Dataset Information

The likelihood of improving physical activity after pulmonary rehabilitation is increased in patients with COPD who have better exercise tolerance.

ABSTRACT:

Purpose

Pulmonary rehabilitation (PR) enhances exercise tolerance in patients with COPD; however, improvements in physical activity (PA) are not guaranteed. This study explored the relationship between baseline exercise tolerance and changes in PA after PR.

Materials and methods

Patient data from prospective clinical trials in the PR settings of Athens and Leuven (2008-2016) were analyzed. Validated PA monitors were worn for 1 week before and after a 12-week program. The proportion of patients who improved PA levels ≥1,000 steps/day ("PA responders") after PR was compared between those with initial 6-minute walk distance [6MWDi] <350 m and ≥350 m. Baseline predictors of PA change were evaluated via univariate and multivariate logistic regression analyses.

Results

Two hundred thirty-six patients with COPD (median [IQR] FEV₁ 44 [33-59] % predicted, age 65±8 years, 6MWDi 416 [332-486] m) were included. The proportion of "PA responders" after PR was significantly greater in those with higher vs lower 6MWDi (37.9% vs 16.4%, respectively; P<0.001). 6MWDi group classification was the strongest baseline independent predictor of PA improvement (univariate OR 3.10, 95% CI 1.51-6.36).

Conclusion

The likelihood of improving PA after PR is increased with greater 6MWDi. Baseline exercise tolerance appears as an important stratification metric for future research in this field.

SUBMITTER: Osadnik CR

PROVIDER: S-EPMC6207410 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Publications

The likelihood of improving physical activity after pulmonary rehabilitation is increased in patients with COPD who have better exercise tolerance.

Osadnik Christian R CR Loeckx Matthias M Louvaris Zafeiris Z Demeyer Heleen H Langer Daniel D Rodrigues Fernanda M FM Janssens Wim W Vogiatzis Ioannis I Troosters Thierry T

International journal of chronic obstructive pulmonary disease 20181024

<h4>Purpose</h4>Pulmonary rehabilitation (PR) enhances exercise tolerance in patients with COPD; however, improvements in physical activity (PA) are not guaranteed. This study explored the relationship between baseline exercise tolerance and changes in PA after PR.<h4>Materials and methods</h4>Patient data from prospective clinical trials in the PR settings of Athens and Leuven (2008-2016) were analyzed. Validated PA monitors were worn for 1 week before and after a 12-week program. The proportio ...[more]

PMID: 30498342

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Project description:OBJECTIVE:Pulmonary rehabilitation is a cornerstone treatment in the management of chronic obstructive pulmonary disease (COPD). Acute bouts of exercise can lead to short bursts of inflammation in healthy individuals. However, it is unclear how COPD patients respond to acute bouts of exercise. This study assessed inflammatory responses to exercise in COPD patients at the start (phase 1) and end (phase 2) of pulmonary rehabilitation. METHODS:Blood samples were collected before and after an acute exercise bout at the start (phase 1, n?=?40) and end (phase 2, n?=?27) of pulmonary rehabilitation. The primary outcome was change in fibrinogen concentrations. Secondary outcomes were changes in CRP concentrations, total/differential leukocyte counts, markers of neutrophil activation (CD11b, CD62L and CD66b), and neutrophil subsets (mature, suppressive, immature, progenitor). RESULTS:Acute exercise (phase 1) did not induce significant changes in fibrinogen (p?=?0.242) or CRP (p?=?0.476). Total leukocyte count [mean difference (MD), 0.5?±?1.1 (109 L-1); p?=?0.004], neutrophil count [MD, 0.4?±?0.8 (109 L-1); p?<?0.001], and immature neutrophils (MD, 0.6?±?0.8%; p?<?0.001) increased post-exercise. Neutrophil activation markers, CD11b (p?=?0.470), CD66b (p?=?0.334), and CD62L (p?=?0.352) were not significantly altered post-exercise. In comparison to the start of pulmonary rehabilitation (phase 2), acute exercise at the end of pulmonary rehabilitation led to a greater fibrinogen response (MD, 84 mg/dL (95% CI -?14, 182); p?=?0.045). CONCLUSION:An acute bout of exercise does not appear to induce significant alterations in the concentrations of inflammatory mediators but can increase white blood cell subsets post-exercise. A greater fibrinogen response to acute exercise is seen at the end of pulmonary rehabilitation when compared to the start. Further research is required to understand the clinical context of these acute inflammatory responses to exercise.

Project description:Introduction: Oxidative stress is increasingly recognized as a significant factor in the pathogenesis of chronic obstructive pulmonary disease (COPD). Pulmonary rehabilitation, a major component of which is prescribed exercise, is essential in COPD care. Regular exercise has been proposed to increase antioxidant defenses and overall enhance the ability of the body to counteract oxidative stress. However, the mechanisms through which it improves COPD outcomes remain unclear. Objectives: We aimed to appraise the current evidence around the impact of pulmonary rehabilitation on redox status, compared with other exercise interventions, to gain an understanding of optimal exercise interventions to modify this pathophysiological mechanism. Methods: We performed a systematic review through searching CENTRAL, MEDLINE, PubMed, Scopus, and Web of Science. Results were independently reviewed and relevant studies were selected by two independent assessors. Studies were assessed by two independent people using the modified RoB 2 tool and discrepancies were resolved through discussion. Results: We identified 1,710 records and 1,117 records after duplicate removal. Six studies were included in the final analysis. The evidence available was low quality and four studies had high risk of bias and two studies had unclear risk of bias. Studies were small (15-56 participants); only two included details of randomization and patient cohorts were of varying ages and poorly described. Differences in smoking status and previous exercise levels, which are known to impact redox status, were not well documented. Studies were not standardized and used different exercise doses and measured different outcomes. One study reported lower malondialdehyde levels, a marker of lipid peroxidation, after pulmonary rehabilitation, compared with control. However, one study saw no difference following whole-body vibration training and another study showed higher malondialdehyde levels following supervised modified arm swing exercise compared with control. Conclusion: Understanding the impact of exercise on oxidative stress in COPD could lead to tailored exercise programs and modification of pathological mechanisms. However, we identify a lack of high-quality evidence to determine this. Larger, standardized, and high quality randomized controlled trials (RCTs) are essential, which use carefully clinically characterized and controlled cohorts to determine the relative impact of different exercise interventions on redox status to guide COPD management. We propose an idealized RCT design, which could be used to try and meet this need.

Dataset Information

The likelihood of improving physical activity after pulmonary rehabilitation is increased in patients with COPD who have better exercise tolerance.

Purpose

Materials and methods

Results

Conclusion

Publications

The likelihood of improving physical activity after pulmonary rehabilitation is increased in patients with COPD who have better exercise tolerance.

Similar Datasets

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