Results of a Home-Based Training Program for Patients With COPD

doi:10.1378/chest.118.1.106

Chest

Volume 118, Issue 1, July 2000, Pages 106-114

https://doi.org/10.1378/chest.118.1.106 Get rights and content

Objectives

To have a group of COPD patients undergo a simple program of home-based exercise training, using the shuttle walking test (SWT) to standardize the intensity of training.

Methods

Sixty patients participated, randomly distributed into two groups (rehabilitation and control) of 30 patients each. The following evaluations were carried out at baseline and at 12 weeks: (1) pulmonary function studies; (2) SWT; (3) submaximal intensity resistance test; (4) cycle ergometer test; (5) quality of life; and (6) dyspnea. The rehabilitation group underwent a lower-extremity training program. Walking was selected as the type of exercise. The intensity of training was set at 70% of the maximum speed attained on the SWT. Divided sessions were held, lasting 1 h, 6 days/wk, at home, with a checkup every 2 weeks. The duration of the program was 12 weeks.

Results

The following patients completed the study: 20 patients (66.6%) from the rehabilitation group (mean [± SD]) age, 64.3 ± 8.3 years; mean FEV₁, 41.7 ± 15.6% of predicted); and 17 patients (56.6%) from the control group (mean age, 63.1 ± 6.9 years; mean FEV₁, 40 ± 16.4% of predicted). We found no changes in pulmonary function or effort parameters (SWT or cycle ergometer) in the rehabilitation group at 12 weeks. A twofold increase (1,274 ± 980 to 2,651 ± 2,056 m; p < 0.001) was achieved in the submaximal intensity resistance test, with less dyspnea at the conclusion of the test (p = 0.05). Significant improvement also was achieved in basal dyspnea and, both statistically and clinically, in the quality of life. Significant changes were not achieved in the control group patients.

Conclusions

A simple home-based program of exercise training achieved improvement in exercise tolerance, posteffort dyspnea, basal dyspnea, and quality of life in COPD patients.

Section snippets

Patients

We studied 60 patients who had COPD diagnosed in accordance with the European Respiratory Society Consensus Statement,¹ which defines this illness as a disorder characterized by decreased maximum expiratory flow and slow forced emptying of the lungs that is slowly progressive, irreversible, and does not change markedly over several months. All patients were in a stable phase of their disease with optimal drug management (ie, bronchodilator therapy and oxygen therapy, if necessary). The criteria

Results

Ten patients dropped out of the rehabilitation group: 6 left for lack of cooperation (20%), and 4 were excluded due to acute exacerbation of their underlying pathology. Thirteen patients dropped out the control group: 7 did not cooperate with evaluations (23%); 4 had acute exacerbations; 1 had suffered a cerebral vascular accident; and 1 was waiting for prostate cancer surgery. Twenty patients from the rehabilitation group and 17 from the control group completed the study.

Baseline pulmonary

Discussion

With our simple home-based program of standardized training for the muscles of ambulation, our group of COPD patients with moderate disease showed improvement in their tolerance of submaximal exercise, in dyspnea, and in quality of life. These results are similar to those found in the literature,⁷^,⁸ although the latter were obtained through rather complex rehabilitation programs.

We did not find changes in pulmonary function or in arterial blood gas levels.13, 14, 15, 16 We also did not find

ACKNOWLEDGMENT

The authors thank Dr. Cayuela for his assistance in the statistical analyses, and Drs. Cejudo and Whaley for their assistance in the translation of the manuscript into English.

