Search

Pulmonary rehabilitation is one of the most important treatment modalities for patients with chronic lung disease. To determine the effects of an outpatient pulmonary rehabilitation program for the older members (aged 77 +/- 3 years; seniors) of an elderly patient group with chronic lung disease, we prospectively compared the degrees of improvement of lung function, dyspnea, daily activities and exercise tolerance (6-minute walking distance) after a 9-week rehabilitation program in 27 seniors with chronic lung disease (COPD 18, post-tuberculosis lung disorders 8, lung fibrosis 1; %FEV1 50.9 +/- 17.1%) with that in disease- and %FEV1-matched younger members (aged 70 +/- 2 years; juniors; %FEV1 49.3 +/- 16.1%) of the elderly patient group. All patients performed supervised weekly outpatient exercise and education activities for 9 weeks and a home exercise regimen. Assessments were made before and after the program. Twenty-three of the seniors and 25 of the juniors completed the program. There was no significant difference in the withdrawal rates between these groups. Although lung function and blood gas data had not changed significantly after rehabilitation, the clinical symptoms and the 6-minute walking exercise improved significantly in both groups (Baseline Dyspnea Index focal score: +1.3 +/- 0.9 in the seniors and +0.6 +/- 0.9 in the juniors: 6-minute walking distance: +/- 52 m and +/- 62 m, respectively) and the improvement of the Baseline Dyspnea Index focal score was significantly greater in the seniors than in the juniors. We observed the patients after they had followed the program for 2,000 days and found that the continuation ratio of rehabilitation in the seniors was far inferior to that in the juniors (continuation ratios for 1.2 and 3 years in the seniors were 50.5, 18.0 and 0%, respectively, and in the juniors, 79.5, 66.2 and 61.5%). We concluded that, although the senior elderly patients could benefit from the pulmonary rehabilitation program, it is difficult to maintain this benefit for many years.

Pulmonary rehabilitation is one of the most important components of comprehensive care for patients with significant disability due to chronic respiratory failure. Because pulmonary rehabilitation has not been popular in Japan, the long-term effectiveness of pulmonary rehabilitation has rarely been reported. We therefore examined the long-term effectiveness of an outpatient pulmonary rehabilitation program for patients with chronic respiratory failure. Our program was composed of a once-a-week introduction program for 2 months and a support program that was continued every 4 weeks as long as possible. Thirty stable patients with chronic respiratory failure were enrolled in the program; 21 patients (COPD: 15, lung complications of tuberculosis: 6) completed the 9-week introduction program and the ensuing 6-month support program. Good compliance with the home training regimen was maintained during the period. The introduction program significantly alleviated dyspnea (Fletcher's grade: 3.3 to 3.0, p < 0.01) and improved the data for activity (Spector's score: 5.3 to 5.8, p < 0.01) and 6-minute walking distance (319 to 384 m, p < 0.01). These benefits were sustained during the 6-month support program. We concluded that outpatient pulmonary rehabilitation can alleviate dyspnea and improve the activity and exercise tolerance of patients with chronic respiratory failure, and that the effectiveness of training can be well maintained with a minimal support program.

Exertional dyspnea is a most popular symptom in COPD patients often lead to exercise intolerance. Indeed the reduced activity in patient's daily life due to dyspnea may lead to deconditioning and peripheral muscle weakness. Bronchodilators and anti-inflammatory drugs are an important treatment to reduce symptoms and improve airflow limitation but not improve deconditioning. Impairment of exercise tolerance is a common problem in patients with COPD and therefore exercise training is an important component of all pulmonary rehabilitation programs. It is now clearly established that exercise training reduce dyspnea, improve exercise tolerance and improve activities of daily living (ADL) and health related quality of life (QOL). Oxygen therapy during exercise are often considered in the COPD patients with exercise induced hypoxemia.

