The likelihood of improving physical activity after pulmonary rehabilitation is increased in patients with COPD who have better exercise tolerance

Abstract

PurposePulmonary 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 methodsPatient 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.ResultsTwo 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).ConclusionThe 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.

The past, present and future of pulmonary rehabilitation

“…If physical activity is important, more emphasis, particularly in the maintenance programmes, should be given to physical activity. Recent work from our group suggests that enhancing physical activity is more likely to happen when patients have a minimum of physical fitness . This was also shown in a study of tele‐coaching outside the context of pulmonary rehabilitation .…”

Use of pedometers as a tool to promote daily physical activity levels in patients with COPD: a systematic review and meta-analysis

“…OSADNIK et al [38] proposed that patients with COPD who exhibit greater exercise capacity prior to pulmonary rehabilitation are more likely to achieve greater improvements in daily physical activity. They reported clinically meaningful improvements in steps per day with patients reporting a 6MWD >350 m compared with <350 m (707±1780 versus 157±1694 steps·day −1 ).…”

“…This review has found further evidence that patients benefit more from physical activity promotion when baseline levels of physical activity are >4000 steps·day −1 . Therefore, consideration of baseline daily physical activity levels and/or exercise tolerance [38], should feature prominently in future studies. Furthermore, future studies should investigate the combined benefits of pulmonary rehabilitation, physical activity promotion and cognitive behavioural therapy for those patients with severe COPD who are anxious and depressed and therefore exhibit limitations in improving daily physical activity.…”

“…Furthermore, future studies should investigate the combined benefits of pulmonary rehabilitation, physical activity promotion and cognitive behavioural therapy for those patients with severe COPD who are anxious and depressed and therefore exhibit limitations in improving daily physical activity. Moreover, future studies could incorporate the addition of semi-automated tele-coaching as delivered by DEMEYER et al [7], as a low maintenance approach to providing continued support towards daily physical activity feedback [38].…”

Patient assessment and selection for pulmonary rehabilitation

“…Lower pre‐PR quadriceps strength and baseline quadriceps contractile fatigue have also been correlated with improvements in 6MWD following exercise training. Conversely, the likelihood that patients' daily PA will increase following PR was found to be greater among those with higher baseline exercise tolerance (6MWD >350 m) …”