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Most patients with COPD do not maintain exercise training after pulmonary rehabilitation (PR).
Does a 12-month home-based, minimal-equipment strength training program after PR have an effect on dyspnea, exercise capacity, and patient-reported outcomes in patients with COPD?
In a parallel-arm multicenter study across four Swiss PR clinics, patients with COPD were allocated randomly (1:1 ratio) into an intervention group (IG; home-based strength training program) or control group (CG; usual care). The primary outcome was change in Chronic Respiratory Questionnaire (CRQ) dyspnea scale score from baseline to 12 months. Secondary outcomes were change in exercise capacity (1-min sit-to-stand-test [1MSTST], 6-min walk test [6MWT]), health-related quality of life, exacerbations, and symptoms. We assessed the IG’s experience by interviews at study end. Main analyses were based on the intention-to-treat approach, and adjusted linear regression models were used.
One hundred twenty-three patients with COPD (IG, n = 61; CG, n = 62) were randomized, 61 of whom were women and whose mean ± SD age was 66.8 ± 8.1 years and mean ± SD FEV₁ was 39.3 ± 15.3% predicted. One hundred four participants completed 12 months of follow-up (IG, n= 53; CG, n= 51). Of the 53 IG participants, 37 participants (70%) conducted the training until study end. We found no difference in change in CRQ dyspnea scale score over 12 months (adjusted mean difference, 0.28; 95% CI, –0.23 to 0.80; P = .27). We found moderate evidence for a difference in 1MSTST repetitions favoring the IG (adjusted mean difference, 2.6; 95% CI, 0.22-5.03; P = .033), but no evidence for an effect in other outcomes. Seventy-nine percent of the IG reported positive effects that they attributed to the training.
The home exercise program had no effect on dyspnea, but improved 1MSTST performance and patient-perceived fitness. The supported program was well accepted by patients with COPD and may facilitate continued exercise training at home.
ClinicalTrials.gov; No.: NCT03461887; URL: www.clinicaltrials.gov
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Challenges with self-management are a major contributor to poor outcomes among adults with chronic obstructive pulmonary disease (COPD). The causes of poor self-management in COPD are manifold, and they arise from physical, cognitive, socioeconomic, environmental and societal sources. To address this complexity, we developed the Supporting self-Management Behaviors in Adults with COPD (SaMBA-COPD) model, which uses lay health coaches to identify a patient's barriers to effective COPD self-management and provide tailored support to help them overcome those barriers, reduce their symptoms and need for urgent care and improve their quality of life. The 6-month intervention includes referral of patients to a pharmacist for prescription of antibiotic and oral steroid “rescue packs” and support for a structured home exercise routine. All interactions of coaches and patients will take place by telephone or video call. We will test the feasibility and preliminary efficacy of SaMBA-COPD in a trial of 58 patients randomized 1:1 to the intervention or a COPD education control. Outcomes will be assessed at 6 and 9 months. Data from the trial will be used to inform the design of a fully powered, multi-site randomized trial of the intervention.
Effect of pulmonary rehabilitation programs including lower limb endurance training on dyspnea in stable COPD: A systematic review and meta-analysis
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Citation Excerpt :
On average, participants allocated to rehabilitation programs had significantly greater changes in MRC (MD, −0.64; 95% CI, −0.99 to −0.30; p = 0.0003; I2 = 68%) (Fig. 3A). Transitional dyspnea index (TDI) was evaluated in 5 studies with 187 participants [26,29,32–34]. The mean change in TDI was significantly greater in the intervention group than in the control group (MD, 1.95; 95% CI, 1.09 to 2.81; p = 0.0001; I2 = 65%) (Fig. 3B).
Pulmonary rehabilitation (PR) is recommended as an effective treatment for patients with chronic obstructive pulmonary disease (COPD). Previous meta-analyses showed that PR improves exercise capacity and health-related quality of life (HRQOL). However, they did not evaluate the effect of PR on the sensation of dyspnea.
We searched six databases in May 2019 for randomized controlled trials (RCTs) that examined PR, including supervised lower limb endurance training as a minimal essential component that was continued for 4–12 weeks, in patients with stable COPD, with changes from baseline dyspnea as a primary outcome. Secondary outcomes were changes in exercise capacity, HRQOL, activity of daily life (ADL), physical activity (PA), and adverse events. We calculated the pooled weighted mean difference (MD) using a random effects model. We identified 42 studies with 2150 participants. Compared with the control, PR improved dyspnea, as shown using the British Medical Research Council (MRC) questionnaire (MD, −0.64; 95% CI, −0.99 to −0.30; p = 0.0003), transitional dyspnea index (MD, 1.95; 95% CI, 1.09 to 2.81; p = 0.0001), modified Borg score during exercise (MD, −0.62; 95% CI, −1.10 to −0.14; p = 0.01), and Chronic Respiratory Questionnaire (CRQ) dyspnea score (MD, 0.91; 95% CI, 0.39 to 1.44; p = 0.0007). PR significantly increased exercise capacity measured by the 6 min walking distance time, peak workload, and peak VO₂. It improved HRQOL measured by the St. George's Respiratory Questionnaire and CRQ, but not on PA or ADL. These results indicated that PR programs including lower limb endurance training improve dyspnea, HRQOL, and exercise capacity in patients with stable COPD.
The impact of exercise training on fatigue in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis
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Of these, 405 were excluded after the abstracts were read and 89 full-texts were analysed for inclusion criteria. Sixteen out of the 48 studies evaluating perceived fatigue satisfied the inclusion criteria and were included in the meta-analysis23–38 (Fig. 1). No study out of the other 41 evaluating changes in performance fatigue satisfied the inclusion criteria.
Fatigue can be divided in perceived fatigue, the feeling of exhaustion or lack of energy, and performance fatigue, the reduction in muscle force/activation during a given task. This meta-analysis evaluates the impact of exercise training on fatigue, compared with normal care in patients with COPD.
We searched randomised controlled trials on MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and CINAHL databases from their inception to December, 31st 2019 using the terms COPD, Fatigue, Fatigability, Muscle activation, Muscle endurance, Muscle Performance, Voluntary Activation, Motoneuron excitability, Force Development, Exercise, AND Rehabilitation.
We evaluated 494 potential articles. Sixteen, all evaluating perceived fatigability, satisfied the inclusion criteria and were included. Twelve studies (463 patients) assessed fatigue by the Chronic Respiratory Questionnaire showing that intervention improved significantly more than the control group [SMD 0.708; 95% CI 0.510, 0.907; p < 0.001; I² = 34.3%; p = 0.116]. Two studies (68 patients) using the Fatigue Impact Scale, did not find any significant differences between groups [SMD −0.922; 95%CI −2.258, 0.413; p = 0.176; I² = 83.9%; p = 0.013]. Two studies (82 patients) assessed perceived fatigue by the Fatigue Severity Scale: the intervention improved significantly more than the control group [SMD −2.282; 95%CI −2.870, −1.699; p < 0.001; I² = 64.6%, p = 0.093]. No study evaluating performance fatigue was found.
This study provided low-quality evidence of a positive impact of different exercise training programs on perceived fatigue in patients with COPD. Further studies are needed to assess the effects of exercise training on fatigue and to test tailored programs.
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Chest