Pulmonary rehabilitation is comprehensive and multidimensional care for patients with COPD and their families. The aim of pulmonary rehabilitation is for patients to achieve and maintain the individual's maximum level of independence and functioning in the communities. Recent investigation of well-designed studies confirmed the efficacy of lower extremity training, upper extremity training, and ventilatory muscle training in some selected patients. Patient education is a essential component. Pulmonary rehabilitation improves exercise tolerance, the symptoms of dyspnea and health-related QOL, and reduce the frequency and period of hospitalizations. Pulmonary rehabilitation programs include assessment and education of patient, exercise training, and chest physical therapy techniques. In our follow-up study in 100 patients with chronic pulmonary emphysema who participated in pulmonary rehabilitation programs, groups that continued exercise more than 30 minutes a day at home, had tendency to escape from progression of dyspnea after 19 months (mean).

It has been suggested that pulmonary rehabilitation compined with inspiratory muscle training (IMT) might improve pulmonary function and respiratory muscle strength in elderly patients with chronic obstructive pulmonary disease (COPD). To test this hypothesis, inspiratory muscle strength (PImax), expiratory muscle strength (PEmax) and resting pulmonary function were measured in 13 elderly patients with COPD (aged 70.3 +/- 2.7 years). Inspiratory muscle training (IMT) was performed for 15 min twice a day, using a pressure threshold device, for a total of 12 weeks. The inspiratory threshold was set at 15% of maximal inspiratory pressure (PImax) for each individual. Pulmonary rehabilitation was performed for 12-h sessions over a 12-week period. Patients with COPD were assigned randomly to two groups: pulmonary rehabilitation combined with IMT (group A) (n = 7), and conventional pulmonary rehabilitation only (group B) (n = 6). Functional residual capacity (FRC) decreased significantly from 4.3 +/- 0.4 L at baseline to 3.9 +/- 0.4 L after rehabilitation (p < 0.01), Vp significantly increased from 4.6 +/- 0.8 L/sec at baseline to 5.1 +/- 0.7 L/sec after rehabilitation (p < 0.05) and the PImax increased significantly from 51.5 +/- 5.4 cmH2O at baseline to 80.9 +/- 7.0 cmH2O after rehabilitation (p < 0.02) in group A. However, these variables did not change in group B. There was no improvement in the 10-minutes walking distance of group A, but there was a significant increase in that of group B. It can be concluded that pulmonary rehabilitation combined with IMT improves pulmonary function and inspiratory muscle strength in elderly patients with COPD.

The pulmonary function test and arterial blood gas analysis were performed before and after a 2-month rehabilitation program in a pool filled with 38 degrees C hot-spring water in 15 elderly patients (75.7 +/- 3.7 years of age; 12 males and 3 females; 6 cases of pulmonary emphysema and 9 cases of bronchial asthma) and 10 young patients (56.4 +/- 14.2 years of age, 7 males and 3 females; 4 cases of pulmonary emphysema and 6 cases of bronchial asthma) with stable chronic obstructive pulmonary disease treated at Gunma University Hospital between 1995 and 1996. After the exercise program, the ratio of forced expired volume in one second to forced vital capacity (FEV1.0%) was significantly increased (p < 0.05), while the ratio of forced vital capacity to predicted normal value (%VC) did not change in either group. Furthermore, a tendency toward an increase in peak flow (PF) and maximal expiratory flow at 25 and 50 percent (V25 and V50) was observed in both groups. An increase in PaO2 was observed in both groups, while an decrease in PaCO2 was observed in the young group (p < 0.05). These effects were observed more clearly in patients with asthma than in those with emphysema. The changes in pulmonary function and arterial blood gas were considered to be resulted from respiratory muscle training and expiration into water in addition to an increase in cardiac output by hydraulic pressure. Therefore, physical therapy in a pool filled with hot-spring water may be useful in treating chronic obstructive pulmonary disease in elderly as well as in young patients.

