Evolution of functional capacity and health status two years after a pulmonary rehabilitation programme

Background: Pulmonary rehabilitation programs (PRP) have been shown to improve exercise capacity and health status and to reduce dyspnoea and use of healthcare resources, in patients with chronic lung disease. These benefits usually wane after the programs conclusion. Aim: Evaluate functional capacity and health status 2 years after the end of a PRP. Methods: Retrospective study of patients who took part in PRP. After PRP, patients who reported a physically active lifestyle were included in the active group (AG). The other patients were considered as the control group (CG). Functional capacity was evaluated with 6. minute walk distance (6MWD) and health status with St George's Respiratory Questionnaire (SGRQ). Results: Thirty-two patients were included, 24 in the AG and 8 in the CG. Immediately after PRP, there was a significant improvement in the 6MWD and SGRQ global score, for both groups. After completing PRP, in the AG, there was a decline in the mean 6MWD when evaluated at 6 months, 1 and 2 years and also in health status.However, after 2 years, the AG continued to show an average improvement of 32 m (p=0.03) in the 6MWD and at least 4 points in SGRQ compared to pre-PRP, while in the CG, there was a clinically significant decline in 6MWD (-34 m) and SGRQ score (13 points worse). Conclusion: Despite the progressive decline of benefits gained after completing PRP, in the AG these are still significantly positive after 2 years. An active lifestyle seems to help maintain the benefits of the Rehabilitation Program.publishersversionpublishe

Evolução da capacidade funcional e estado de saúde dois anos após um programa de reabilitação respiratória

Resumo: Introdução: Os programas de reabilitação respiratória (PRR) têm demonstrado em doentes com patologia pulmonar crónica, melhoria da capacidade de exercício e do estado de saúde e diminuição da dispneia e da utilização de recursos de saúde. Habitualmente, estes benefícios diminuem após conclusão dos programas. Objetivo: Avaliar a capacidade funcional e o estado de saúde 2 anos após o término de um PRR. Métodos: Estudo retrospetivo de doentes que completaram um PRR. Após o PRR, os doentes que referiam ter adotado um estilo de vida fisicamente ativo foram incluídos no grupo ativo (GA). Os restantes doentes foram considerados como grupo controlo (GC). A capacidade funcional foi avaliada com a prova de marcha dos 6 minutos (PM6m) e o estado de saúde com o questionário de St. George na doença respiratória (SGRQ). Resultados: Foram incluídos 32 doentes, 24 no GA e 8 no GC. Imediatamente após o PRR observou-se, em ambos os grupos, uma melhoria significativa na PM6m e na pontuação total do SGRQ. Após o término do PRR, no GA, observou-se um declínio na distância média percorrida na PM6m aos 6 meses, 1 ano e 2 anos, bem como no estado de saúde.Contudo, 2 anos após o PRR e comparando com os valores avaliados antes do início do PRR, o GA continuava a apresentar uma melhoria na distância percorrida na PM6m, em média de 32 m (p = 0,03) e de pelo menos 4 pontos no SGRQ. No GC observou-se um declínio clinicamente significativo na PM6m (â34 m) e no SGRQ (agravamento de 13 pontos). Conclusão: Embora se verifique uma perda progressiva dos benefícios do PRR após a sua cessação, estes ainda são significativamente positivos até 2 anos após o treino no GA. Um estilo de vida fisicamente ativo parece contribuir para manter os benefícios do Programa de Reabilitação. Abstract: Background: Pulmonary rehabilitation programs (PRP) have been shown to improve exercise capacity and health status and to reduce dyspnoea and use of healthcare resources, in patients with chronic lung disease. These benefits usually wane after the programs conclusion. Aim: Evaluate functional capacity and health status 2 years after the end of a PRP. Methods: Retrospective study of patients who took part in PRP. After PRP, patients who reported a physically active lifestyle were included in the active group (AG). The other patients were considered as the control group (CG). Functional capacity was evaluated with 6 minute walk distance (6MWD) and health status with St George's Respiratory Questionnaire (SGRQ). Results: Thirty-two patients were included, 24 in the AG and 8 in the CG. Immediately after PRP, there was a significant improvement in the 6MWD and SGRQ global score, for both groups. After completing PRP, in the AG, there was a decline in the mean 6MWD when evaluated at 6 months, 1 and 2 years and also in health status.However, after 2 years, the AG continued to show an average improvement of 32 m (p=0.03) in the 6MWD and at least 4 points in SGRQ compared to pre-PRP, while in the CG, there was a clinically significant decline in 6MWD (â34 m) and SGRQ score (13 points worse). Conclusion: Despite the progressive decline of benefits gained after completing PRP, in the AG these are still significantly positive after 2 years. An active lifestyle seems to help maintain the benefits of the Rehabilitation Program. Palavras-chave: Reabilitação pulmonar, Exercício, Estado de saúde, DPOC grave, Keywords: Pulmonary rehabilitation, Exercise, Health status, Severe COP