Clinical Investigations: RehabilitationResults of a Home-Based Training Program for Patients With COPD

Objectives

Methods

Results

Conclusions

Section snippets

Patients

Results

Discussion

ACKNOWLEDGMENT

Chest

Lancet

Chest

Chest

Arch Bronconeumol

Chest

Clin Chest Med

Arch Bronconeumol

Control Clin Trial

Clin Chest Med

Optimal assessment and management of chronic pulmonary obstructive disease (COPD): the European Respiratory Society Task Force.

Eur Respir J

Pulmonary rehabilitation research

NIH workshop summary Am J Respir Crit Care Med

Position paper of the American Association of Cardiovascular and Pulmonary Rehabilitation.

J Cardiopulm Rehabil

Principles and practice of pulmonary rehabilitation.

Physical rehabilitation for the chronic bronchitis: results of a controlled trial of exercises in home.

Thorax

Quality of life in patients with chronic obstructive pulmonary disease improves after rehabilitation at home.

Eur Respir J

Long term benefits of rehabilitation at home on quality of life and exercise tolerance in patients with chronic obstructive pulmonary disease.

Thorax

Long-term effects of home rehabilitation on physical performance in chronic obstructive pulmonary disease.

Am J Respir Crit Care Med

The effects of a community-based pulmonary rehabilitation program on exercise tolerance and quality of life: a randomized controlled trial.

Eur Respir J

Clinical Investigations: Rehabilitation
Results of a Home-Based Training Program for Patients With COPD