The Effects of Education Alone and in Combination with Pulmonary Rehabilitation on Self-Efficacy in Patients with COPD

This study compared the effects on self-efficacy of participation by patients with chronic obstructive pulmonary disease (COPD) in a pulmonary rehabilitation program that combined education and supervised exercise training with the results demonstrated by participation in a program that provided education alone. Thirty-seven patients participated in the pulmonary rehabilitation program, and 22 patients participated in the education-only program. Self-efficacy, as it effects managing or avoiding breathing difficulty, was measured before and after the programs. Patients' self-efficacy scores significantly improved after the pulmonary rehabilitation program and remained significantly improved 6 months later. Education alone was also effective in significantly improving self-efficacy scores, but patients' scores 6 months later were not significantly better than preprogram scores. This study indicates that a rehabilitation program that combines education and exercise training is more effective in improving long-term self-efficacy in patients with COPD.     

6-Minute walk test in patients with COPD: clinical applications in pulmonary rehabilitation

Pulmonary rehabilitation is an evidence-based intervention for the management of patients with chronic obstructive pulmonary disease (COPD). In clinical practice, the 6-minute walk test (6MWT) is commonly used to assess changes in functional exercise capacity in COPD patients following pulmonary rehabilitation with the primary outcome reported being the distance walked during the test (i.e. 6MWD). The 6MWD has demonstrated validity, reliability after one familiarisation test and the capacity to detect changes following pulmonary rehabilitation. In addition to assessing the outcomes of pulmonary rehabilitation, 6MWD may be used to quantify the magnitude of a patient's disability, prescribe a walking programme, identify patients likely to benefit from a rollator and to identify the presence of exercise-induced hypoxaemia. This review describes the applications of the 6MWD in patients with COPD undergoing pulmonary rehabilitation.     

Pulmonary rehabilitation: exercise training, nutritional intervention and patient education

The optimal care of patients with COPD generally requires combining pharmacologic and non pharmacologic therapies and the latter provides as pulmonary rehabilitation. Pulmonary rehabilitation, which includes exercise training, patient education, psychosocial support, nutritional intervention, and outcome assessments. Pulmonary rehabilitation has demonstrated effectiveness over multiple outcome areas such as dyspnea, exercise capacity, and health-related quality of life compared with other interventions such as pharmacologic therapy. However, it is not enough access for pulmonary rehabilitation, so effort should be made for easy access of this effective medical care.     

Efficacy of pulmonary rehabilitation]

Pulmonary rehabilitation is comprehensive and multidimensional care for patients with COPD and their families. The aim of pulmonary rehabilitation is for patients to achieve and maintain the individual's maximum level of independence and functioning in the communities. Recent investigation of well-designed studies confirmed the efficacy of lower extremity training, upper extremity training, and ventilatory muscle training in some selected patients. Patient education is a essential component. Pulmonary rehabilitation improves exercise tolerance, the symptoms of dyspnea and health-related QOL, and reduce the frequency and period of hospitalizations. Pulmonary rehabilitation programs include assessment and education of patient, exercise training, and chest physical therapy techniques. In our follow-up study in 100 patients with chronic pulmonary emphysema who participated in pulmonary rehabilitation programs, groups that continued exercise more than 30 minutes a day at home, had tendency to escape from progression of dyspnea after 19 months (mean).     

社区肺康复对轻中度慢性阻塞性肺疾病患者生存质量的影响

目的 探讨社区肺康复对轻、中度慢性阻塞性肺疾病(COPD)患者生存质量的影响.方法 对161例轻、中度COPD患者给予运动疗法、教育、心理社会与行为干预等肺康复干预措施,干预前后分别进行肺功能、呼吸困难、体质指数、6min步行测验、日常生活活动能力(ADL)和生活满意指数(LSIA)两个量表进行评估.结果 干预1年后患者的呼吸困难、6min步行测验、ADL和LSIA有显著改善(P＜0.01);肺功能、体质指数有改善(P＜0.05).结论 社区肺康复可提高轻、中度COPD患者的运动耐力,减轻呼吸困难症状,提高ADL,改善生活质量等,从而有效提高患者的生存质量.     

