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Exercise performance and differences in physiological response to pulmonary rehabilitation in severe chronic obstructive pulmonary disease with hyperinflation
OBJECTIVE: Pulmonary rehabilitation (PR) improves exercise capacity in most but not all COPD patients. The factors associated with treatment success and the role of chest wall mechanics remain unclear. We investigated the impact of PR on exercise performance in COPD with severe hyperinflation. METHO...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Sociedade Brasileira de Pneumologia e Tisiologia
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853065/ https://www.ncbi.nlm.nih.gov/pubmed/27167433 http://dx.doi.org/10.1590/S1806-37562015000000078 |
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author | de Albuquerque, André Luis Pereira Quaranta, Marco Chakrabarti, Biswajit Aliverti, Andrea Calverley, Peter M. |
author_facet | de Albuquerque, André Luis Pereira Quaranta, Marco Chakrabarti, Biswajit Aliverti, Andrea Calverley, Peter M. |
author_sort | de Albuquerque, André Luis Pereira |
collection | PubMed |
description | OBJECTIVE: Pulmonary rehabilitation (PR) improves exercise capacity in most but not all COPD patients. The factors associated with treatment success and the role of chest wall mechanics remain unclear. We investigated the impact of PR on exercise performance in COPD with severe hyperinflation. METHODS: We evaluated 22 COPD patients (age, 66 ± 7 years; FEV(1) = 37.1 ± 11.8% of predicted) who underwent eight weeks of aerobic exercise and strength training. Before and after PR, each patient also performed a six-minute walk test and an incremental cycle ergometer test. During the latter, we measured chest wall volumes (total and compartmental, by optoelectronic plethysmography) and determined maximal workloads. RESULTS: We observed significant differences between the pre- and post-PR means for six-minute walk distance (305 ± 78 vs. 330 ± 96 m, p < 0.001) and maximal workload (33 ± 21 vs. 39 ± 20 W; p = 0.02). At equivalent workload settings, PR led to lower oxygen consumption, carbon dioxide production (VCO(2)), and minute ventilation. The inspiratory (operating) rib cage volume decreased significantly after PR. There were 6 patients in whom PR did not increase the maximal workload. After PR, those patients showed no significant decrease in VCO(2) during exercise, had higher end-expiratory chest wall volumes with a more rapid shallow breathing pattern, and continued to experience symptomatic leg fatigue. CONCLUSIONS: In severe COPD, PR appears to improve oxygen consumption and reduce VCO(2), with a commensurate decrease in respiratory drive, changes reflected in the operating chest wall volumes. Patients with severe post-exercise hyperinflation and leg fatigue might be unable to improve their maximal performance despite completing a PR program. |
format | Online Article Text |
id | pubmed-4853065 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Sociedade Brasileira de Pneumologia e Tisiologia |
record_format | MEDLINE/PubMed |
spelling | pubmed-48530652016-05-10 Exercise performance and differences in physiological response to pulmonary rehabilitation in severe chronic obstructive pulmonary disease with hyperinflation de Albuquerque, André Luis Pereira Quaranta, Marco Chakrabarti, Biswajit Aliverti, Andrea Calverley, Peter M. J Bras Pneumol Original Article OBJECTIVE: Pulmonary rehabilitation (PR) improves exercise capacity in most but not all COPD patients. The factors associated with treatment success and the role of chest wall mechanics remain unclear. We investigated the impact of PR on exercise performance in COPD with severe hyperinflation. METHODS: We evaluated 22 COPD patients (age, 66 ± 7 years; FEV(1) = 37.1 ± 11.8% of predicted) who underwent eight weeks of aerobic exercise and strength training. Before and after PR, each patient also performed a six-minute walk test and an incremental cycle ergometer test. During the latter, we measured chest wall volumes (total and compartmental, by optoelectronic plethysmography) and determined maximal workloads. RESULTS: We observed significant differences between the pre- and post-PR means for six-minute walk distance (305 ± 78 vs. 330 ± 96 m, p < 0.001) and maximal workload (33 ± 21 vs. 39 ± 20 W; p = 0.02). At equivalent workload settings, PR led to lower oxygen consumption, carbon dioxide production (VCO(2)), and minute ventilation. The inspiratory (operating) rib cage volume decreased significantly after PR. There were 6 patients in whom PR did not increase the maximal workload. After PR, those patients showed no significant decrease in VCO(2) during exercise, had higher end-expiratory chest wall volumes with a more rapid shallow breathing pattern, and continued to experience symptomatic leg fatigue. CONCLUSIONS: In severe COPD, PR appears to improve oxygen consumption and reduce VCO(2), with a commensurate decrease in respiratory drive, changes reflected in the operating chest wall volumes. Patients with severe post-exercise hyperinflation and leg fatigue might be unable to improve their maximal performance despite completing a PR program. Sociedade Brasileira de Pneumologia e Tisiologia 2016 /pmc/articles/PMC4853065/ /pubmed/27167433 http://dx.doi.org/10.1590/S1806-37562015000000078 Text en http://creativecommons.org/licenses/by-nc/4.0 This is an open-access article distributed under the terms of the Creative Commons Attribution License |
spellingShingle | Original Article de Albuquerque, André Luis Pereira Quaranta, Marco Chakrabarti, Biswajit Aliverti, Andrea Calverley, Peter M. Exercise performance and differences in physiological response to pulmonary rehabilitation in severe chronic obstructive pulmonary disease with hyperinflation |
title | Exercise performance and differences in physiological response to pulmonary rehabilitation in severe chronic obstructive pulmonary disease with hyperinflation |
title_full | Exercise performance and differences in physiological response to pulmonary rehabilitation in severe chronic obstructive pulmonary disease with hyperinflation |
title_fullStr | Exercise performance and differences in physiological response to pulmonary rehabilitation in severe chronic obstructive pulmonary disease with hyperinflation |
title_full_unstemmed | Exercise performance and differences in physiological response to pulmonary rehabilitation in severe chronic obstructive pulmonary disease with hyperinflation |
title_short | Exercise performance and differences in physiological response to pulmonary rehabilitation in severe chronic obstructive pulmonary disease with hyperinflation |
title_sort | exercise performance and differences in physiological response to pulmonary rehabilitation in severe chronic obstructive pulmonary disease with hyperinflation |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853065/ https://www.ncbi.nlm.nih.gov/pubmed/27167433 http://dx.doi.org/10.1590/S1806-37562015000000078 |
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