Treino de exercício na doença pulmonar crónica

Exacerbation and functional capacity of patients with COPD undergoing an exercise training program: longitudinal study

Objective To analyze if there is influence of body weight, body mass index (BMI), body composition, dyspnoea, grip strength and tolerance to exertion in the occurrence of exacerbation during a 12-month follow up of patients with COPD who underwent a physical training program. Material and methods Sixty three patients were distributed in two groups, (Exacerbation Group — EG, n = 29; Non-Exacerbated Group — NEG, n = 34). The Mann Whitney test was used for the comparison between groups, the Friedman test (posthoc Dunn) to compare the assessments and the logistic regression analysis, with a significance level of p < 0.05. Results There is a significant difference between the groups in age and walked distance (WD) in the sixminute walk test (6MWT). The WD was reduced in 6th, 9th and 12th month revaluation compared to baseline and 3 months for the EG. Logistic regression analysis showed a significant interaction between the lean body mass and the WD, BMI with the lean body mass and the BMI with the WD, this and the isolated dyspnoea, and lean body mass with body weight. Conclusion Involving several variables along the follow up of patients with COPD in physical therapy programs is important, since it may prevent or reduce the chance of the occurrence of exacerbations. In addition, older patients with less tolerance to physical activity had a higher number of episodes of exacerbation, even when participating in a physiotherapy program associated to exercise training.

Evolution of functional capacity and health status two years after a pulmonary rehabilitation programme

BACKGROUND

Pulmonary rehabilitation programs (PRP) have been shown to improve exercise capacity and health status and to reduce dyspnoea and use of healthcare resources, in patients with chronic lung disease. These benefits usually wane after the programs conclusion.

AIM

Evaluate functional capacity and health status 2 years after the end of a PRP.

METHODS

Retrospective study of patients who took part in PRP. After PRP, patients who reported a physically active lifestyle were included in the active group (AG). The other patients were considered as the control group (CG). Functional capacity was evaluated with 6minute walk distance (6MWD) and health status with St George's Respiratory Questionnaire (SGRQ).

RESULTS

Thirty-two patients were included, 24 in the AG and 8 in the CG. Immediately after PRP, there was a significant improvement in the 6MWD and SGRQ global score, for both groups. After completing PRP, in the AG, there was a decline in the mean 6MWD when evaluated at 6 months, 1 and 2 years and also in health status. However, after 2 years, the AG continued to show an average improvement of 32 m (p=0.03) in the 6MWD and at least 4 points in SGRQ compared to pre-PRP, while in the CG, there was a clinically significant decline in 6MWD (-34 m) and SGRQ score (13 points worse).

CONCLUSION

Despite the progressive decline of benefits gained after completing PRP, in the AG these are still significantly positive after 2 years. An active lifestyle seems to help maintain the benefits of the Rehabilitation Program.