 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
1 June 1995 | Volume 122 Issue 11 | Pages 823-832
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.
Author and Article Information
From the University of California, San Diego, San Diego, California.
ARTICLE
Effects of Pulmonary Rehabilitation on Physiologic and Psychosocial Outcomes in Patients with Chronic Obstructive Pulmonary Disease
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.
This article has been cited by other articles:
|
|
 |
|
  J. Maurer, V. Rebbapragada, S. Borson, R. Goldstein, M. E. Kunik, A. M. Yohannes, N. A. Hanania, and for the ACCP Workshop Panel on Anxiety and Depress Anxiety and Depression in COPD: Current Understanding, Unanswered Questions, and Research Needs Chest, October 1, 2008; 134(4_suppl): 43S - 56S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J Bourbeau and S J Bartlett Patient adherence in COPD Thorax, September 1, 2008; 63(9): 831 - 838. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R Howard, R Sanders, and S. Lydall-Smith The implementation of Restoring Health - a chronic disease model of care to decrease acute health care utilization Chronic Respiratory Disease, August 1, 2008; 5(3): 133 - 141. [Abstract] [PDF]
|
|
|
|
|
|
B. R. Celli Update on the Management of COPD Chest, June 1, 2008; 133(6): 1451 - 1462. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A E Holland, C J Hill, M Conron, P Munro, and C F McDonald Short term improvement in exercise capacity and symptoms following exercise training in interstitial lung disease Thorax, June 1, 2008; 63(6): 549 - 554. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E Haave and M. Hyland Different short-term and longitudinal results on perceived health status for asthma and COPD patients after pulmonary rehabilitation. Patients living alone have the largest improvements in perceived quality of life Chronic Respiratory Disease, May 1, 2008; 5(2): 69 - 73. [Abstract] [PDF]
|
|
|
|
|
|
T Ringbaek, E Brondum, G Martinez, P Lange, and and Pulmonary Rehabilitation Research Group Rehabilitation in COPD: the long-term effect of a supervised 7-week program succeeded by a self-monitored walking program Chronic Respiratory Disease, May 1, 2008; 5(2): 75 - 80. [Abstract] [PDF]
|
|
|
|
 |
|
 S. D. Ramsey, S. D. Sullivan, and R. M. Kaplan Cost-Effectiveness of Lung Volume Reduction Surgery Proceedings of the ATS, May 1, 2008; 5(4): 406 - 411. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. G. Collins, W. E. Langbein, L. Fehr, S. O'Connell, C. Jelinek, E. Hagarty, L. Edwards, D. Reda, M. J. Tobin, and F. Laghi Can Ventilation-Feedback Training Augment Exercise Tolerance in Patients with Chronic Obstructive Pulmonary Disease? Am. J. Respir. Crit. Care Med., April 15, 2008; 177(8): 844 - 852. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Jenkins Which is the best exercise test to assess therapeutic intervention in COPD? Chronic Respiratory Disease, February 1, 2008; 5(1): 3 - 5. [PDF]
|
|
|
|
|
|
M. Medinas-Amoros, C. Alorda, F. Renom, M. Rubi, J. Centeno, V. Ferrer, T. Gorriz, C. Mas-Tous, and F. Ramis Quality of life in patients with chronic obstructive pulmonary disease: the predictive validity of the BODE index Chronic Respiratory Disease, February 1, 2008; 5(1): 7 - 11. [Abstract] [PDF]
|
|
|
|
 |
|
 F. Venuta, E. A. Rendina, T. De Giacomo, and G. F. Coloni Bronchoscopic lung volume reduction MMCTS, December 17, 2007; 2007(1217): 2121. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Dr. R. Jones Too little, too late the patients' perspective on education for COPD Chronic Respiratory Disease, November 1, 2007; 4(4): 189 - 190. [PDF]
|
|
|
|
|
|
