Pulmonary Rehabilitation Center, Respiratory Division, Escola Paulista de Medicina, Federal University of Sao Paulo (Unifesp/Lar Escola Sao Francisco), São Paulo, Brazil (Drs Porto, Castro, de Souza, and Jardim and Mr Cortopassi); Adventist University, São Paulo, Brazil (Drs Porto and Castro); Federal University of Pampa, Rio Grande do Sul, Brazil (Dr Castro); Pulmonary Department, State University of Rio de Janeiro, Rio de Janeiro, Brazil (Mr Cortopassi).
J Cardiopulm Rehabil Prev. 2018 Mar;38(2):118-123. doi: 10.1097/HCR.0000000000000292.
Pulmonary rehabilitation (PR) improves exercise tolerance in patients with chronic obstructive pulmonary disease. However, it is unclear why some patients do not improve quality of life during a training program. Our objective was to evaluate the differences between patients with chronic obstructive pulmonary disease who improve and those who do not improve quality of life during a pulmonary rehabilitation program.
Seventy-three patients underwent a PR program. All patients trained at 80% (legs) and 50% (arms) of their maximum load. Incremental and endurance tests, 6-min walk test, and health-related quality of life with the St George Respiratory Questionnaire (SGRQ) were measured. We subdivided the groups based on a decrease ≥4 points in the pre- and post-PR SGRQ total score (G1); <4-point change in the SGRQ total score (G2); and an increase in scores ≥4 points (G3).
Exacerbation frequency (P = .004) and SGRQ total scores (P < .001) were lower in G1 and G2 than in G3. G1 (P = .0007) and G2 (P = .0005) significantly improved 6-min walk test distance. Before PR, G1 and G2 walked greater distances than G3 (P = .003); however, the difference was no longer significant after PR (P = .34). A significant load increase was seen after PR for the 3 groups (P < .05). We found a significant correlation between the SGRQ and the Charlson index (r = 0.78, P < .0001), exacerbation frequency (r = 0.72, P < .0001), and basal dyspnea index (r = -0.48, P < .0001).
Patients whose quality of life did not improve after comprehensive PR presented a higher number of disease-related exacerbations with comorbidities.
肺康复（PR）可提高慢性阻塞性肺疾病患者的运动耐量。然而，尚不清楚为什么有些患者在训练计划中生活质量没有改善。我们的目的是评估慢性阻塞性肺疾病患者在肺康复计划中生活质量改善和未改善的患者之间的差异。
73 例患者接受了 PR 计划。所有患者以 80%（腿部）和 50%（手臂）的最大负荷进行训练。进行递增和耐力测试、6 分钟步行测试和与圣乔治呼吸问卷（SGRQ）相关的健康相关生活质量评估。我们根据 PR 前后 SGRQ 总分降低≥4 分（G1）；SGRQ 总分变化<4 分（G2）；和评分增加≥4 分（G3）将患者分组。
G1 和 G2 的加重频率（P =.004）和 SGRQ 总分（P <.001）低于 G3。G1（P =.0007）和 G2（P =.0005）显著改善 6 分钟步行测试距离。在 PR 之前，G1 和 G2 走的距离比 G3 远（P =.003）；但是 PR 后，差异不再显著（P =.34）。3 组在 PR 后均观察到负荷显著增加（P <.05）。我们发现 SGRQ 与 Charlson 指数（r = 0.78，P <.0001）、加重频率（r = 0.72，P <.0001）和基础呼吸困难指数（r = -0.48，P <.0001）之间存在显著相关性。
综合 PR 后生活质量未改善的患者存在更多与疾病相关的并发症加重。