呼吸康复治疗对慢性阻塞性肺疾病患者呼吸困难、肺功能和运动能力的影响

目的观察中国传统和现代康复治疗对缓解期慢性阻塞性肺病(chronicobstructivepulmonarydisease,COPD)呼吸困难、运动能力和肺功能的影响。方法缓解期COPD门诊患者54例,随机分成传统康复组(33例)和现代康复组(21例);两组先进行康复教育,再行康复锻炼,治疗前后进行呼吸困难评分、肺功能和6min步行测试,康复锻炼1.5h/d,共3月。结果结果显示传统和现代康复对呼吸困难的有效率分别为75.76%和76.19%;传统康复组患者肺功能观察指标显著改善,现代康复组则肺功能改善不明显;两种方法均能增加患者6min步行距离,但两者差异无显著意义。结论两种治疗方法均显示对缓解期COPD患者呼吸困难、运动耐受能力和肺功能有较好的治疗效果,特别是传统康复方法能取得与现代康复相类似的临床治疗效果,在对肺功能的影响方面甚至要优于现代康复方法。     

家庭康复训练对慢性阻塞性肺疾病患者的影响

目的通过考察家庭康复训练对慢性阻塞性肺疾病(COPD)患者的影响,以探讨家庭康复锻炼的方法和效果。方法组织在1998-01/2002-12吉林军医学院附属中心医院接受治疗的COPD患者进行为期12周的以步行为主要锻炼内容的家庭康复训练。训练强度以往复运动实验(SWT)为准。测量记录肺功能、运动能力和呼吸困难等内容。结果训练12周后,康复训练组的FVC(%预期值),FEV(%预期值)和FEV1/FVC比率明显高于对照组(t=1.851～2.892,P<0.05);康复组患者SWT与对照组相比有明显改善(t=2.137～2.938,P<0.05);康复组患者的运动时间和距离明显高于对照组(t=2.892～2.912,P<0.01),心率和呼吸困难程度明显低于对照组(t=2.268～2.938,P<0.05)。结论简单的家庭康复训练,在COPD患者中取得了很好的训练效果,患者的运动能力和呼吸困难程度得到改善。     

Pulmonary rehabilitation of patients following thoracic and upper abdominal surgery

The incidence of pulmonary complications is high in patients undergoing thoracic and upper abdominal surgery. Such surgery requires that an incision be made into the patient's respiratory muscles. As a result, each respiration taken induces great pain, which makes patients breathe shallowly and prevents their taking deep breaths and coughing. This article takes a pathophysiological approach in examining the mechanisms involved in the development of pulmonary complications and critiques the effectiveness of rehabilitative interventions that are described in the published literature. Upper arm exercise is suggested as an effective and acceptable intervention to promote pulmonary rehabilitation for this group of patients.     

A prospective qualitative exploration of views about attending pulmonary rehabilitation

Background and Purpose . Pulmonary rehabilitation has been found to be an effective strategy for managing chronic obstructive pulmonary disease (COPD). However, attendance at such programmes is not optimal, therefore, this study aimed to develop an in‐depth understanding of views regarding attendance at pulmonary rehabilitation and experiences which may have shaped these views. Methods . An inductive qualitative study was carried out within the framework of Interpretative Phenomenological Analysis. Five female and four male individuals with COPD who had been referred for pulmonary rehabilitation participated in semi‐structured interviews. Interviews were conducted prior to participation in pulmonary rehabilitation. Results . Three main themes were identified that related to views about attending pulmonary rehabilitation. The first is entitled ‘Desired benefits of attending pulmonary rehabilitation’, which described realistic hopes about impact on daily life. The second theme was called ‘Evaluating the threat of exercise’, and it encompassed both positive and negative evaluations; some interviewees described fear and avoidance of exercise, while others were determined to overcome symptoms. These attitudes extended to views about pulmonary rehabilitation. The third theme was called ‘Attributing value to pulmonary rehabilitation’. Contrasting opinions about the value of attending pulmonary rehabilitation appeared to be influenced by the nature of prior interactions with health personnel and systems as well as information about the programme provided at referral. The referrer's attitude towards pulmonary rehabilitation appeared to be particularly influential. Conclusion . In summary, when considering rehabilitation attendance, potential participants are able to identify possible benefits, but previous experiences of symptoms and attitudes towards their condition can influence views both positively and negatively. Information and enthusiasm conveyed by the referring clinician, as well as previous interactions with health professionals can have powerful impact on views about attending. Referral practices should be informative and enthusiastic to increase the likelihood of uptake. Copyright © 2009 John Wiley & Sons, Ltd.     

