are required before safety and effectiveness can be established for routine use in COPD patients.

Background: In patients with mild to moderate chronic obstructive pulmonary disease (COPD) the exercise induced increase in exhaled nitric oxide (eNO) parallels that observed in normal untrained subjects. There is no information on the effects of the level of exercise tolerance on eNO in these patients. The aim of this study was to evaluate the effect of a pulmonary rehabilitation programme including exercise training on eNO in patients with COPD., Methods: In 14 consecutive male patients with stable COPD of mean (SD) age 64 (9) years and forced expiratory volume in one second (FEV1) 55 (14)% predicted, fractional eNO concentration (FeNO), peak work rate (Wpeak) and oxygen uptake (VO2peak) were assessed at baseline (T-1), at the end of a 1 month run in period (T0), and after an 8 week outpatient multidisciplinary pulmonary rehabilitation programme (T1) including cycloergometer training., Results: FeNO did not significantly differ at T-1 and T0 (mean (SE) 4.3 (0.6) and 4.4 (0.6) ppb, respectively), whereas it rose significantly at T1 to 6.4 (0.7) ppb (p<0.02). Compared with T0, both Wpeak and VO2 were significantly (p<0.05) increased at T1 (mean (SE) Wpeak from 89 (5.6) W to 109 (6.9) W); VO2peak from 1.27 (0.1) l/min to 1.48 (0.1) l/min). A significant correlation was found between baseline FEV1 and the change in FeNO following the rehabilitation programme (r=-0.71; p<0.05) and between changes in FeNO and Wpeak from T0 to T1(r=0.60; p<0.05)., Conclusions: Pulmonary rehabilitation in patients with mild to moderate COPD is associated with an increase in exhaled nitric oxide.

Background: Patients with chronic pulmonary disease have been shown to benefit from pulmonary rehabilitation programs. Published work has often been from specialized teaching centers and has involved inpatient stay. We assessed an entirely outpatient-based program of pulmonary rehabilitation in patients with chronic lung disease, using the St. George's Respiratory Questionnaire (SGRQ) (which measures health-related quality of life) as the primary outcome measure., Methods: We undertook a randomized, prospective, parallel-group controlled study of an outpatient rehabilitation program in 65 patients with COPD (44 men and 21 women; mean age, 69.5 years [SD, 9.2 years]; FEV(1), 41% predicted [SD, 18.5%]). The active group (n = 36) took part in a 6-week program of education (2 h weekly) and exercise (1 h weekly). The control group (n = 29) were reviewed routinely as medical outpatients. The SGRQ was administered under supervision by a blinded observer at study entry, 12 weeks, and 24 weeks., Results: The SGRQ in the active group was 59.9 (SE, 2.0) at study entry (n = 36), 47.4 (SE, 2.3) at 12 weeks (n = 32), and 50.6 (SE, 2.5) at 24 weeks (n = 24). The SGRQ in the control group was 59.3 (SE, 2.5) at study entry and did not change significantly over 24 weeks. There was a difference of 10.4 points (confidence interval [CI], 3.6 to 17.3) between the two groups at 12 weeks (p < 0.001) and of 8.1 points (CI, 1.4 to 14.9) at 24 weeks (p = 0.02) in favor of the active group., Conclusions: A 6-week outpatient-based program significantly improved quality of life in patients with moderate-to-severe COPD. Benefit was still evident after 24 weeks.

In the course of chronic respiratory insufficiency, acute episodes often require the use of mechanical ventilation. Failure of weaning, or worsening of alveolar hypoventilation, results in long term ventilatory assistance with the need of overall care of the patient. The pneumologist has a key role in the choice of indications, devices and mode of home mechanical ventilation. Thanks to the non-invasive ventilation with a facial or nasal mask, tracheostomy is less often needed. Respiratory failure due to lung restriction is the best indication of mechanical ventilation. The results in COPD are questionable. Whatever to the technique of ventilation and the underlying disease, the pneumologist has to ascertain the steady state of the medical condition, patient and family education, and social situation, all factors to be taken into account before the patient can be discharged. Knowing the specific needs in these patients'care, the pneumologist plays a key role at each stage of home return and follow-up. He co-ordinates the different aspects of pneumological care, like rehabilitation and acute episodes treatment. The overall care of the patients should be improved by the development of health networks in the field of chronic respiratory insufficiency.

