A Feasibility and Efficacy Randomized Controlled Trial of Two Exercise Programs in Severe AECOPD Patients with Resting Hypoxemia

Abstract

Resting hypoxemia is the most severe stage of Chronic Obstructive Pulmonary Disease (COPD). Due to their impairments during the exacerbation, these patients are limited to traditional exercise rehabilitation and are excluded from the majority of the studies. The aim of this study was to assess the feasibility and the efficacy of two exercise programs in Acute Exacerbation of COPD (AECOPD) patients with resting hypoxemia. In this randomized clinical trial, patients hospitalized due to an acute exacerbation of COPD with hypoxemia at rest were included. Patients were randomly assigned into three groups. A Control Group (pharmacological treatment), a Global Exercise Group (GEG), and a Functional Electrostimulation Group (FEG). Patients were treated during the hospitalization period. The main outcomes were lower limb strength (assessed by a dynamometer), balance (assessed by the one leg standing balance test), health related quality of life (assessed by the EQ-5D), adverse events and adherence. At the end of the intervention, there were significant differences in all the variables in favour of the experimental groups (p < 0.05). We concluded that conducting an exercise program is feasible and improves lower limb strength, balance, and health related quality of life in AECOPD patients with resting hypoxemia.

A systematic review of exercise studies for individuals hospitalized with an acute exacerbation of chronic obstructive pulmonary disease: Focus on the principles of exercise training

“…29,36,47 Both reversibility and diminishing returns were applied by 10 studies, 26,27,29–31,35,38,40,43,51 whereas 17 studies did not apply appropriately or fully described these principles. 28,32–34,36,37,39,41,42,44–50,52…”

“…26,29,30,34,[36][37][38]40,43,44,52 Ten studies appropriately applied overload, 27,29,31,38,44,45,47,49,51,52 whereas 12 studies did not apply this principle, 28,30,32,36,37,[39][40][41][42][43]48,50 and five studies described it in an unclear manner. 26,33,34,44,46 Initial values was the principle most frequently applied, described by 24 studies, [26][27][28][30][31][32][33][34][35][37][38][39][40]…”

“…27,28,31,33,35,42,[44][45][46][47] Nine papers reported on three components, 29,30,[37][38][39]41,[50][51][52] five papers reported on two components, 26,34,40,48,49 two papers reported on one component, 32,43 and one paper did not report on any component. 36 Prescribed frequency was reported by 23 studies, [26][27][28][29][30][31][33][34][35][37][38][39][40][41][42][43][44][45][46][47][48]50,51 was not reported in two studies,…”

“…32,36,49,52 Patient's adherence to the intensity was reported by six studies, 27,28,31,45,46,51 and 21 studies did not report it. 26,29,30,[32][33][34][35][36][37][38][39][40][41][42][43][44][47][48][49][50]52 Only three papers reported on patient's adherence to the time prescribed, 27,28,31 and 23 papers did not report it. 26,29,30,[32][33][34][35][36][37][38][39][40][41][43][44][45]…”

“…26,29,30,[32][33][34][35][36][37][38][39][40][41][43][44][45][46][47][48][49][50][51][52] One paper was not clear in its reporting about adherence to time. 42 Type of exercise completed was reported in 10 studies, [27][28][29][30][31]38,41,42,46,51 unclearly reported by two studies, 43,47 and not reported by 15. 26,[32][33][34][35][36][37]39,40,44,45,[48][49][50]52…”