The Effect of Pulmonary Rehabilitation in Patients with Chronic Lung Disease

Choe, Kang Hyeon; Park, Young Joo; Cho, Won Kyung; Lim, Chae Man; Lee, Sang Do; Koh, Youn Suck; Kim, Woo Sung; Kim, Dong Soon; Kim, Won Dong

Abstract

Background
It is known that pulmonary rehabilitation improves dyspnea and exercise tolerance in patient with chronic lung disease, although it does not improve pulmonary function. But there is a controversy whether this improvement after pulmonary rehabilitation is due to increased aerobic exercise capacity. We performed this study to evaluate the effect of pulmonary rehabilitation for 6 weeks on the pulmonary function, gas exchange, exercise tolerance and aerobic exercise capacity in patients with chronic lung disease.
Methods
Pulmonary rehabilitations including education, muscle strengthening exercise and symptom-limited aerobic exercise for six weeks, were performed in fourteen patients with chronic lung disease (COPD 11, bronchiectasis 1, IPF 1, sarcoidosis 1 ; mean age 57 +/-4 years ; male 12, female 2). Pre- and post-rehabilitation pulmonary function and exercise capacity were compared.
Results
1) Before the rehabilitation, FVC, FEV1 and FEF25-75% of the patients were 71.5+/-6.4%, 40.6+/- 3.4% and 19.3+/-3.8% of predicted value respectively. TLC, FRC and RV were 130.3+/-9.3%, 157.3 +/-13.2% and 211.1 +/-23.9% predicted respectively. Diffusing capacity and MW were 59.1 +/-1.1% and 48.6 +/-6.2%. These pulmonary functions did not change after pulmonary rehabilitation. 2) In the incremental exercise test using bicycle ergometer, maximum work rate (57.7 +/-4.9 watts vs. 64.8 +/-6.0 watts, P=0.036), maximum oxygen consumption (0.81 +/-0.07 L/min vs. 0.96 +/-0.08 L/min, P=0.004) and anaerobic threshold (0.60 +/-0.06 L/min vs. 0.76 +/-0.06 L/min, P=0.009) were significantly increased after pulmonary rehabilitation. There was no improvement in gas exchange after rehabilitation. 3) Exercise endurances of upper (4.5 +/-0.7 joule vs. 14.8+/-2.4 joule, P< 0.001) and lower extremity (25.4+/-5.7 joule vs. 42.6+/-7.7 joule, P<0.001), and 6 minute walking distance (392+/-35 meter vs. 459+/-33 meter, P<0.001) were significantly increased after rehabilitation. Maximum inspiratory pressure was also increased after rehabilitation (68.5 +/-5.4 cmH2O vs. 80.4 +/-6.4 cmH20, P<0.001).
Conclusion
The pulmonary rehabilitation for 6 weeks can improve exercise performance in patients with chronic lung disease.