Di Meo Francesco, Pedone Claudio, Lubich Sergio, Pizzoli Carlo, Traballesi Marco, Incalzi Raffaele Antonelli
Fondazione Santa Lucia, Istituto di Ricovero e Cura a Carattere Scientifico, Roma, Italy.
Age Ageing. 2008 Sep;37(5):530-5. doi: 10.1093/ageing/afn126. Epub 2008 Jun 19.
pulmonary rehabilitation (PR) improves health status and exercise tolerance, but not respiratory function in patients with chronic obstructive pulmonary disease (COPD). Our objective was to identify predictors of improvement in the 6-min walked distance (6'WD) in elderly COPD patients after PR.
this was a prospective observational study performed in an ambulatory rehabilitation setting. We enrolled 74 patients aged 65-83 years (mean: 74.2, SD: 4.4) with stable COPD in GOLD stage 3-4. About half (45.6%) of them had a basal O(2) saturation of 90% or less. After a baseline multi-dimensional assessment, patients underwent a 20-session rehabilitation cycle including training of the upper and lower extremities, and respiratory exercises, along with education sessions. The difference between final and basal 6'WD was expressed as a per cent of the basal value (6'WD gain). Patients were divided into two groups according to whether the 6'WD gain was above or under the 75th percentile, corresponding to 33% gain.
patients whose 6'WD improved more had lower baseline forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) (46.0 versus 52.2%, P = 0.03) and baseline 6'WD, both as an absolute value (329.5 versus 408.9 m, P = 0.01) and as a per cent of the predicted (71.1 versus 93.5%, P = 0.002). After correction for potential confounders, baseline 6'WD was the only variable associated with the outcome (OR for 5% increments: 0.79; 95% CI 0.65-0.95).
among elderly patients with COPD, a comprehensive rehabilitation programme can significantly improve the 6'WD even in the presence of chronic hypoxemia. The most physically impaired patients achieve the greatest benefit from rehabilitation, but we could not develop a model accurately predicting the response to rehabilitation.
肺康复（PR）可改善慢性阻塞性肺疾病（COPD）患者的健康状况和运动耐力，但对呼吸功能无改善作用。我们的目的是确定老年COPD患者在接受PR后6分钟步行距离（6'WD）改善的预测因素。
这是一项在门诊康复机构进行的前瞻性观察性研究。我们纳入了74例年龄在65 - 83岁（平均74.2岁，标准差4.4岁）的稳定期GOLD 3 - 4级COPD患者。其中约一半（45.6%）患者的基础氧饱和度为90%或更低。在进行基线多维评估后，患者接受了为期20节的康复周期，包括上下肢训练、呼吸锻炼以及教育课程。最终6'WD与基础6'WD的差值以基础值的百分比表示（6'WD增益）。根据6'WD增益是否高于或低于第75百分位数（对应33%的增益）将患者分为两组。
6'WD改善较多的患者，其基线第1秒用力呼气容积（FEV1）/用力肺活量（FVC）较低（46.0%对52.2%，P = 0.03），且基线6'WD无论是绝对值（329.5对408.9米，P = 0.01）还是预测值的百分比（71.1%对93.5%，P = 0.002）均较低。在对潜在混杂因素进行校正后，基线6'WD是与结局相关的唯一变量（每增加5%的比值比：0.79；95%置信区间0.65 - 0.95）。
在老年COPD患者中，即使存在慢性低氧血症，综合康复计划也可显著改善6'WD。身体功能受损最严重的患者从康复中获益最大，但我们无法建立一个准确预测康复反应的模型。