R. ZuWallack The Nonpharmacologic Treatment of Chronic Obstructive Pulmonary Disease: Advances in Our Understanding of Pulmonary Rehabilitation Proceedings of the ATS, October 1, 2007; 4(7): 549 - 553. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Foglio, N. Ambrosino, and S. Agati Maintaining the benefits of pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: where are we now? Chronic Respiratory Disease, August 1, 2007; 4(3): 131 - 133. [PDF]
|
|
|
|
|
|
A. L. Ries, G. S. Bauldoff, B. W. Carlin, R. Casaburi, C. F. Emery, D. A. Mahler, B. Make, C. L. Rochester, R. ZuWallack, and C. Herrerias Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines Chest, May 1, 2007; 131(5_suppl): 4S - 42S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T.-P. Ng, M. Niti, W.-C. Tan, Z. Cao, K.-C. Ong, and P. Eng Depressive Symptoms and Chronic Obstructive Pulmonary Disease: Effect on Mortality, Hospital Readmission, Symptom Burden, Functional Status, and Quality of Life Arch Intern Med, January 8, 2007; 167(1): 60 - 67. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Palange, S. A. Ward, K-H. Carlsen, R. Casaburi, C. G. Gallagher, R. Gosselink, D. E. O'Donnell, L. Puente-Maestu, A. M. Schols, S. Singh, et al. Recommendations on the use of exercise testing in clinical practice Eur. Respir. J., January 1, 2007; 29(1): 185 - 209. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. F. M. Wouters Nonpharmacological modulation of dynamic hyperinflation Eur. Respir. Rev., December 1, 2006; 15(100): 90 - 96. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R White, P Walker, S Roberts, S Kalisky, and P White Bristol COPD Knowledge Questionnaire (BCKQ): testing what we teach patients about COPD Chronic Respiratory Disease, July 1, 2006; 3(3): 123 - 131. [Abstract] [PDF]
|
|
|
|
|
|
L. Nici, C. Donner, E. Wouters, R. Zuwallack, N. Ambrosino, J. Bourbeau, M. Carone, B. Celli, M. Engelen, B. Fahy, et al. American thoracic society/european respiratory society statement on pulmonary rehabilitation. Am. J. Respir. Crit. Care Med., June 15, 2006; 173(12): 1390 - 1413. [Full Text] [PDF]
|
|
|
|
|
|
L. B. Herpel, R. E. Kanner, S. M. Lee, H. E. Fessler, F. C. Sciurba, J. E. Connett, R. A. Wise, and for the Lung Health Study Research Group and the N Variability of Spirometry in Chronic Obstructive Pulmonary Disease: Results from Two Clinical Trials Am. J. Respir. Crit. Care Med., May 15, 2006; 173(10): 1106 - 1113. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. S. Alexopoulos, J. A. Sirey, P. J. Raue, D. Kanellopoulos, T. E. Clark, and R. S. Novitch Outcomes of depressed patients undergoing inpatient pulmonary rehabilitation. Am J Geriatr Psychiatry, May 1, 2006; 14(5): 466 - 475. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. A. Mahler Mechanisms and Measurement of Dyspnea in Chronic Obstructive Pulmonary Disease Proceedings of the ATS, May 1, 2006; 3(3): 234 - 238. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. W. Jones and A. G. N. Agusti Outcomes and markers in the assessment of chronic obstructive pulmonary disease. Eur. Respir. J., April 1, 2006; 27(4): 822 - 832. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Guell, V. Resqueti, M. Sangenis, F. Morante, B. Martorell, P. Casan, and G. H. Guyatt Impact of Pulmonary Rehabilitation on Psychosocial Morbidity in Patients With Severe COPD. Chest, April 1, 2006; 129(4): 899 - 904. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Venuta, E. A. Rendina, T. De Giacomo, M. Anile, D. Diso, C. Andreetti, F. Pugliese, and G. F. Coloni Bronchoscopic procedures for emphysema treatment Eur. J. Cardiothorac. Surg., March 1, 2006; 29(3): 281 - 287. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T Eaton, P Young, K Nicol, and J Kolbe The endurance shuttle walking test: a responsive measure in pulmonary rehabilitation for COPD patients Chronic Respiratory Disease, January 1, 2006; 3(1): 3 - 9. [Abstract] [PDF]
|
|
|
|
|
|