Outpatient vs. home-based pulmonary rehabilitation in COPD: a randomized controlled trial

Abstract Background Chronic obstructive pulmonary disease (COPD) is a common cause of morbidity and mortality affecting a large number of individuals in both developed and developing countries and it represents a significant financial burden for patients, families and society. Pulmonary rehabilitation (PR) is a multidisciplinary program that integrates components of exercise training, education, nutritional support, psychological support and self-care, resulting in an improvement in dyspnea, fatigue and quality of life. Despite its proven effectiveness and the strong scientific recommendations for its routine use in the care of COPD, PR is generally underutilized and strategies for increasing access to PR are needed. Home-based self-monitored pulmonary rehabilitation is an alternative to outpatient rehabilitation. In the present study, patients with mild, moderate and severe COPD submitted to either an outpatient or at-home PR program for 12 weeks were analyzed. Methods Patients who fulfilled the inclusion criteria were randomized into three distinct groups: an outpatient group who performed all activities at the clinic, a home-based group who performed the activities at home and a control group. PR consisted of a combination of aerobic exercises and strengthening of upper and lower limbs 3 times a week for 12 weeks. Results There was a significant difference in the distance covered on the six-minute walk test (p Conclusion A home-based self-monitoring pulmonary rehabilitation program is as effective as outpatient pulmonary rehabilitation and is a valid alternative for the management of patients with COPD.</p

Chronic Intermittent Hypoxia-Induced Dysmetabolism Is Associated with Hepatic Oxidative Stress, Mitochondrial Dysfunction and Inflammation

The association between obstructive sleep apnea (OSA) and metabolic disorders is well-established; however, the underlying mechanisms that elucidate this relationship remain incompletely understood. Since the liver is a major organ in the maintenance of metabolic homeostasis, we hypothesize that liver dysfunction plays a crucial role in the pathogenesis of metabolic dysfunction associated with obstructive sleep apnea (OSA). Herein, we explored the underlying mechanisms of this association within the liver. Experiments were performed in male Wistar rats fed with a control or high fat (HF) diet (60% lipid-rich) for 12 weeks. Half of the groups were exposed to chronic intermittent hypoxia (CIH) (30 hypoxic (5% O2) cycles, 8 h/day) that mimics OSA, in the last 15 days. Insulin sensitivity and glucose tolerance were assessed. Liver samples were collected for evaluation of lipid deposition, insulin signaling, glucose homeostasis, hypoxia, oxidative stress, antioxidant defenses, mitochondrial biogenesis and inflammation. Both the CIH and HF diet induced dysmetabolism, a state not aggravated in animals submitted to HF plus CIH. CIH aggravates hepatic lipid deposition in obese animals. Hypoxia-inducible factors levels were altered by these stimuli. CIH decreased the levels of oxidative phosphorylation complexes in both groups and the levels of SOD-1. The HF diet reduced mitochondrial density and hepatic antioxidant capacity. The CIH and HF diet produced alterations in cysteine-related thiols and pro-inflammatory markers. The results obtained suggest that hepatic mitochondrial dysfunction and oxidative stress, leading to inflammation, may be significant factors contributing to the development of dysmetabolism associated with OSA