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Jean-Marie Grosbois,1 Axelle Détrée,2 Adeline Pierache,3,4 Nathalie Bautin,5,6 Thierry Pérez,5,6 Benoit Wallaert,5,6 Cécile Chenivesse,5,6 Olivier Le Rouzic5,6 1FormAction Santé, Pérenchies, F-59840, France; 2Groupe Hospitalier Loos Haubourdin, Réhabilitation Respiratoire, Loos, F-59120, France; 3Université de Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, F-59000, France; 4CHU Lille, Department of Biostatistics, Lille, F-59000, France; 5Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, F-59000, France; 6CHU Lille, Pneumologie et Immuno-Allergologie, Centre de référence constitutif pour les maladies pulmonaires rares, Lille, F-59000, FranceCorrespondence: Olivier Le Rouzic, Pneumologie et Immuno-Allergologie, Institut Cœur Poumon, 1 boulevard Jules Leclercq, CHU de Lille, Lille, 59037, France, Tel +33 3 20 44 59 48, Fax +33 3 20 44 57 68, Email olivier.lerouzic@univ-lille.frBackground: Cardiovascular and metabolic comorbidities in chronic obstructive pulmonary disease (COPD) are associated with higher symptoms burden. Few center-based studies have evaluated the impact of these comorbidities on short-term pulmonary rehabilitation outcomes with contrasting results.Research Question: This study aimed to determine whether cardiovascular diseases and metabolic comorbidities impacted long-term outcomes of a home-based PR program in COPD patients.Study Design and methods: Data of 419 consecutive COPD patients addressed to our pulmonary rehabilitation program between January 2010 and June 2016 were retrospectively analyzed. Our program consisted of once-weekly supervised home sessions, including therapeutic education and self-management support, with unsupervised retraining exercises and physical activities the other days for 8 weeks. Exercise capacity (6-min stepper test [6MST]), quality of life (visual simplified respiratory questionnaire), and anxiety and depression (hospital anxiety and depression scale) were assessed respectively, before (M0) and at the end (M2) of the pulmonary rehabilitation program, and at 6 (M8) and 12 months (M14) after its achievement.Results: Patients (mean age 64.1± 11.2 years, 67% males, mean forced expiratory volume in one second (FEV1) 39.2± 17.0% predicted) were classified as having cardiovascular comorbidities (n=195), only metabolic disorders (n=122) or none of these comorbidities (n=102). After adjustment, all outcomes appeared similar between groups at baseline and improved after pulmonary rehabilitation with a greater effect at M14 for patients with only metabolic disorders on anxiety and depression score (− 5.0± 0.7 vs − 2.9± 0.8 and − 2.6± 0.6, p=0.021). Quality of life and exercise capacity improvements were not significantly different between the three groups at M2 and M14.Conclusion: Cardiovascular and metabolic comorbidities do not preclude COPD patients from obtaining clinically meaningful improvements in exercise capacity, quality of life and anxiety-depression up to 1 year after a home-based pulmonary rehabilitation.Keywords: anxiety, exercise tolerance, quality of life, comorbidities, home based pulmonary rehabilitation, COPD

Sarah Gephine,1,2 Olivier Le Rouzic,3,4 François Machuron,5 Benoit Wallaert,3 Cécile Chenivesse,3,4 Didier Saey,2 François Maltais,2 Patrick Mucci,1 Jean-Marie Grosbois6 1Univ. Lille, Univ. Artois, Univ. Littoral Côte d’Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille F-59000, France; 2Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada; 3CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Lille F-59000, France; 4Univ. Lille, Lille F-59000, France; 5Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, Lille F-59000, France; 6FormAction Santé, Pérenchies, FranceCorrespondence: Jean-Marie GrosboisFormAction Santé, Pérenchies, Zone d’Activité du Bois, Rue de Pietralunga, Pérenchies, F-59840, FranceEmail jmgrosbois@formactionsante.comBackground: Long-term effectiveness of pulmonary rehabilitation (PR) is still uncertain in older people with severe chronic obstructive pulmonary disease (COPD). The objective was to compare the effects of home-based PR in people with COPD above and below the age of 70 years.Methods: In this retrospective study, 480 people with COPD were recruited and divided into those ≤ 70 (n=341) and those > 70 years of age (n=139). All participants underwent an 8 weeks of home-based PR, consisting of a weekly supervised 90-minute home session. Six-minute stepper test (6MST), timed-up and go test (TUG), Hospital Anxiety and Depression Scale, and Visual Simplified Respiratory Questionnaire (VSRQ) were assessed at baseline (M0), at 2 (M2), 8 (M8), 14 (M14) months after baseline.Results: The older group was described by fewer current smokers (p < 0.001), more long-term oxygen therapy use (p = 0.024), higher prevalence of comorbidities (p< 0.001), lower 6MST score and higher TUG score (p< 0.001), compared to the younger group. Both groups improved every outcome at M2 compared to baseline. At M2, 88% of people ≤ 70 years of age and 79% of those above 70 were considered as responders in at least one evaluated parameter (p = 0.013). Both groups maintained the benefits at M14, except for the VSRQ score and the number of responders to this outcome in the older group.Conclusion: Regardless of the age, personalized home-based PR was effective for people with COPD in the short term. Above 70 years, an ageing effect appeared on the long-term effectiveness of quality of life benefit.Keywords: chronic obstructive pulmonary disease, exercise tolerance, pulmonary rehabilitation, quality of life, older age

