ABSTRACT Purpose: To compare change...

ABSTRACT

Purpose: To compare changes in functional exercise capacity, dyspnea, functional status, and depression in patients after 8 weeks (24 sessions) and 12 weeks (36 sessions) of pulmonary rehabilitation (PR) Methods: A prospective sample of 31 participants in our PR program complet issue measures prior to and during the eighth and twelfth weeks of the program. The 6-minute walk standard (6MWT) and a stairs climbing trial (ST) measured functional exercise capacity. Perceived dyspnea (PD) was measured with a 6-20 scale. The Pulmonary Function Status Scale (PFSS) measured functional status, and the Cardiac Depression Scale (CDS) measured depression. Results: Statistically significant improvements were seen in the 6MWT PD during 6MWT and ST after 8 weeks and after 1 2 weeks of PR unless the improvements between 8 and 12 weeks were small and not statistically significant. After 8 weeks, PFS total scores refer toed increased difficulty carrying out daily tasks that moderated at 12 weeks. CDS scores showed unobtrusive but not statistically significant improvements, after 8 and 12 weeks. Conclusion: Statistically significant and clinically important improvements in 6MWT ST and dyspnea come into view after 8 weeks and 12 weeks of PR however the changes between 8 and 12 weeks were not large enough to be statistically significant or clinically important. Neither 8 nor 12 weeks was sufficient to furnish statistically significant changes in functional status and depression.

INTRODUCTION

Multidisciplinary pulmonary rehabilitation (PR) programs are accepted as an effective treatment for patients with chronic lung disease. The primary goal of rehabilitation, to restore the patient to the highest possible of the same height of independent function, usually is accomplished from helping patients to be more active by means of exercise training and to change into and gain control of symptoms.1 A review of randomized controll trials of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD) conclud exercise relieves dyspnea and fatigue and enhances patients' intellect of control over their condition and that rehabilitation forms an important ingredient of the management of COPD2 Despite general consensus that pulmonary rehabilitation is efficacious, there is little agreement about what constitutes the greatest in quantity effective and efficient pulmonary rehabilitation program.3

The duration of PR programs varies widely. The evidence-based guidelines bring to maturityed by the American College of Chest Physicians and American Association of Cardiovascular and Pulmonary Rehabilitation1 were based forward 14 controlled trials of lower extremity exercise training that varied in duration from 4 weeks to 6 month Similarly, meta-analyses published at Lacasse et al4 and Cambach et al5 examined PR programs ranging in duration from 6 weeks to continuous. Lacasse et al4 conclud duration of the program did not affect maximum exercise capacity measured as peak workload (watts) during an incremental period ergometer test. However, analysis of the weight of PR on functional exercise capacity, measured as walking distance, showed heterogeneity among the cogitation results. A post-hoc analysis showed a significant difference between programs of 6 month duration and shorter programs, which Lacasse et al4 hypothesized as the source of heterogeneity.

Pulmonary rehabilitation programs 8 weeks or les in duration have shown varying be the effects Young et al6 reported statistically significant improvements in 6-minute walk distance, dyspnea, and quality of life measures after a 1month (7 sessions) program. However, increases in walk distance did not reach the minimally clinically important difference of 54 meters7 until 3 month after completing the formal rehabilitation program. Ringbaek et al8 conclud that their program of 8 weeks (16 sessions) was insufficient to exhibit significant improvements in 6-minute walk distance or quality of life measures. by conversion Singh et al9 found significant improvements in shuttle walking proof distance, treadmill endurance, and quality of life measures after 7 weeks (14 sessions) of PR

Several studies have specifically examined the force of program duration. Green et al'?° actionsed a randomized controlled trial of comparable twice-weekly PR programs of 4 and 7 weeks duration. make submissives who completed the 7week program had greater improvements in all issue measures than those in the 4-week program. The differences in improvements reached statistical significance for the total Chronic Respiratory Disease Questionnaire score and the domains of dyspnea, emotion, and mastery. The 7week cluster improved in the shuttle walk and treadmill endurance example but the differences between the 4 and 7week clusters were not statistically significant. The authors conclud that 7 weeks of PR provide greater benefit to patients.

The randomized, controll trial of Bendstrup et al" featured exercise training 3 times weekly for 12 weeks. Data were infered at 6 and 12 weeks with a follow-up after 24 weeks. The increase in 6-minute walk distance was significant after 6 weeks, nevertheless further improvements were small. This indicated a shorter PR program might be sufficient. However, the differences between the regulate and treatment groups for the Activities of Daily Living score and the Chronic Respiratory Disease Questionnaire score did not become statistically significant until 12 and 24 weeks, respectively.