康复锻炼对慢性阻塞性肺疾病患者心肺运动能力的影响

目的对慢性阻塞性肺疾病(COPD)患者进行康复锻炼,旨在检验康复锻炼能能够提高患者心肺运动能力的假设。方法患者接受为期12周的康复锻炼,每周训练4次,共48次。锻炼结束前进行15min的放松训练。每次锻炼时间约为1.5h。锻炼安排在晨练时间进行。锻炼计划实施前组织患者参加呼吸疾病健康教育,内容包括呼吸技术训练和呼吸肌锻炼。锻炼开始前和结束后分别对患者进行心肺运动能力评定。指标包括最大运动能力、无氧阈、最大摄氧量和6min步行试验(6MD)。结果康复锻炼后与锻炼前比较,患者最大运动能力(t=2.820,P=0.009)、无氧阈(t=2.278,P=0.038)、最大摄氧量(t=2.189,P=0.041)和6min步行试验(t=2.834,P=0.009)差异有显著性或非常显著性意义(P<0.05或P<0.01),心肺运动能力百分数变化差异也有显著意义(P<0.05或P<0.01)。结论康复锻炼可显著提高COPD患者心肺运动能力。     

Attacking the disease spiral in chronic obstructive pulmonary disease: an update

In chronic obstructive pulmonary disease (COPD) a pathophysiological cycle occurs such that locomotor muscle weakness and fatiguabilty exist, which in turn limit exercise performance both because of leg discomfort and also because anaerobic metabolism leads to lactic acid production. Since the lactic acid is buffered by bicarbonate there is consequent carbon dioxide (CO2) production. Patients with advanced COPD are flow limited and cannot excrete the CO2 by raising ventilation and thus these patients experience breathlessness which discourages exercise and, in turn, prompts further deconditioning. Structured exercise, termed pulmonary rehabilitation is at the core of reversing the cycle but novel strategies should be employed for patients with advanced disease and alternative therapeutic opportunities may soon be available to improve pulmonary mechanics.     

两种不同强度上下肢训练对老年COPD患者的疗效比较

目的比较两种不同强度的上下肢训练对老年COPD患者的疗效评价。方法采用随机分组的方法将73例稳定期老年COPD患者分为2组,分别接受2种不同强度的上下肢训练,为期12周。比较康复前后及2组患者的肺功能、6min步行距离、基线呼吸困难指数评分、体重指数的差异及2组的脱漏率。结果经过12周的两种不同强度的上下肢训练干预,高强度肺康复组在6min步行距离、呼吸困难程度评分较低强度肺康复组明显改善（P〈0．01）;但脱漏率明显增高（P〈0．05）。两组的肺功能、体重指数在康复前后无明显改变。结论对于老年稳定期COPD患者两种不同强度的上下肢训练均能改善其呼吸困难症状及运动耐力;高强度肺康复组较低强度肺康复组疗效明显;但脱漏率明显增高;而肺功能、体重指数两组在康复前后无明显改善。     

运动疗法加音乐疗法对COPD患者生活质量影响的研究

目的 评价运动加音乐疗法对改善慢性阻塞性肺疾病(COPD)患者生活质量的效果.方法 对40例中度和重度慢性阻塞性肺疾病患者进行6个月的运动康复训练和音乐治疗,在治疗前、后分别进行6 min步行试验(6MWT)测量和生活质量评价,然后进行统计学分析.结果 与训练前比较,患者训练后6 min行走距离较训练前明显延长(P=0.000);同时生活质量各方面(日常生活能力、社会活动能力和抑郁焦虑症状)都有明显改善(P=0.000).结论 对COPD患者实施长期、个体化的运动和音乐治疗可有效改善其生活质量.     

A comparison of twice- versus once-weekly supervision during pulmonary rehabilitation in chronic obstructive pulmonary disease

OBJECTIVE: To compare the effects of twice- versus once-weekly supervised pulmonary rehabilitation on exercise capacity and quality of life in patients with chronic obstructive pulmonary disease (COPD). DESIGN: Prospective, randomized, parallel-group study. SETTING: Hospital outpatient physiotherapy department. PARTICIPANTS: Patients with COPD. INTERVENTION: Group 1 (n=46) received 1 supervised exercise session a week and 2 unsupervised sessions; group 2 (n= 45) received 2 supervised exercise sessions a week and 1 unsupervised session for 6 weeks. Patients were assessed at baseline and at 6 weeks, 2 months, and 6 months. MAIN OUTCOME MEASURES: Incremental (ISWT) and endurance (ESWT) shuttle walk tests and Chronic Respiratory Disease Questionnaire (CRDQ). RESULTS: Sixty-six of 91 patients (group 1, n=34; group 2, n=32) completed the 6-week program. There was no significant difference in key outcome measures between the 2 groups (ISWT, 13.50m; 95% confidence interval [CI], -10.06 to 37.15m; ESWT, 72.64s; 95% CI, -96.01 to 241.29s; CRDQ total score, 2.54; 95% CI, -3.16 to 8.24). The results of the ESWTs suggest there may be an interaction between baseline exercise capacity and benefit of pulmonary rehabilitation, with more disabled patients achieving greater benefit if they are supervised twice weekly. Irrespective of group, allocation benefits after pulmonary rehabilitation had almost dissipated by 6 months. CONCLUSIONS: There was no difference in the effectiveness of twice- versus once-weekly supervised pulmonary rehabilitation. This study highlights the need for development of strategies that will maintain the improvement achieved by the initial pulmonary rehabilitation program.     