Jean-Marie Grosbois,1,2 Justine Heluain-Robiquet,3 François Machuron,4 Gaelle Terce,2 Cécile Chenivesse,3,5,6 Benoit Wallaert,3,5,6 Olivier Le Rouzic3,5 1FormAction Santé, Pérenchies F-59840, France; 2CH Béthune, Service de Pneumologie et Réhabilitation Respiratoire, Béthune F-62400, France; 3CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Department of Heart and Lung Diseases, Lille F-59000, France; 4CHU Lille, Department of Biostatistics, University Lille, EA 2694 - Santé Publique: Epidémiologie Et Qualité Des Soins, Lille F-59000, France; 5University Lille, Lille F-59000, France; 6Inserm, CNRS, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille F-59000, FranceCorrespondence: Jean-Marie Grosbois Email jmgrosbois@formactionsante.comBackground: Pulmonary rehabilitation (PR) improves exercise tolerance and quality of life in patients with chronic obstructive pulmonary disease (COPD), regardless of disease severity. Socioeconomic deprivation has been linked to the incidence of COPD; however, little is known about its impact on PR outcomes.Methods: In this retrospective observational study, 459 COPD patients were enrolled and dichotomized into socially deprived (n=276) and non-socially deprived (n=183) groups based on a cut-off of 30.17 in the EPICES questionnaire (Evaluation of Deprivation and Inequalities in Health Centers), which evaluates socioeconomic disadvantage. The PR program consisted of once-weekly home sessions for 8 weeks, and consisted of an individualized plan of retraining exercises, physical activities, therapeutic education, and psychosocial and motivational support. Exercise tolerance, anxiety and depression, and quality of life were assessed using the 6 min stepper test (6MST), Hospital Anxiety and Depression Scale (HADS), and Visual Simplified Respiratory Questionnaire (VSRQ). Assessments were made before the PR program (baseline) and then at 2 (T2), 8 (T8), and 14 (T14) months after baseline.Results: Compared with the non-socially deprived group, socially deprived patients were younger, more frequently women, active smokers, and living alone, and belonged to lower socioprofessional categories. At baseline, 6MST, VSRQ, and HADS measures were lower for the socially deprived than the non-socially deprived group. At T2, T8, and T14, there were no significant between-group differences in any outcome, and the percentage of patients showing clinically important improvements was the same in both groups.Conclusion: Home-based PR is effective for COPD patients in the short and long term, regardless of socioeconomic status.Keywords: home-based pulmonary rehabilitation, exercise tolerance, quality of life, anxiety, depression, socioeconomic deprivation

Jérémy B Coquart,1 Olivier Le Rouzic,2 Ghazi Racil,3 Benoit Wallaert,2 Jean-Marie Grosbois4 1CETAPS, EA 3832, UFR STAPS, University of Rouen, Normandie-Univ, Mont Saint Aignan, France; 2Department of Respiratory Diseases, University of Lille, CHRU Lille, Lille, France; 3Department of Biology, Faculty of Sciences, El Manar University, Tunis, Tunisia; 4FormAction Santé, Pérenchies, France Background: Pulmonary rehabilitation (PR) is a key treatment of chronic obstructive pulmonary disease (COPD) but studies are still needed to identify the most pertinent criteria to personalize this intervention and improve its efficacy.Objective: This real-life retrospective study compared the effects of home-based PR on exercise tolerance, anxiety, depression, and health-related quality of life (HRQoL) in COPD patients, according to their medical equipment.Methods: Exercise tolerance, anxiety, depression, and HRQoL were evaluated in 109 patients equipped with long-term oxygen therapy (LTOT), 84 patients with noninvasive ventilation (NIV), 25 patients with continuous positive airway pressure (CPAP), and 80 patients with no equipment (NE), before, just after, and 6 and 12 months after PR.Results: At baseline, the body mass index in the CPAP and NIV groups was higher (p

