EA 7369 - URePSSS - Multidisciplinary Research Unit in Sport Health Society, University of Lille, Lille, France.
EA 7369 - URePSSS - Multidisciplinary Research Unit in Sport Health Society, University of Lille, Lille, France -
Eur J Phys Rehabil Med. 2019 Feb;55(1):103-112. doi: 10.23736/S1973-9087.18.05093-1. Epub 2018 Jun 14.
Pulmonary rehabilitation (PR) improves performance in the 6-min walk test (6MWT) in a subset of patients with fibrotic idiopathic interstitial pneumonia (f-IIP); however, a large proportion of patients does not respond to PR.
To investigate the effects of a PR program on cardiorespiratory responses during a 6MWT and to identify the characteristics of patients who do not show improved performance after PR.
An observational study.
Patients were recruited from the Competence Centre for Rare Pulmonary Diseases at Lille University Hospital, France and completed an 8-week home-based PR program.
A total of 19 patients with f-IIP; 12 with idiopathic pulmonary fibrosis (IPF) and 7 with fibrotic non-specific interstitial pneumonia.
Patients underwent spirometry and completed a 6MWT before and after an 8-week PR program. Gas exchange, heart rate, and pulse O2 saturation were measured continuously during the 6MWT. Quality of life, dyspnea, and anxiety/depression were assessed using the Short-Form 36 (SF-36), the baseline/transition dyspnea index (BDI/TDI), and the Hospital Anxiety and Depression Scale (HADS) questionnaires.
Patients who did and did not improve the distance walked in the 6MWT by at least 30 m after PR were classified as responders (N.=9) and non-responders (N.=10), respectively. O2 uptake, ventilation rate, and distance covered during the 6MWT were significantly improved only in the responder group (P<0.05). Changes in SF-36, BDI/TDI, and HADS scores did not differ significantly between responders and non-responders. The non-responder group contained significantly more patients with IPF (P<0.05) and experienced greater arterial oxygen desaturation during the 6MWT compared with the responder group.
Failure to improve performance in the 6MWT after PR was associated with a diagnosis of IPF, non-improvement in gas exchange, and greater arterial oxygen desaturation.
Most f-IIP patients who did not respond to PR were diagnosed with IPF and displayed greater hypoxemia during exercise. Clinical practitioners should seek to determine why patients fail to improve exercise performance after PR and propose an alternative exercise regimen to these patients.
肺康复（PR）可改善特发性肺纤维化（IPF）等部分纤维化特发性间质性肺炎（f-IIP）患者的 6 分钟步行试验（6MWT）表现；然而，很大一部分患者对 PR 没有反应。
研究 PR 方案对 6MWT 期间心肺反应的影响，并确定 PR 后运动表现无改善的患者的特征。
观察性研究。
患者在法国里尔大学医院稀有肺部疾病卓越中心招募，并完成了 8 周的家庭 PR 方案。
共 19 例 f-IIP 患者；12 例特发性肺纤维化（IPF）和 7 例纤维化非特异性间质性肺炎。
患者在 PR 方案前和后均进行了肺量测定并完成了 6MWT。在 6MWT 期间连续测量气体交换、心率和脉搏血氧饱和度。使用简明 36 项健康调查量表（SF-36）、基础/转移呼吸困难指数（BDI/TDI）和医院焦虑抑郁量表（HADS）评估生活质量、呼吸困难和焦虑/抑郁。
根据 PR 后 6MWT 步行距离至少增加 30m 将患者分为有反应者（N=9）和无反应者（N=10）。仅在有反应者中，O2 摄取、通气率和 6MWT 期间的距离明显改善（P<0.05）。有反应者和无反应者之间的 SF-36、BDI/TDI 和 HADS 评分变化无显著差异。无反应者组中 IPF 患者明显更多（P<0.05），与有反应者组相比，6MWT 期间动脉血氧饱和度下降更大。
PR 后运动表现无改善与 IPF 诊断、气体交换无改善和更大的动脉血氧饱和度下降有关。
大多数对 PR 无反应的 f-IIP 患者被诊断为 IPF，运动时出现更大程度的低氧血症。临床医生应努力确定为什么患者在 PR 后运动表现无法改善，并为这些患者提出替代运动方案。