Pulmonary rehabilitation has been reported to be effective in patients with chronic obstructive pulmonary disease (COPD). To investigate the effect of a moderate period of pulmonary rehabilitation combined with inspiratory muscle training (IMT) in elderly patients with COPD, we instituted pulmonary rehabilitation for 60 weeks in five elderly patients (age: 65.4 +/- 3.7 SE years). IMT was performed for 15 min twice daily using a pressure threshold device. The inspiratory threshold was set at 15% of the maximal inspiratory pressure (PImax) of each individual. Maximal peak flow significantly increased from 3.0 +/- 0.6 (L/s) at baseline to 4.1 +/- 0.7 (L/s) after 12 weeks (p < 0.02) and was maintained at that level for 60 weeks. PImax increased significantly from 49.9 +/- 6.4 cmH2O at baseline to 67.3 +/- 3.0 cmH2O after 12 weeks (p < 0.05) and to 72.8 +/- 3.5 cmH2O (p < 0.02) after 60 weeks of rehabilitation. The 10-minute walking distance increased from 666.6 +/- 55.0 to 764.0 +/- 49.9 m (p < 0.05) after 12 weeks and was maintained at the same level. We conclude that pulmonary rehabilitation combined with IMT improves pulmonary function and inspiratory muscle strength in elderly patients with COPD between for 12 weeks after commencement, but occurs that no significant increase on lung function or 10-minute walking distance from 12 to 60 weeks. Respiratory muscle strength may further increase after 60 weeks.

We developed a program of respiratory muscle stretch gymnastic (RMSG), and measured lung function, exercise capacity, dyspnea, and quality of life before and after 4 weeks of training with this program. Thirteen patients with chronic obstructive pulmonary disease (mean FEVi, 1.24 liters) began the program. They participated in three sessions of RMSG each day. Twelve patients completed all 4 weeks. RMSG significantly (p < 0.01) decreased functional residual capacity (from 4.19 +/- 1.27 to 3.88 +/- 1.03 liters), total lung capacity (from 5.98 +/- 1.35 to 5.66 +/- 1.20 liters), residual volume (from 3.29 +/- 1.16 to 2.89 +/- 0.89 liters), and residual volume as a percent of total lung capacity (from 53.9 +/- 11.2% to 50.6 +/- 9.74%). The distance walked in 6 min increased by an average of 43 +/- 30 meters (+ 15%, p < 0.01). Dyspnea after a 6-minute walk (measured with a 150-mm visual analog scale) decreased significantly (from 65.1 +/- 40.8 to 36.1 +/- 36.8, p < 0.05). Quality of life was measured with the Chronic Respiratory Disease Questionnaire of Guyatt, et al., and was found to have improved significantly. Respiratory muscle stretch gymnastics may be useful in pulmonary rehabilitation.

To evaluate the effects of pulmonary rehabilitation in patients with chronic respiratory failure, 43 patients with stable chronic respiratory failure were enrolled in a pulmonary rehabilitation program. The program included education, instruction in diaphragmatic breathing, respiratory muscle training, and exercise training (walking and riding a stationary bicycle). Patients were divided into 2 groups by the lowest SpO2 during a 12-minute-walk test done before rehabilitation: lowest SpO2 < 90% (Group A, 32 patients) and lowest SpO2 > or = 90% (Group B, 11 patients). In group A, SpO2 during exercise training was maintained over 90% by O2 inhalation, by load reduction, or by maintaining a slower walking speed. During 2 months of rehabilitation, the distance walked in 12 minutes and the maximum distance walked with an SpO2 > or = 90% significantly increased in both groups, but PaO2, VC, and FEV1 increased only in group A. In group A, the patients with chronic obstructive pulmonary disease had significant increases in PaO2, VC, and FEV1, but those with old tuberculosis sequelae had significant increases in PaO2 only. Pulmonary rehabilitation in patients with chronic respiratory failure may not only increase exercise tolerance but may also improve arterial oxygenation and pulmonary function.