Pulmonary rehabilitation--exercise training and nutritional support

Exercise training, widely regarded as the cornerstone of pulmonary rehabilitation, is the best available means of improving exercise capacity, exertional dyspnea, and activities of daily living in COPD. However, optimal intensity of training, long-term benefits and more efficient ways for severe patients with COPD remain uncertain. Adjunctive strategies, such as neuromuscular electrical stimulation (NMES) and noninvasive positive pressure ventilation (NPPV), must be developed. Although nutritional status is an important determinant of symptoms, disability, and prognosis in COPD, present evidence suggests that nutritional supplementation alone may not be sufficient strategy. Nutritional support to be accompanied by exercise training and to attenuate systemic inflammation should be established. In addition, administration of orexigenic factor(e.g. ghrelin) may be new strategy for COPD patients with nutritional depletion.     

Pulmonary rehabilitation for patients with bronchiectasis: case reports

The effectiveness of pulmonary rehabilitation (PR) has been recognized in national and international guidelines and highlighted by the National Institute of Clinical Excellence as one of the six key priorities for improving the care of chronic obstructive pulmonary disease (COPD) patients. PR is likely to be effective in bronchiectasis as it is in COPD. We evaluated the efficacy of PR in the management of bronchiectasis. Three outpatients affected by bronchiectasis, with cough, sputum production, dyspnea, and decreased exercise tolerance, were submitted to five months of PR program consisting in treadmill walking, cycle ergometry, breathing exercises, and postural drainage with clapping percussion-vibratory-shaking. In all patients, after PR, chest X-ray showed that the obstructive disease decreased with bronchial wall thickness reduction. This improvement facilitated the performance of breath actions increasing the exercise tolerance and quality of life, evaluated respectively with the 6-minute walk test, the SF36, and the RPE Borg scale. The improvements in both exercise capacity and health status observed at the end of the PR program were maintained in a 6-month follow-up after the cessation of training with also a reduction of acute bronchial exacerbations. These results highlighted the potential role of PR in patients with bronchiectasis, however further investigations are needed to identify the most eligible patients and to optimize the training programs to maintain long term benefit. Chest x-ray may represent a relevant instrument to observe the clinical improvement of these patients, also when spirometric values do not change significantly.     

Factor analysis of quality of life, dyspnea, and physiologic variables in patients with chronic obstructive pulmonary disease before and after rehabilitation

OBJECTIVE: To identify the relationships between quality of life (QOL) and the clinical state using factor analysis pre- and postrehabilitation. Patients with chronic obstructive pulmonary disease (COPD) suffer from a significant physiologic impairment associated with an altered QOL. Comprehensive rehabilitative programs, including exercise training, have beneficial effects on exercise tolerance and QOL for these patients. DESIGN: Factor analysis (n = 6) was conducted using the data of 32 patients with COPD. Patients had been evaluated for QOL using the Nottingham Health Profile (NHP), spirometric values, dyspnea, and the variables assessed by an incremental exercise test at three levels of activity. All measurements were obtained pre- and postrehabilitation. RESULTS: Factor analysis showed that the following two factors characterize the pathophysiologic condition of patients with COPD: (1) the specific cardiorespiratory responses to incremental exercise test and the spirometric values; and (2) the QOL results. The factor analysis results differed with the testing time (pre, post) and the level of activity. CONCLUSIONS: QOL, as evaluated by a generic questionnaire and the clinical state of patients with COPD, was independent; this independence characterized the pathophysiologic condition of our patients. Our results reinforce the usefulness of different types of evaluation, especially pre- and postrehabilitation, because they reflect independent benefits used to understand the success and follow-up of rehabilitative programs.     

