Systematic Review of Supervised Exercise Programs After Pulmonary Rehabilitation in Individuals With COPD.

Systematic Review of Supervised Exercise Programs after Pulmonary Rehabilitation in Individuals with COPD.

Chest. 2013 Feb 21;
Beauchamp MK, Evans R, Janaudis-Ferreira T, Goldstein RS, Brooks D

ABSTRACT BACKGROUND: The success of pulmonary rehabilitation (PR) is established, but how to sustain benefits over the long-term is less clear. The aim of this systematic review was to determine the effect of supervised exercise programs after primary PR on exercise capacity and health-related quality of life (HRQL) in individuals with COPD. METHODS: Randomized controlled trials (RCTs) of post-rehabilitation supervised exercise programs versus usual care for individuals with COPD were identified after searches of six databases and reference lists of appropriate studies. Two reviewers independently assessed study quality. Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated using a fixed-effect model for measures of exercise capacity and HRQL. RESULTS: Seven RCTs, with a total of 619 individuals with moderate to severe COPD, met the inclusion criteria. At 6-months follow-up there was a significant difference in exercise capacity in favor of the post-rehabilitation interventions (SMD -0.20, 95%CI -0.39 to -0.01), which was not sustained at 12 months (SMD -0.09 95%CI -0.29 to 0.11). There was no difference between post-rehabilitation interventions and usual care with respect to HRQL at any time-point. CONCLUSIONS: Supervised exercise programs after primary PR appear to be more effective than usual care for preserving exercise capacity in the medium-term but not the long-term. In this review, there was no effect on HRQL. The small number of studies precludes a definitive conclusion as to the impact of post rehabilitation exercise maintenance on longer term benefits in individuals with COPD. HubMed – rehab


Sildenafil to improve respiratory rehabilitation outcomes in COPD: a controlled trial.

Eur Respir J. 2013 Feb 21;
Blanco I, Santos S, Gea J, Güell R, Torres F, Gimeno-Santos E, Rodriguez DA, Vilaró J, Gómez B, Roca J, Barberà JA

Pulmonary hypertension is a serious complication of COPD that currently has no established pharmacological treatment.To assess whether concomitant treatment with sildenafil would enhance the results of pulmonary rehabilitation in patients with COPD and increased pulmonary arterial pressure (PAP).Double-blind, randomised, controlled trial. Patients received 20 mg sildenafil or placebo t.i.d. and underwent pulmonary rehabilitation for 3 months. The primary endpoint was the gain in the cycle endurance time at a constant work-rate. Secondary endpoints included performance in the incremental exercise test, six-minute walk distance and quality of life.63 patients with severe COPD and moderately increased PAP were randomised. Cycle endurance time increased by 149 seconds (95% CI, 26-518) in the sildenafil group and by 169 seconds (95%CI, 0-768) in the placebo group (median change difference, -7 seconds (95%CI, -540-244; p=0.77). Gains in the incremental exercise test, six-minute walk distance and quality of life at the end of the study did not differ between groups. Measurements of arterial oxygenation and adverse events were similar in both groups.In patients with severe COPD and moderately increased PAP, concomitant treatment with sildenafil does not improve the results of pulmonary rehabilitation in exercise tolerance. HubMed – rehab


No room to breathe: the importance of lung hyperinflation in COPD.

Prim Care Respir J. 2013 Feb 21;
Thomas M, Decramer M, O’Donnell DE

Patients with chronic obstructive pulmonary disease (COPD) are progressively limited in their ability to undertake normal everyday activities by a combination of exertional dyspnoea and peripheral muscle weakness. COPD is characterised by expiratory flow limitation, resulting in air trapping and lung hyperinflation. Hyperinflation increases acutely under conditions such as exercise or exacerbations, with an accompanying sharp increase in the intensity of dyspnoea to distressing and intolerable levels. Air trapping, causing increased lung hyperinflation, can be present even in milder COPD during everyday activities. The resulting activity-related dyspnoea leads to a vicious spiral of activity avoidance, physical deconditioning, and reduced quality of life, and has implications for the early development of comorbidities such as cardiovascular disease. Various strategies exist to reduce hyperinflation, notably long-acting bronchodilator treatment (via reduction in flow limitation and improved lung emptying) and an exercise programme (via decreased respiratory rate, reducing ventilatory demand), or their combination. Optimal bronchodilation can reduce exertional dyspnoea and increase a patient’s ability to exercise, and improves the chance of successful outcome of a pulmonary rehabilitation programme. There should be a lower threshold for initiating treatments appropriate to the stage of the disease, such as long-acting bronchodilators and an exercise programme for patients with mild-to-moderate disease who experience persistent dyspnoea. HubMed – rehab



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