The likelihood of improving physical activity after pulmonary rehabilitation is increased in patients with COPD who have better exercise tolerance
Received 25 May 2018
Accepted for publication 22 August 2018
Published 24 October 2018 Volume 2018:13 Pages 3515—3527
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 2
Editor who approved publication: Dr Richard Russell
Christian R Osadnik,1–4,* Matthias Loeckx,1,5,6,* Zafeiris Louvaris,1,7 Heleen Demeyer,1,6 Daniel Langer,1,6 Fernanda M Rodrigues,1,6 Wim Janssens,6,8 Ioannis Vogiatzis,7,9 Thierry Troosters1,6
1Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; 2Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia; 3Monash Lung and Sleep, Monash Health, Melbourne, Victoria, Australia; 4Institute for Breathing and Sleep, Melbourne, Victoria, Australia; 5Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg; 6Respiratory Division, University Hospitals, KU Leuven, Leuven, Belgium; 7Faculty of Physical Education and Sports Sciences, National and Kapodistrian University of Athens, Athens, Greece; 8Department of Chronic Disease, Metabolism and Aging, KU Leuven, Leuven, Belgium; 9Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK
*These authors contributed equally to this work
Purpose: Pulmonary rehabilitation (PR) enhances exercise tolerance in patients with COPD; however, improvements in physical activity (PA) are not guaranteed. This study explored the relationship between baseline exercise tolerance and changes in PA after PR.
Materials and methods: Patient data from prospective clinical trials in the PR settings of Athens and Leuven (2008–2016) were analyzed. Validated PA monitors were worn for 1 week before and after a 12-week program. The proportion of patients who improved PA levels ≥1,000 steps/day (“PA responders”) after PR was compared between those with initial 6-minute walk distance [6MWDi] <350 m and ≥350 m. Baseline predictors of PA change were evaluated via univariate and multivariate logistic regression analyses.
Results: Two hundred thirty-six patients with COPD (median [IQR] FEV1 44 [33–59] % predicted, age 65±8 years, 6MWDi 416 [332–486] m) were included. The proportion of “PA responders” after PR was significantly greater in those with higher vs lower 6MWDi (37.9% vs 16.4%, respectively; P<0.001). 6MWDi group classification was the strongest baseline independent predictor of PA improvement (univariate OR 3.10, 95% CI 1.51–6.36).
Conclusion: The likelihood of improving PA after PR is increased with greater 6MWDi. Baseline exercise tolerance appears as an important stratification metric for future research in this field.
Keywords: exercise and pulmonary rehabilitation, COPD, physical activity, clinical respiratory medicine, responder analysis
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