R ZuWallack, A Hashim, C McCuskerl, E Nonnandin, M L Benoit-Connors, and B Lahiri The trajectory of change over multiple outcome areas during comprehensive outpatient pulmonary rehabilitation Chronic Respiratory Disease, January 1, 2006; 3(1): 11 - 18. [Abstract] [PDF]
|
|
|
|
|
|
B. R. Celli Chronic Obstructive Pulmonary Disease: From Unjustified Nihilism to Evidence-based Optimism. Proceedings of the ATS, January 1, 2006; 3(1): 58 - 65. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. S. Hill Pulmonary rehabilitation. Proceedings of the ATS, January 1, 2006; 3(1): 66 - 74. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Birnbaum and B. Carlin Pulmonary Rehabilitation and Respiratory Therapy Services in the Physician Office Setting Chest, January 1, 2006; 129(1): 169 - 173. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. M. Mercken, G. J. Hageman, A. M. W. J. Schols, M. A. Akkermans, A. Bast, and E. F. M. Wouters Rehabilitation Decreases Exercise-induced Oxidative Stress in Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., October 15, 2005; 172(8): 994 - 1001. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. G. Cote and B. R. Celli Pulmonary rehabilitation and the BODE index in COPD Eur. Respir. J., October 1, 2005; 26(4): 630 - 636. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Q. Nguyen and V. Carrieri-Kohlman Dyspnea Self-Management in Patients With Chronic Obstructive Pulmonary Disease: Moderating Effects of Depressed Mood Psychosomatics, October 1, 2005; 46(5): 402 - 410. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Porta, M. Vitacca, L. S. Gile, E. Clini, L. Bianchi, E. Zanotti, and N. Ambrosino Supported Arm Training in Patients Recently Weaned From Mechanical Ventilation Chest, October 1, 2005; 128(4): 2511 - 2520. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Kozora, C. F. Emery, M. C. Ellison, F. S. Wamboldt, P. T. Diaz, and B. Make Improved Neurobehavioral Functioning in Emphysema Patients Following Lung Volume Reduction Surgery Compared With Medical Therapy Chest, October 1, 2005; 128(4): 2653 - 2663. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Norweg, J. Whiteson, R. Malgady, A. Mola, and M. Rey The Effectiveness of Different Combinations of Pulmonary Rehabilitation Program Components: A Randomized Controlled Trial Chest, August 1, 2005; 128(2): 663 - 672. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Verrill, C. Barton, W. Beasley, and W. M. Lippard The Effects of Short-term and Long-term Pulmonary Rehabilitation on Functional Capacity, Perceived Dyspnea, and Quality of Life Chest, August 1, 2005; 128(2): 673 - 683. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Troosters, R. Casaburi, R. Gosselink, and M. Decramer Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., July 1, 2005; 172(1): 19 - 38. [Full Text] [PDF]
|
|
|
|
|
|
M Decramer, R Gosselink, P Bartsch, C-G Lofdahl, W Vincken, R Dekhuijzen, J Vestbo, R Pauwels, R Naeije, and T Troosters Effect of treatments on the progression of COPD: report of a workshop held in Leuven, 11-12 March 2004 Thorax, April 1, 2005; 60(4): 343 - 349. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Venuta, T. de Giacomo, E. A. Rendina, A. M. Ciccone, D. Diso, A. Perrone, D. Parola, M. Anile, and G. F. Coloni Bronchoscopic Lung-Volume Reduction With One-Way Valves in Patients With Heterogenous Emphysema Ann. Thorac. Surg., February 1, 2005; 79(2): 411 - 416. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Rossi, F. Florini, M. Romagnoli, T. Bellantone, S. Lucic, D. Lugli, and E. Clini Length and Clinical Effectiveness of Pulmonary Rehabilitation in Outpatients With Chronic Airway Obstruction Chest, January 1, 2005; 127(1): 105 - 109. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. F. Plankeel, B. McMullen, and N. R. MacIntyre Exercise Outcomes After Pulmonary Rehabilitation Depend on the Initial Mechanism of Exercise Limitation Among Non-Oxygen-Dependent COPD Patients Chest, January 1, 2005; 127(1): 110 - 116. