Back to Journals » International Journal of Chronic Obstructive Pulmonary Disease » Volume 10 » Issue 1

Personalized pulmonary rehabilitation and occupational therapy based on cardiopulmonary exercise testing for patients with advanced chronic obstructive pulmonary disease

Authors Maekura R, Hiraga T, Miki K, Kitada S, Miki M, Yoshimura K, Yamamoto H, Kawabe T, Mori M

Received 11 April 2015

Accepted for publication 16 June 2015

Published 3 September 2015 Volume 2015:10(1) Pages 1787—1800


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 4

Editor who approved publication: Dr Richard Russell

Ryoji Maekura, Toru Hiraga, Keisuke Miki, Seigo Kitada, Mari Miki, Kenji Yoshimura, Hiroshi Yamamoto, Toshiko Kawabe, Masahide Mori

Department of Respiratory Medicine and Rehabilitation, National Hospital Organization Toneyama Hospital, Toyonaka City, Osaka, Japan

Take-home summary: Personalized pulmonary rehabilitation including occupational therapy improves the prognosis of patients with advanced COPD.
Purpose: We previously reported that patients with chronic obstructive pulmonary disease (COPD) exhibit three exercise-induced life-threatening conditions: hypoxemia, sympathetic overactivity, and respiratory acidosis. We aimed to verify whether mortality in patients with advanced COPD could be reduced by a personalized pulmonary rehabilitation (PPR) program in hospital, which determines individual safe ranges and includes occupational therapy (PPR-OT), to prevent desaturation and sympathetic nerve activation during daily activities.
Patients and methods: The novel PPR-OT program was evaluated in a retrospective study of patients with COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] Grade D) who underwent cardiopulmonary exercise testing (CPET) between April 1990 and December 1999. They received regular treatment without the proposed therapy (control group: n=61; male-to-female ratio [M:F] =57:4; mean age: 68.5±6.7 years) or with the proposed therapy (PPR-OT group: n=46; M:F =44:2; mean age: 68.7±7.1 years). A prospective observational study included patients with COPD receiving home oxygen therapy (HOT) between April 1995 and March 2007 to compare the survival rates of the control group (n=47; M:F ratio =34:13; mean age: 71.3±10.0 years) and the PPR-OT group (n=85; M:F =78:7; mean age: 70.7±6.1 years) who completed the proposed therapy. Survival after CPET or HOT was analyzed using Cox proportional-hazards regression and Kaplan–Meier analyses.
In both studies, the program significantly improved all-cause mortality (retrospective study: risk ratio =0.389 [range: 0.172–0.800]; P=0.0094; log-rank test, P=0.0094; observational study: risk ratio =0.515 [range: 0.296–0.933]; P=0.0291; log-rank test, P=0.0232]. At 5 years and 7 years, all-cause mortality was extremely low in patients in the PPR-OT group receiving HOT (18.8% and 28.2%, respectively), compared to that in the control group (34.0% and 44.7%, respectively). Survival of patients with life-threatening pathophysiological conditions also greatly improved.
Conclusion: The PPR-OT program improved the survival of patients with advanced COPD probably because it modified life-threatening conditions.

COPD, prognosis, pulmonary rehabilitation, occupational therapy, cardiopulmonary exercise testing

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]


Other article by this author:

Effects of tiotropium on sympathetic activation during exercise in stable chronic obstructive pulmonary disease patients

Yoshimura K, Maekura R, Hiraga T, Kitada S, Miki K, Miki M, Tateishi Y

International Journal of Chronic Obstructive Pulmonary Disease 2012, 7:109-118

Published Date: 2 May 2012

Readers of this article also read:

C-reactive protein levels in stable COPD patients: a case-control study

Silva DR, Gazzana MB, Knorst MM

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:1719-1725

Published Date: 31 August 2015

Modified Medical Research Council scale vs Baseline Dyspnea Index to evaluate dyspnea in chronic obstructive pulmonary disease

Perez T, Burgel PR, Paillasseur JL, Caillaud D, Deslée G, Chanez P, Roche N

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:1663-1672

Published Date: 18 August 2015

Safety of inhaled glycopyrronium in patients with COPD: a comprehensive analysis of clinical studies and post-marketing data

D’Urzo AD, Kerwin EM, Chapman KR, Decramer M, DiGiovanni R, D’Andrea P, Hu H, Goyal P, Altman P

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:1599-1612

Published Date: 11 August 2015

Relation between systemic inflammatory markers, peripheral muscle mass, and strength in limb muscles in stable COPD patients

Ferrari R, Caram LMO, Faganello MM, Sanchez FF, Tanni SE, Godoy I

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:1553-1558

Published Date: 6 August 2015

Is dynamometry able to infer the risk of muscle mass loss in patients with COPD?

Ramos D, Bertolini GN, Leite MR, Carvalho Junior LCS, da Silva Pestana PR, Santos VR, Fortaleza ACS, Rodrigues FMM, Ramos EMC

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:1403-1407

Published Date: 21 July 2015

Underdiagnosis and prognosis of chronic obstructive pulmonary disease after percutaneous coronary intervention: a prospective study

Almagro P, Lapuente A, Pareja J, Yun S, Garcia ME, Padilla F, Heredia JL, De la Sierra A, Soriano JB

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:1353-1361

Published Date: 16 July 2015

Pulmonary hemodynamic profile in chronic obstructive pulmonary disease

Portillo K, Torralba Y, Blanco I, Burgos F, Rodriguez-Roisin R, Rios J, Roca J, Barberà JA

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:1313-1320

Published Date: 14 July 2015