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Title: Survival after pulmonary rehabilitation in patients with COPD: impact of functional exercise capacity and its changes
Austin Authors: Camillo, Carlos A;Langer, Daniel;Osadnik, Christian R;Pancini, Lisa;Demeyer, Heleen;Burtin, Chris;Gosselink, Rik;Decramer, Marc;Janssens, Wim;Troosters, Thierry
Affiliation: Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
University Hospital Leuven, Respiratory Division and Rehabilitation, Leuven, Belgium
Department of Physiotherapy, Monash University, Melbourne, VIC, Australia
Monash Health, Monash Lung and Sleep, Melbourne, VIC, Australia
Hasselt University, Rehabilitation Research Centre, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
Issue Date: 26-Oct-2016
Publication information: International Journal of COPD 2016; 11(1): 2671-2679
Abstract: The impact of rehabilitation-induced changes in 6-minute walk distance (6MWD) on the survival of patients with chronic obstructive pulmonary disease (COPD) has not been fully elucidated. This study sought to determine the association of baseline 6MWD and its changes after pulmonary rehabilitation (PR) with 5-year survival in patients with COPD. Patients who were referred to a 12-week outpatient PR program were followed up for 5 years postcompletion, and survival status was verified. Survival was analyzed according to four groups based upon initial 6MWD (6MWDi) and its changes (Δ6MWD) after PR (Group 1: 6MWDi ≥350 m and Δ6MWD ≥30 m; Group 2: 6MWDi ≥350 m and Δ6MWD <30 m; Group 3: 6MWDi <350 m and Δ6MWD ≥30 m; and Group 4: 6MWDi <350 m and Δ6MWD <30 m) via Kaplan–Meier analysis and log rank test. Cox regression was performed to identify possible confounders of mortality estimates. In total, 423 patients (with mean ± standard deviation of forced expiratory volume in the first second [FEV1] 43±16% predicted, age 65±8 years, and 6WMDi 381±134 m) underwent PR between 1999 and 2010. Survival rates decreased progressively from Group 1 to Group 4 (Group 1, 81%; Group 2, 69%; Group 3, 47%; Group 4, 27%; log rank test, P<0.05). 6MWDi ≥350 m (hazard ratio [HR] 0.39 [95% confidence interval {CI} 0.30–0.50]) and Δ6MWD ≥30 m (HR 0.66 [95% CI 0.51–0.85]) were strongly and independently associated with survival. Compared with Group 1, mortality risks progressively increased in Group 2 (HR 1.36 [95% CI 0.92–2.00]; not significant), Group 3 (HR 1.90 [95% CI 1.28–2.84]; P=0.001), and Group 4 (HR 3.28 [95% CI 2.02–5.33]; P,0.0001). Both poor 6MWD and lack of improvement >30 m after PR are associated with worse 5-year survival in patients with COPD.
DOI: 10.2147/COPD.S113450
PubMed URL: 27822029
Type: Journal Article
Subjects: Pulmonary disease
Chronic obstructive
Exercise training
6-minute walk test
Minimally important difference
Appears in Collections:Journal articles

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