Long-term beneficial effects of lung volume reduction surgery on quality of life in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is characterized by progressive airflow limitation, which results in exertional dyspnea and physical disability. Subsequently, those cause a difficulty in performing routine activities of daily living and affect their health-related quality of life (HRQOL). Lung volume reduction surgery (LVRS) has been reported to be an effective treatment for selected patients with advanced COPD to improve pulmonary function, lung mechanics, exercise tolerance, and dyspnea. However, the long-term effects of LVRS on HRQOL have not been fully investigated. Therefore the effects of LVRS on generic and disease-specific HRQOL were assessed in patients with COPD following LVRS for 36 months. Nineteen patients (65.1 +/- 7.0 [mean +/- S.D.] years old) who underwent pulmonary rehabilitation plus LVRS (LVRS group), and 8 patients (67.2 +/- 5.8 years old) who did pulmonary rehabilitation but not LVRS (Medical group) were studied. In both groups, optimal medication was given throughout this period. Generic HRQOL and disease-specific HRQOL were evaluated before rehabilitation, and 3, 12, 24, and 36 months after LVRS. Following LVRS, the generic HRQOL was significantly improved and the disease-specific HRQOL was maintained up to 36 months. In Medical group, disease-specific HRQOL rapidly deteriorated. In conclusion, the long-term effects of LVRS on HRQOL in COPD patients were maintained up to 36 months compared with Medical group. Both generic and disease-specific HRQOL changed differently, suggesting the importance of both assessments especially in long-term follow up.     

以呼吸生理为导向的康复锻炼对慢性阻塞性肺疾病预后影响的随机对照研究

目的 观察以呼吸生理为导向的呼吸康复锻炼在慢性阻塞性肺疾病(COPD)康复治疗中的价值.方法 按2006年慢性阻塞性肺疾病全球倡议(GOLD)标准选择60例稳定期重度至极重度COPD患者,按随机原则分为3组,每组20例.A组给予以呼吸生理为导向的呼吸康复锻炼8周,每日3次,每次15 min.B组给予缩唇呼吸康复锻炼8周,每日3次,每次15 min.C组不给予呼吸康复锻炼.分别测定锻炼前后6 min步行距离(6MWD)、呼吸困难评分(MRC)、日常生活活动能力(ADL)评分、最大呼气口腔压(MEP)、最大吸气口腔压(MIP)及生存质量(QOL)评分.结果 A、B、C组在呼吸康复锻炼中分别有3、5、5例退出试验.A、B组呼吸康复锻炼后MRC评分较锻炼前有显著下降(P均<0.01),而两组间差异无统计学意义(P>0.05).A、B组呼吸康复锻炼后6MWD、ADL评分、MEP、MIP均较锻炼前显著增加,且A组明显高于B组(P<0.05或P<0.01).A、B组呼吸康复锻炼后身体状况、呼吸短促、社会活动、家务工作以及A组不安评分均较锻炼前显著改善(P<0.05或P<0.01);而锻炼前后心情、头痛和食欲评分差异均无统计学意义(P均>0.05).A、B组间呼吸康复锻炼后QOL评分比较差异均无统计学意义(P均>0.05).结论 缩唇呼吸锻炼和以呼吸生理为导向的呼吸康复锻炼均能明显改善重度至极重度COPD患者的呼吸困难、提高ADL和QOL评分,增加运动耐力和呼吸肌功能;而以呼吸生理为导向的呼吸康复锻炼效果显著,可认为是重度至极重度COPD患者进行呼吸康复锻炼更为有效的方法.     

Synergetic interactions between rehabilitation and pharmacotherapy in COPD

BACKGROUND: Once viewed as an irreversible condition, chronic obstructive pulmonary disease (COPD) is now considered as a preventable and treatable disease. The past ten years of research have clearly indicate that dyspnea, exercise tolerance and quality of life can be improved considerably with appropriate therapeutic interventions that include pharmacological and non-pharmacological components. It is also becoming evident that it is the concomitant use of appropriate pharmacotherapy and non-pharmacological approaches, such as exercise training and pulmonary rehabilitation, that offers the best hope for an optimal status. PURPOSE: The objective of this short paper is to review the rationale of combining pharmacological and non-pharmacological therapeutic approaches to optimize functional status and quality of life in patients with COPD. PRINCIPAL FINDINGS: Optimal bronchodilation is the mainstay of treatment. Leg fatigue will prevent patients with COPD from obtaining full advantage of bronchodilation. Quadriceps fatigue during cycling exercise is linked to events taking place within the muscle providing a muscular and metabolic basis to explain the observation that some patients with COPD develop contractile fatigue after exercise. Muscle fatigue can be improved with exercise training. Pharmacotherapy and exercise training offer the best hope for an optimal status in COPD. CONCLUSION: Our goals are to stimulate interest in COPD, provide a strong case against the nihilistic approach to this disease to ultimately raise the standard of care to the benefit of the numerous patients afflicted by this condition.