RationaleThe relationship of functional parameters such as lung mechanics, chest kinematics, metabolism and peripheral and respiratory muscle function with the level of exercise tolerance remains a controversial subject. While it has been previously shown that pulmonary rehabilitation is capable of improving exercise tolerance in patients afflicted by COPD, as expressed by values of 6-minute walking test (6MWT), the degree of contribution to this change by each of the aforementioned parameters remains unclear.AimsTo investigate the correlation between changes in exercise capacity and other functional markers following pulmonary rehabilitation in COPD and to determine which parameters are more closely related to improvements of exercise tolerance.Materials and methodsThree hundred and twenty-seven patients with COPD (with average, 95% CI for forced expiratory volume in the first second [FEV1]: 45% [25%–83%] predicted, age: 64 [48–80] years, and BMI: 27 [13.5–40.4] kg/m2) participated in this study. Thirty percent of the patients had pulmonary hypertension as comorbidity. Patients underwent a pulmonary rehabilitation program with 20–30 minutes sessions two to three times per day for 4 weeks. The program was composed of chest wall-stretching, controlled breathing exercises, and a personalized training schedule for cycling and treadmill use. Measurements of 6MWT, lung function, chest wall expansion, grip strength, maximal inspiratory pressure, and breath holding time were taken. The Body mass index, airflow Obstruction, Dyspnea and Exercise capacity (BODE-index), body mass index [BMI], FEV1, 6MWT, modified Medical Research Dyspnea Scale score, and an alternative scale score (for BMI, FEV1, 6MWT, and COPD Assessment Test) were calculated.ResultsRehabilitation resulted in a generalized improvement in 6MWT among patients (average: 360 [95% CI: 178–543 m] vs average: 420 [95% CI: 238–601 m], p<0.05). Improvements in exercise tolerance were found to be most closely associated with changes in composite BODE-index (R2=−0.6), Alternative Scale (R2=−0.56), dyspnea score (modified Medical Research Dyspnea Scale R2=−0.54), and health status (COPD Assessment Test R2=−0.4, p<0.05). In addition, improvements in exercise tolerance were found to moderately correlate with improvements in inspiratory vital capacity (IVC, R2=0.34, p<0.05). Post-rehabilitation changes in IVC displayed a connection with grip strength (R2=0.6) and chest expansion (R2=0.48).ConclusionEnhancements in exercise tolerance had correlation with changes in IVC, BODE-index, and the new Alternative Scale. However, comprehensive assessment needs to include considerations of chest kinematics and peripheral and respiratory muscle function as well.

Pulmonary rehabilitation can reduce the functional depletion caused by the thoracic surgical operation. Identification of more predictive factors of severe complications can help making preoperative risk stratification more precisely.

Background: Functional condition is crucial for operability of patients with lung cancer and/or chronic respiratory diseases. The aim of the study was to measure changes of functional and quality of life parameters in terms of the effectiveness of perioperative pulmonary rehabilitation (PR). Conclusions: Improvements in exercise capacity and quality of life were seen following PR both before and after thoracic surgery.

Background: The role of pre-and post-lung transplant rehabilitation is to maintain or improve exercise tolerance, lung mechanics, peripheral and respiratory muscle function. Our aim was to measure the effectiveness of pre-and post-transplant rehabilitation in terms of the changes of functional and quality of life markers. Methods: Sixty-three patients (40 COPD FEV1: 21±5 %pred, 18 IPF TLC: 42±13 %pred, 4 bronchiectasis FEV1: 28±4 %pred and 1 alveolitis fibrotisans TLC: 31 %pred) participated in a pre-and 14 took part in a post-transplant rehabilitation program (more than 2 months after lung transplantation (LTx), primary diagnoses: 9 COPD, 4 IPF). The rehabilitation program consisted of chest-wall stretching, controlled breathing techniques and personalized exercise of 20-30 minutes by cycling and treadmill 2-3 times per day for 4 weeks. Seven functional and quality of life markers, like lung function, chest wall expansion (CWE), 6-minute walking distance (6MWD), modified Medical Research Council Dyspnea Scale (mMRC), COPD Assessment Test (CAT), breath holding time (BHT) and hand grip strength (HGS) were measured at the onset and the end of the rehabilitation program. The safety profile of the rehabilitation program was followed-up. Results: Pre-transplant pulmonary rehabilitation resulted in significant improvement in CWE (3.24±1.49 vs. 4.48±1.62 cm), CAT IQR {19 [13-25] vs. 15 [11-21]}, 6MWD (315±118 vs. 375±114 m), P<0.05. FEV1, FVC, mMRC, BHT and HGS did not change significantly. Post-transplant rehabilitation resulted in significant improvement in CWE (3.7±2.1 vs. 6.2±1.8 cm), CAT IQR {17 [11-23] vs. 10 [6-14], BHT (22±14 vs. 35±16 s), FEV1 (73±8 vs. 86±9 %pred) and FVC (70±12 vs. 85±14 %pred), P<0.05. The 6MWD, mMRC and HGS did not change significantly. No cardiovascular or other side effects were detected during the rehabilitation program.Conclusions: Our results underline the importance of perioperative pulmonary rehabilitation in the complex treatment of lung transplant patients in Hungary, as well. There was a limitation because no control group was evaluated without rehabilitation.

Chronic obstructive pulmonary disease (COPD) is associated with the accelerated aging of the lung. The protein klotho has been implicated in longevity, and there is some evidence that it might be involved in the pathomechanism of chronic respiratory diseases. Therefore, we aimed to examine whether the clinical condition of COPD patients is reflected in plasma klotho concentration. As plasma concentration of the protein is modulated by physiological factors that are generally improved during pulmonary rehabilitation, we hypothesized that a complex rehabilitation program may alter plasma klotho concentration. Blood samples were taken from 31 stable COPD patients. Clinical parameters such as respiratory function, 6-minute walking distance (6MWD), impact of disease (CAT), dyspnea, grip strength, chest expansion and breath holding time, smoking history, and body mass index (BMI) were evaluated. 19 patients who participated in a 3-week inpatient rehabilitation program had blood sample collection on the first, third, and last days of the program and had the above functional measurements before and after rehabilitation. Plasma klotho concentration was assessed by enzyme-linked immunosorbent assay. Klotho levels showed no correlation with clinical parameters (FEV1%, 6MWD, grip strength, CAT, smoking history, p > 0.05). Coefficient of variation of klotho measurements was 4.5% between Day 1 and Day 3. Although the rehabilitation resulted in significant improvements in 6MWD, CAT, grip strength, and chest expansion, klotho levels did not change significantly (510.1 ± 149.9 vs. 504.2 ± 139.8 pg/ml, p > 0.05). Plasma klotho concentration can be reliably measured in stable COPD; however, its levels are not correlated with clinical parameters of patients. Despite functional improvement, klotho level remains unchanged during the rehabilitation program.