Pulmonary rehabilitation confers long-term benefits in patients with COPD
Patients with COPD who completed an 8-week pulmonary rehabilitation program had sustained improvements in anxiety and quality of life at 2-year follow-up, according to findings published in Chest.
However, short-term improvements in dyspnea, depression and stress observed after the 8-week program were not maintained at 2-year follow-up.
“To date, in most of the research that has been carried out in pulmonary rehabilitation, COPD patients were followed for no more than 1 year,” Abebaw M. Yohannes, PhD, professor in the department of physical therapy at the School of Behavioral and Applied Sciences at Azusa Pacific University in California, told Healio. “Thus, the long-term benefits beyond this point had not been adequately examined. Our research shows that some of the benefits gained at 8 weeks persist as long as 2 years.”
Researchers evaluated 165 adults with COPD (mean age, 72.2 years; 55% men) who completed an 8-week, community-based, comprehensive pulmonary rehabilitation program. The program comprised twice-weekly 2-hour sessions of aerobic exercise and an educational program. Patients were also encouraged to perform 30 minutes of walking exercise daily at home. At baseline, 8 weeks and 2 years, researchers assessed dyspnea, quality of life, anxiety and depression, as well as exercise capacity at baseline and 8 weeks.
At 8 weeks, the researchers reported significant improvements from baseline in dyspnea (modified Medical Research Council questionnaire score, 2.5 vs. 2.8), quality of life (St. George’s Respiratory Questionnaire score, 45.1 vs. 50.8), anxiety (Anxiety Inventory for Respiratory Disease score, 7.8 vs. 9.2), depression (Depression Anxiety Stress Scale score, 7.6 vs. 9.6) and exercise capacity (Incremental Shuttle Walk Test score, 285 m vs. 220 m). Ninety-three percent of patients reported feeling much better after completing the pulmonary rehabilitation program, according to the results.
At 2-year follow-up, the improvements were maintained for anxiety symptoms (8.5) and quality of life scores (47.3), according to the results.
Initial elevated levels of dyspnea, depression, anxiety and decreased exercise capacity were predictors of greater improvement in quality of life at 2 years in multivariate analysis (P < .001 for all). Furthermore, subgroup analysis in patients with COPD with potential clinically significant high load of anxiety, depression and stress symptom improvement at baseline gained at 8 weeks were maintained up to 2 years (P < .001 for all).
“Our findings highlight the value of pulmonary rehabilitation for this vulnerable patient group,” Yohannes told Healio.
The researchers noted several limitations of the study, including its observational design and lack of a control group.
“Future studies need to focus on including a maintenance program and using a prospective randomized controlled design,” Yohannes said. “In addition, studies should explore the potential benefits gained in terms of reducing hospitalization and premature mortality.”
For more information:
Abebaw M. Yohannes, PT, PhD, FCCP, ATSF, can be reached at firstname.lastname@example.org.