Quality of Life and Exercise Tolerance in Chronic Obstructive Pulmonary Disease: Effects of a Short and Intensive Inpatient Rehabilitation Program.

Fuchs-Climent D, Le Gallais D, Varray A, et al (Laboratoire de Physiologie des Interactions, Service Central de Physiologie; Laboratoire Interface Biopsychosociale, Hopital Arnaud de Villeneuve, Universite Montpellier, Montpellier; La Clinique du Souffle, Osseja, France), Am J Phys Med Rehabil. 1999;78:330-335.

It has been well documented that patients with chronic obstructive pulmonary disease (COPD) exhibit a decrease in exercise tolerance marked by a diminished maximal oxygen uptake ([Vo.sub.2]max) and a lower ventilatory anaerobic threshold. In addition to these physiological impairments, patients with COPD also display psychological disorders that can be manifested as depression, anxiety, social isolation, and impaired quality of life (QOL). The purposes of this study were: (1) to determine the impact of a 3-week intensive inpatient rehabilitation program on the QOL of patients with COPD and (2) to examine the correlations between QOL measures and physiologic variables throughout the exercise program.

Thirty-two patients diagnosed with COPD by spirometric testing who were nonsmokers (20 men, 12 women) were included in this study. The researchers determined that the subjects were clinically stable with optimal drug management (ie, no infections in the last 2 months, stable blood gases, no supplemental oxygen) and that they had no comorbidities. Upon entering and exiting the program, subjects completed a spirometric evaluation of expiratory flow-volume curves, responded to a QOL questionnaire (ie, the Nottingham Health Profile, which measures dimensions of physical mobility, pain, social isolation, emotional reactions, energy, and sleep), and performed an incremental calibrated cycle ergometer exercise test to determine the symptom-limited [Vo.sub.2]max and the heart rate corresponding to the ventilatory anaerobic threshold.

The subjects participated in an inpatient rehabilitation program 5 days a week at the Clinique du Souffle in Osseja, France. The program lasted for 3 successive weeks and included (1) health education (2 hours/week)with information about pulmonary disease, medications, healthy daily living strategies, and psychological problems linked to COPD; (2) respiratory therapy (1 hour/day) consisting of aerosol or drainage; (3) personalized training (4 hours/day); and (4) adapted physical activity (15 minutes/day). The personalized training was composed of cycling or walking (using the entry-level ventilatory anaerobic threshold and corresponding heart rate to set the intensity), gymnastics, and relaxation. The cycling was performed for 10 minutes at ventilatory anaerobic threshold intensity, followed by 5 minutes of active recovery, and was repeated 3 times for a total of 45 minutes. After cycling, subjects stretched for 10 minutes. The walking component was described as 45 minutes of nature walking at ventilatory anaerobic threshold intensity followed by 1 hour and 15 minutes of walking at a lower speed, for a total of 2 hours. The gymnastics included 1 hour of weight training, abdominal exercises, and stretching followed by 30 minutes of relaxation. Cycling, gymnastics, and relaxation were done on the same half-day and walking was done on the other half-day.

The results of this study revealed a significant improvement (25%) in all QOL scores except pain. Power (watts) measured during cycle ergometry increased significantly by 13.2% and 14.1% at ventilatory anerobic threshold and maximal power, respectively. Symptom-limited [Vo.sub.2]max also increased significantly by 14.8%, although no significant improvement occurred in spirometric values. However, the QOL scores were not significantly correlated with the physiologic variables before or after rehabilitation efforts.

According to the authors, it would appear that a short, intense, inpatient rehabilitation program offers the same positive psychological and physiological benefits to patients with COPD as an outpatient program of lower intensity and longer duration. The lack of correlation between QOL scores and physiologic parameters for this short program led the authors to conclude that these 2 factors should be given separate, yet equal, consideration when determining the effectiveness of a rehabilitation program such as the one described in this study. Although QOL is a subjective assessment, it measures the individual's perception of improvement as a result of rehabilitation efforts. Therefore, the authors believed that an improvement in QOL scores may be the best guarantee of adherence to continuing self-care strategies for patients with COPD.

Nancy B Schuster, PT Community Health Services Portland, Me