Introduction: The conclusion of previous investigations that pulmonary rehabilitation (PR) is an effective intervention for the management of chronic lung disease may not be generalizable to PR programs with limited experience delivering this complex, interdisciplinary service., Objective: Determine whether PR is effective for the first group of patients treated in a newly formed interdisciplinary PR program., Methods: We conducted a longitudinal analysis of changes in health-related quality of life and 6-minute walk test for the first group of patients completing our newly formed 8-week outpatient PR program. We studied 6 men, age 65-77 years, with stable severe chronic obstructive pulmonary disease. Patients completed the Chronic Respiratory Disease Questionnaire immediately before and 1 year after participation in our PR program., Results: Four patients completed the PR 6-minute walk test both before and after the program. We found improvement in all Chronic Respiratory Disease Questionnaire domains at follow-up (mean +/- SD before and after): dyspnea 1.67 +/- 0.82 vs 4.92 +/- 0.49; emotional function 2.33 +/- 0.82 vs 5.50 +/- 0.55; fatigue 2.00 +/- 0.63 vs 5.00 +/- 0.63; feeling of mastery over disease 1.83 +/- 0.41 vs 5.83 +/- 1.17. The interval improvements in all health-related quality of life domains were statistically significant (p < 0.02 for all comparisons). There was a trend toward improvement in exercise tolerance: 231 +/- 213 ft before PR vs 353 +/- 66 ft at the 1-year follow-up (p = 0.2)., Conclusions: PR can result in sustained improvement in the quality of life of patients with severe chronic obstructive pulmonary disease, even when this complex, interdisciplinary service is delivered by a newly formed and inexperienced PR program.

A number of studies in western countries have shown that respiratory and physical rehabilitation of patients with chronic obstructive pulmonary disease (COPD) only has a minimal effect on respiratory function but can significantly improve physical capacity. The aim of our study was to apply these methods to patients in Kinshasa, Democratic Republic of Congo. We treated 38 patients (20 women) who had bronchial asthma (n=14) or COPD (n=24). These ambulatory patients were treated in two different hospitals in Kinshasa, the university hospital and the general hospital, three times per week for twelve weeks. The patients were treated with kinestherapy and inhaled bronchodilator drugs (salbutamol, and/or ipratropium bromide with a boreal nebulizer) as well as bronchial hygiene and performed breathing exercises on a Bodyguard Ergometer 990 with walking, running and climbing steps until exhaustion. After the rehabilitation program FEV1 increased from 1.37 +/- 0.62 (50% expected) to 1.54 +/- 0.69 (56% expected) (p<0.01). The same trend was observed for walking distance (from 644 +/- 459 m to 1213 +/- 569 m, p<0.001) and for maximal power developed on the cycloergometer (from 45 +/- 20 w to 73 +/- 37 w, p<0.001). In contrast, the maximal work load performed during climbing steps (from 106 +/- 44 w to 115 +/- 23 w) did not improve significantly. COPD patients improved their FEV1 significantly compared with asthma patients. Our study show that pulmonary rehabilitaion increase the level of spontaneous physical activity. The pulmonary rehabilitation program changes the quality of life of COPD patients who are able to move about better for longer periods of time, have a longer walking distance, and improved physical activity level.

Functional exercise tolerance in patients with chronic obstructive pulmonary disease (COPD) is often assessed by the 6-min walking test (6MWT). To assess if the use of multiple factors adds to walking distance in describing performance in the 6MWT, an exploratory factor analysis was performed on physiological measurements and dyspnea ratings recorded during testing. Eighty-three patients with mild to severe COPD performed repeated 6MWTs before inpatient pulmonary rehabilitation. Factor analysis on 15 variables yielded a stable four-factor structure explaining 78.4% of the total variance. Recorded heart rate variables contributed to factor 1 (heart rate pattern), walking distance, heart rate increase, and decrease contributed to factor 2 (endurance capacity), oxygen desaturation variables contributed to factor 3 (impairment of oxygen transport), and dyspnea and effort variables contributed to factor 4 (perceived symptoms). Walking distance decreased in half of the 53 patients measured posttreatment, but self-perceived change in exercise tolerance improved in 84% and was explained by change in walking distance, by less desaturation, and by less dyspnea (R(2) = 0.55, p = 0.005). Qualitative analysis showed that 29 of 53 patients improved in three or four factors. Performance in the 6MWT can be described with four statistically independent and clinically interpretable factors. Because clinically relevant changes consist of more than only walking distance, assessment of functional exercise tolerance in patients with COPD improves by reporting multiple variables.

