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Tristan Bonnevie,1,2 Clement Medrinal,2,3 Yann Combret,4,5 David Debeaumont,6 Bouchra Lamia,2,3,7 Jean-François Muir,1,2,7 Antoine Cuvelier,2,7 Guillaume Prieur,2,3,5 Francis-Edouard Gravier1,2 1ADIR Association, Rouen University Hospital, Rouen, France; 2Normandy University UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France; 3Intensive Care Unit Department, Le Havre Hospital, Le Havre, France; 4Physiotherapy Department, Le Havre Hospital, Le Havre, France; 5Institute of Experimental and Clinical Research (IREC), Pole of Pulmonology, ORL and Dermatology, Catholic University of Louvain, Brussels, Belgium; 6Department of Respiratory and Exercise Physiology and CIC-CRB 1404, Rouen University Hospital, Rouen, France; 7Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, FranceCorrespondence: Tristan BonnevieADIR Association, Rouen University Hospital, Rouen, FranceTel +33 235592970Fax +33 235592971 Email rehabilitation@adir-hautenormandie.comPurpose: Cognitive dysfunction is a common impairment associated with COPD. However, little is known about 1) its prevalence among those subjects referred for pulmonary rehabilitation (PR), 2) how it may affect the benefit of PR, 3) whether PR improves cognitive function and 4) whether cognitive dysfunction affects the usability of telehealth technology usually used to deliver in-home PR.Patients and Methods: Fifty-six subjects with stable COPD (54% females, mean age 62 years (SD 9) and median FEV1 0.9 L (IQR 0.7 to 1.1)) participated in this multicenter observational study and performed 24 sessions of PR. The Montreal Cognitive Assessment tool (MoCA) was used to assess the occurrence of mild cognitive dysfunction (using a screening cutoff < 26) at baseline, completion of PR and 3 months of follow-up.Results: Mild cognitive dysfunction was found in 41 subjects (73% [95% CI: 60 to 83%]). The MoCA score significantly improved following PR for those people with baseline mild cognitive dysfunction (p< 0.01). There was no significant difference in clinical outcomes between those people with or without mild cognitive dysfunction following PR nor in the proportion of subjects who were autonomous in using the telemonitoring system (83% compared with 71%, p=0.60).Conclusion: Mild cognitive dysfunction is highly prevalent among those people with COPD referred for PR but does not affect the benefits of PR nor the usability of a telemonitoring system. PR may improve short- and mid-term cognitive function for those people who experience mild cognitive dysfunction at the time they are referred to PR.Keywords: COPD, pulmonary rehabilitation, exercise, cognitive dysfunction

Tristan Bonnevie,1,2 Mathilde Allingham,3 Guillaume Prieur,1,4 Yann Combret,5,6 David Debeaumont,7 Maxime Patout,1,8 Antoine Cuvelier,1,8 Catherine Viacroze,8 Jean-François Muir,1,2,8 Clement Medrinal,1,4 Francis-Edouard Gravier1,2 1Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France; 2ADIR Association, Rouen University Hospital, Rouen, France; 3Rouen University Hospital, School of Physiotherapy, Rouen, France; 4Intensive Care Unit Department, Le Havre Hospital, Hôpital Jacques Monod, Montivilliers, France; 5Institute of Experimental and Clinical Research (IREC), Pole of Pulmonology, ORL and Dermatology, Catholic University of Louvain, Brussels, Belgium; 6Physiotherapy Department, Le Havre Hospital, Le Havre, France; 7Department of Respiratory and Exercise Physiology and CIC-CRB 1404, Rouen University Hospital, Rouen, France; 8Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France Purpose: There are many barriers to pulmonary rehabilitation, including a limited access to evaluation centers. To cope with these difficulties, field tests are often used to prescribe endurance training. As field tests are related to muscle strength, they could also be used to prescribe strength training and increase the access to pulmonary rehabilitation in rural area. However, their validity for this purpose has never been studied.Patients and methods: The relationship between the 6-minute stepper test (6MST), 6-minute walk test, maximal workload achieved during cardiopulmonary exercise testing (Wpeak), and one repetition maximum (1RM) was assessed in 35 patients with COPD through a retrospective chart review to derive predictive equation of the 1RM from these tests. The effectiveness of these equations to prescribe strength training at 70% of the 1RM was assessed in an independent cross-validation group of 34 patients with COPD.Results: There was a moderate relationship between the 6MST, Wpeak and the 1RM (r=0.44 and r=0.41, respectively, both P≤0.01). Whatever the test, the prescription of strength training using the estimated 1RM compared with the measured 1RM resulted in a mean absolute difference and a mean bias of about 30 kg.Conclusion: The use of the 6MST and Wpeak for the prescription of strength training would result in a clinically not acceptable error. Therefore, they should not be used as a substitute for the 1RM to prescribe strength training. Keywords: six-minute stepper test, strength training, COPD, pulmonary rehabilitation