No abstract

This study tested the effect of two methods of training, one individualized at the heart rate corresponding to the gas exchange threshold (GET) and the other at the heart rate corresponding to 50% of maximal heart rate reserve, on maximal and submaximal cardiorespiratory response in 24 patients with chronic airway limitation (CAL).The patients were randomly assigned to either the individualized training group (IT; n=12) or the standardized training group (ST; n=12). The training programme consisted of 4 weeks of stationary bicycle exercise, 5 days·week -1 .Before reconditioning began, the target level based on heart rate was not significantly different between groups (109±4 versus 110±3 beats·min -1 , in IT and ST, respectively). Post-training, a significant increase in symptom-limited oxygen uptake (V 'O 2 ,sl) and maximal O 2 pulse was found in IT, whereas ST exhibited no significant change. In each group, GET was statistically increased in much the same way as V 'O 2 ,sl, with a higher increase in IT (p<0.01) than ST (p<0.05). Nevertheless, IT exhibited a concomitant and gradual decrease in minute ventilation (V 'E), carbon dioxide production (V 'CO 2 ), and venous lactate concentration ([La]), whereas ST presented no significant change in these parameters (intergroup p<0.01). Breathing pattern was also altered after IT, at the same metabolic level and at the same ventilation level (intergroup p<0.05). Cardiac responses were modified in the two groups. At the same metabolic level, a significantly lower cardiac frequency was found both for IT and ST (intragroup p<0.05 after training). In contrast, the increase in O 2 pulse was only significantly higher in IT after training.These data show the greater efficiency of an individualized training protocol based on determination of gas exchange threshold as compared to a standardized protocol, in improving exercise performance, when applied to a patient group. Despite an apparently similar target training level, the individualized method clearly optimized the physiological training effects in patients with chronic airway limitation and, more particularly, decreased their ventilatory requirement.

No abstract

Although the benefits of pulmonary rehabilitation (PR) have been demonstrated in patients with COPD, most studies suggest that short-term programs are insufficient to maintain the benefits beyond a post-discharge period of 6 months to 1 year. We were interested to evaluate the effects of an innovative maintenance intervention compared with a usual after-care. Forty moderate to severe COPD patients, who had just completed their first inpatient PR, were consecutively included in either a maintenance group (MG) or a standard after-care group. The maintenance program was coordinated within a health-care network including self-help associations, and offered weekly activities. We measured the 6-min walk distance (6MWD), the quality of life using the St George Respiratory Questionnaire (SGRQ), the dyspnea, the maximal workload and the health-care utilization. Data were collected at respiratory clinic admission and discharge, and at 6- and 12-month visits after the PR. After 12 months, we found statistically and clinically significant differences in favor of the MG in 6MWD (74 m; p < or = 0.01) and in the three domains of SGRQ: symptom (19%; p < or = 0.01), activity (27%; p < or = 0.01) and impact (32%; p < or = 0.01). The results showed no difference between groups in dyspnea and maximal workload. We also found that the number of days spent in hospital for respiratory disorders was significantly lower in the MG after 12 months (p < or = 0.03). The multidisciplinary management of COPD patients in the post-rehabilitation period within a health-care network including self-help associations seems to be an effective strategy for maintaining, and even improving, the benefits of a first initial structured program.

QOL, as evaluated by a generic questionnaire and the clinical state of patients with COPD, was independent; this independence characterized the pathophysiologic condition of our patients. Our results reinforce the usefulness of different types of evaluation, especially pre- and postrehabilitation, because they reflect independent benefits used to understand the success and follow-up of rehabilitative programs.