Study Objectives: To answer the following questions: in patients with chronic airway obstruction (CAO), (1) can pulmonary rehabilitation lead to similar short-term gains at successive, yearly interventions, and (2) is there any real clinical or physiologic long-term benefit by yearly repetition of pulmonary rehabilitation programs (PRPs)?, Design: Randomized, controlled clinical study., Setting: Pulmonary rehabilitation center., Patients: Sixty-one CAO patients studied 1 year after completing an initial 8-week outpatient PRP (PRP1)., Intervention: Patients were randomly classified into two groups. A second PRP (PRP2) was completed by the first group (group 1) but not by the second group (group 2). One year later, a third PRP (PRP3) was performed by both groups., Measurements: Lung function, cycloergometry, walking test, dyspnea, and health-related quality of life (HRQL) were assessed before and after PRP2, and before and after PRP3. The numbers of hospitalizations and exacerbations over the year were also recorded., Results: Complete data sets were obtained from 36 patients (17 patients in group 1 and 19 patients in group 2). The two groups did not differ in any parameter either before PRP1, after PRP1, or at randomization. There was no significant change over time for airway obstruction in either group. After PRP2, exercise tolerance, dyspnea, and HRQL improved in group 1. Nevertheless, 1 year later, patients of group 1 did not differ from patients of group 2 in any outcome parameter, such that in comparison to before PRP1, only HRQL was still better in both groups 24 months after PRP1. Yearly hospitalizations and exacerbations per patient significantly decreased in both groups in the 2 years following PRP1, when compared to the 2 years prior. Nevertheless, at the 24-month follow-up visit, a further reduction in yearly exacerbations was observed only in group 1 but not in group 2 in comparison to what was observed at the 12-month follow-up visit. The PRP3 resulted in improvement in exercise tolerance in both groups., Conclusion: In patients with CAO, an outpatient PRP can achieve benefits in HRQL and a decreased number of hospitalizations, which persist for a period of 2 years. Successive, yearly interventions lead to similar short-term gains but do not result in additive long-term physiologic benefits. Further reduction in yearly exacerbations seems to be the main benefit of an additional PRP.

Rehabilitation for patients with chronic obstructive pulmonary disease (COPD) is well established and widely accepted as a means of enhancing standard therapy in order to alleviate symptoms and optimize function. The primary goal of rehabilitation is to restore the patient to the highest possible level of independent function. There is, however, no consensus on the optimal training modalities. Both walking and cycling improve exercise performance; there is substantial evidence that lower extremity exercise training should be included in rehabilitation programs for patients with COPD.

Purpose: Brisk walking forms the foundation of aerobic training regimes within a pulmonary rehabilitation service for patients with chronic obstructive pulmonary disease (COPD). Repeated bouts of aerobic training are encouraged in the domestic environment. This study was designed to examine the discriminatory properties of an activity monitor, to assess if brisk walking can be identified clearly from all other activities of daily living. Secondly, the authors examined the overall level of activity generated by patients with COPD compared with a healthy control population., Methods: Eleven patients with COPD and nine age-matched healthy controls were recruited. All subjects were required to wear an activity monitor for 48 hours. Subjects simultaneously recorded their activity (grouped into 10 categories) to the nearest minute., Results: The data indicated that the monitors can detect brisk walking as a distinct activity in patients and a control population. The healthy individuals achieve a significantly higher level of activity than patients, but that the duration of this high intensity activity (i.e., brisk walking) is significantly lower than the patient group. Total activity was not correlated with age, sex, or forced expiratory volume in 1 second., Conclusion: Activity monitors have the capacity to discriminate brisk walking from other domestic activities and can be used to identify low levels of domestic activity in the patient population.