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Effects of Pulmonary Rehabilitation on Physiologic and Psychosocial Outcomes in Patients with Chronic Obstructive Pulmonary Disease

Andrew L. Ries, MD, MPH; Robert M. Kaplan, PhD; Trina M. Limberg, BS; and Lela M. Prewitt
[+] Article and Author Information

From the University of California, San Diego, San Diego, California. Requests for Reprints: Andrew L. Ries, MD, MPH, Division of Pulmonary and Critical Care Medicine, University of California, San Diego, Medical Center, 200 West Arbor Drive-8377, San Diego, CA 92103-8377. Grant Support: By grants R01 HL 34732 and K07 HL 02215 from the National Heart Lung and Blood Institute of the National Institutes of Health (NIH) and Grant RR 00827 to the University of California, San Diego, General Clinical Research Center from the NIH National Center for Research Resources.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1995;122(11):823-832. doi:10.7326/0003-4819-122-11-199506010-00003
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Objective: To compare the effects of comprehensive pulmonary rehabilitation with those of education alone on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease.

Design: Randomized clinical trial.

Setting: University medical center.

Patients: 119 outpatients with chronic obstructive pulmonary disease that was stable while patients received a standard medical regimen.

Intervention: Patients were randomly assigned to either an 8-week comprehensive pulmonary rehabilitation program or to an 8-week education program. Pulmonary rehabilitation consisted of twelve 4-hour sessions that included education, physical and respiratory care instruction, psychosocial support, and supervised exercise training. Monthly reinforcement sessions were held for 1 year. The education group attended four 2-hour sessions that included videotapes, lectures, and discussions but not individual instruction or exercise training.

Measurements: Pulmonary function, maximum exercise tolerance and endurance, gas exchange, symptoms of perceived breathlessness and muscle fatigue with exercise, shortness of breath, self-efficacy for walking, depression, general quality of well-being, and hospitalizations associated with pulmonary diseases. Patients were followed for 6 years.

Results: Compared with education alone, comprehensive pulmonary rehabilitation produced a significantly greater increase in maximal exercise tolerance (+1.5 metabolic equivalents [METS] compared with +0.6 METS (P < 0.001); maximal oxygen uptake, +0.11 L/min compared with +0.03 L/min [P = 0.06]), exercise endurance (+10.5 minutes compared with +1.3 minutes [P < 0.001]), symptoms of perceived breathlessness (score of −1.5 compared with +0.2 [P < 0.001]) and muscle fatigue (score of −1.4 compared with −0.2[P < 0.01]), shortness of breath (score of −7.0 compared with +0.6 [P <0.01]), and self-efficacy for walking (score of +1.4 compared with +0.1 [P < 0.05]). There were slight but nonsignificant differences in survival (67% compared with 56% [P = 0.32]) and duration of hospital stay ( −2.4 days/patient per year compared with +1.3 days/patient per year [P = 0.20]). Measures of lung function, depression, and general quality of life did not differ between groups. Differences tended to diminish after 1 year of follow-up.

Conclusions: Comprehensive pulmonary rehabilitation significantly improved exercise performance and symptoms for patients with moderate to severe chronic obstructive pulmonary disease. Benefits were partially maintained for at least 1 year and tended to diminish after that time.

Figures

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Figure 1.
Results of treadmill endurance exercise tests for patients in the rehabilitation (Rehab) and education groups at baseline and for 12 months of follow-up.P

A. Exercise endurance time. B. Perceived breathlessness rating at the end of exercise. C. Perceived muscle-fatigue rating at the end of exercise. Asterisks indicate < 0.05 for within-group change from baseline; values and error bars represent the mean ±SE.

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Figure 2.
Maximum treadmill workload (measured as estimated oxygen uptake in metabolic equivalents [METS]) for patients in the rehabilitation (Rehab) and education groups at baseline and for 12 months of follow-up.P

Asterisks indicate < 0.05 for within-group change from baseline; values and error bars represent the mean ±SE.

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Figure 3.
Self-reported shortness of breath with daily activities for patients in the rehabilitation (Rehab) and education groups at baseline and for 12 months of follow-up.P

Asterisks indicate < 0.05 for within-group change from baseline; values and error bars represent the mean ±SE.

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Figure 4.
Kaplan-Meier survival curves for patients in the rehabilitation (Rehab) and education (Educ) groups during 6 years of follow-up.

All patients are accounted for without censoring. Numbers at the bottom of the graph indicate the number of patients alive in each group at the beginning of each year.

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