Jácome Cristina, Marques Alda
School of Health Sciences, University of Aveiro, Aveiro, Portugal. Research Centre in Physical Activity, Health and Leisure, Faculty of Sports, University of Porto, Porto, Portugal.
School of Health Sciences, University of Aveiro, Aveiro, Portugal. Unidade de Investigação e Formação sobre Adultos e Idosos, Porto, Portugal.
Respir Care. 2014 Oct;59(10):1577-82. doi: 10.4187/respcare.03091. Epub 2014 May 6.
Pulmonary rehabilitation (PR) is a core component of the management of patients with moderate-to-very-severe COPD. However, as impairments in quadriceps muscle strength and health-related quality of life (HRQOL) are already present in patients with mild COPD, there is a need to investigate whether PR could also be beneficial to these patients. Thus, this study assessed the impact of PR on patients with mild COPD.
A quasi-experimental study was conducted. Twenty-six participants (67.8 ± 10.3 years old; FEV1 83.8 ± 6.4% of predicted) enrolled in a 12-week PR program with exercise training and psychoeducation. Lung function was assessed by spirometry, dyspnea with the Modified Medical Research Council questionnaire, functional balance with the Timed Up and Go test, muscle strength with 10-repetition maximum testing, exercise tolerance with the 6-min walk test, emotional state with the Depression Anxiety Stress Scales, and HRQOL with the St George Respiratory Questionnaire (SGRQ).
Significant effects were observed on participants' dyspnea (P = .003, effect size [ES] = 0.7), functional balance (P < .001, ES = 0.8), shoulder flexor/knee extensor strength (P < .001, ES = 1.2-1.3), and exercise tolerance (P < .001, ES = 0.5). With the exception of the SGRQ impact score, the symptom (P < .001, ES = 0.6), activity (P = .02, ES = 0.4), and total (P = .005, ES = 0.3) scores improved significantly after PR. The PR program had no significant effect on participants' lung function and emotional state.
Patients with mild COPD benefit from PR and could therefore be routinely included in these programs. Studies with more robust designs and with long-term follow-ups are needed to inform guidelines for PR in mild COPD.
肺康复（PR）是中重度慢性阻塞性肺疾病（COPD）患者管理的核心组成部分。然而，由于轻度COPD患者已经存在股四头肌力量受损和健康相关生活质量（HRQOL）下降的情况，因此有必要研究PR对这些患者是否也有益。因此，本研究评估了PR对轻度COPD患者的影响。
进行了一项准实验研究。26名参与者（年龄67.8±10.3岁；第1秒用力呼气容积[FEV1]为预测值的83.8±6.4%）参加了为期12周的PR项目，该项目包括运动训练和心理教育。通过肺量计评估肺功能，使用改良医学研究委员会问卷评估呼吸困难程度，使用定时起立行走测试评估功能平衡，使用10次重复最大负荷测试评估肌肉力量，使用6分钟步行测试评估运动耐力，使用抑郁焦虑压力量表评估情绪状态，使用圣乔治呼吸问卷（SGRQ）评估HRQOL。
观察到PR对参与者的呼吸困难（P = 0.003，效应量[ES]=0.7）、功能平衡（P < 0.001，ES = 0.8）、肩部屈肌/膝部伸肌力量（P < 0.001，ES = 1.2 - 1.3）和运动耐力（P < 0.001，ES = 0.5）有显著影响。除SGRQ影响评分外，PR后症状（P < 0.001，ES = 0.6）、活动（P = 0.02，ES = 0.4）和总分（P = 0.005，ES = 0.3）均有显著改善。PR项目对参与者的肺功能和情绪状态无显著影响。
轻度COPD患者可从PR中获益，因此可常规纳入这些项目。需要设计更严谨且有长期随访的研究，为轻度COPD的PR指南提供依据。