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. L. Brody, A.-C. Roch-Levecq, R. G. Thomas, R. M. Kaplan, and S. I. Brown Self-management of Age-related Macular Degeneration at the 6-Month Follow-up: A Randomized Controlled Trial Arch Ophthalmol, January 1, 2005; 123(1): 46 - 53. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Irwin, J. Pike, and M. Oxman Shingles Immunity and Health Functioning in the Elderly: Tai Chi Chih as a Behavioral Treatment Evid. Based Complement. Altern. Med., December 1, 2004; 1(3): 223 - 232. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M. Kaplan, A. L. Ries, J. Reilly, and Z. Mohsenifar Measurement of Health-Related Quality of Life in the National Emphysema Treatment Trial Chest, September 1, 2004; 126(3): 781 - 789. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D Dattal and R ZuWallack High versus low intensity exercise training in pulmonary rehabilitation: is more better? Chronic Respiratory Disease, July 1, 2004; 1(3): 143 - 149. [Abstract] [PDF]
|
|
|
|
 |
|
 M. Itoh, S. Oh-ishi, H. Hatao, C. Leeuwenburgh, C. Selman, H. Ohno, T. Kizaki, H. Nakamura, and T. Matsuoka Effects of dietary calcium restriction and acute exercise on the antioxidant enzyme system and oxidative stress in rat diaphragm Am J Physiol Regulatory Integrative Comp Physiol, July 1, 2004; 287(1): R33 - R38. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B.R. Celli, W. MacNee, A. Agusti, A. Anzueto, B. Berg, A.S. Buist, P.M.A. Calverley, N. Chavannes, T. Dillard, B. Fahy, et al. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper Eur. Respir. J., June 1, 2004; 23(6): 932 - 946. [Full Text] [PDF]
|
|
|
|
 |
|
 A. M Yohannes and M. J Connolly Pulmonary rehabilitation programmes in the UK: a national representative survey Clinical Rehabilitation, April 1, 2004; 18(4): 444 - 449. [Abstract] [PDF]
|
|
|
|
 |
|
 K Dheda, A Crawford, G Hagan, and C M Roberts Implementation of British Thoracic Society guidelines for acute exacerbation of chronic obstructive pulmonary disease: impact on quality of life Postgrad. Med. J., March 1, 2004; 80(941): 169 - 171. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V.M. Pinto-Plata, C. Cote, H. Cabral, J. Taylor, and B.R. Celli The 6-min walk distance: change over time and value as a predictor of survival in severe COPD Eur. Respir. J., January 1, 2004; 23(1): 28 - 33. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Weiner, R. Magadle, M. Beckerman, M. Weiner, and N. Berar-Yanay Maintenance of inspiratory muscle training in COPD patients: one year follow-up Eur. Respir. J., January 1, 2004; 23(1): 61 - 65. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P M Meek Measurement of dyspnea in chronic obstructive pulmonary disease: what is the tool telling you? Chronic Respiratory Disease, January 1, 2004; 1(1): 29 - 37. [Abstract] [PDF]
|
|
|
|
 |
|
 Y J Cheng, C A Macera, C L Addy, F S Sy, D Wieland, and S N Blair Effects of physical activity on exercise tests and respiratory function Br. J. Sports Med., December 1, 2003; 37(6): 521 - 528. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. R. Celli A 62-Year-Old Woman With Chronic Obstructive Pulmonary Disease JAMA, November 26, 2003; 290(20): 2721 - 2729. [Full Text] [PDF]
|
|
|
|
|
|
M. Decramer Treatment of chronic respiratory failure: lung volume reduction surgery versus rehabilitation Eur. Respir. J., November 16, 2003; 22(47_suppl): 47s - 56s. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. D. Sin, F. A. McAlister, S. F. P. Man, and N. R. Anthonisen Contemporary Management of Chronic Obstructive Pulmonary Disease: Scientific Review JAMA, November 5, 2003; 290(17): 2301 - 2312. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Article