Claudine Fabre,1 Baptiste Chehere,1 Frédéric Bart,2 Patrick Mucci,1 Benoit Wallaert,3 Jean Marie Grosbois2,4 1University of Lille, EA-7369 – URePSSS, Unité de Recherche Pluridisciplinaire Sport, Santé, Société, Faculté des Sciences du Sport et de l’EP, Ronchin, 2Centre Hospitalier Béthune, Service de Pneumologie et d’Allergologie, Rue Delbecque, Beuvry, 3CHRU Lille – Service de Pneumologie et Immunoallergologie, Centre des Compétences des Maladies Pulmonaires Rares, Hôpital Calmette, CHRU Lille and Hospital Center Regional University De Lille, Lille, 4FormAction Santé, ZA du Bois, Pérenchies, France Background: It has been scientifically proven that pulmonary rehabilitation improves exercise tolerance and facilitates the carrying out of daily physical activities. To optimize the physical and physiological benefits, it is necessary to individualize the training intensity for each patient. The aim of this study is to compare the heart rate (HR) responses to three exercise modalities measuring aerobic fitness in chronic obstructive pulmonary disease patients, in order to easily prescribe individual target HRs for endurance training.Patients and method: Fifty COPD patients (mean age: 60.1±8.5 years) were included in the study. Each patient carried out a cardiopulmonary exercise test, a 6-minute walk test (6MWT) and a 6-minute stepper test (6MST). During these tests, HR was recorded continuously. After the cardiopulmonary exercise test, the HR was noted at the ventilatory threshold (VT) and at the end of the two exercise field tests (6MWTpeak and 6MSTpeak). The values of the HR during the last 3 minutes of both field tests were averaged (6MWT456 and 6MST456). Finally, the HR at 60% of the HR reserve was calculated with the values of the HR measured during 6MWT and 6MST (HRr60%walk, HRr60%step).Results: The HRs measured during the 6MST were significantly higher than those measured during the 6MWT. The HRr60%step was not significantly different from 6MWT456 and 6MWTpeak HR (P=0.51; P=0.48). A significant correlation was observed between 6MWT456 and 6MWTpeak (r=0.58). The 6MWT456 and 6MWTpeak HR were correlated with HRr60%step (r=0.68 and r=0.62). The VT could be determined in 28 patients. The HRVT was not different from 6MWT456, 6MWTpeak, and HRr60%step (P=0.57, P=0.41 and P=0.88) and was correlated to 6MWT456, 6MWTpeak, and HRr60%step (r=0.45, r=0.40, r=0.48).Conclusion: An individualized target HR for endurance training can be prescribed from the HR measured during routine tests, such as 6MWT or 6MST. Keywords: cardiopulmonary exercise testing, chronic obstructive pulmonary disease, 6-minute walk test, 6-minute stepper test, endurance training

Jérémy B Coquart,1 Jean-Marie Grosbois,2,3 Cecile Olivier,4 Frederic Bart,2 Ingrid Castres,1 Benoit Wallaert4 1Faculté des Sciences du Sport, Université de Rouen, CETAPS, EA 3832, Mont Saint Aignan, 2Service de Pneumologie, Centre Hospitalier de Béthune, Beuvry, 3Formaction Santé, Perenchies, 4Service de Pneumologie et Immunoallergologie, Centre Hospitalier Universitaire de Lille, Hôpital Calmette, Université de Lille 2, France Background: This retrospective, observational study of a routine clinical practice reports the feasibility and efficiency of home-based pulmonary rehabilitation (PR), including transcutaneous neuromuscular electrical stimulation (NMES) or usual endurance physical exercise (UEPE), on exercise tolerance, anxiety/depression, and health-related quality of life (HRQoL) in patients with COPD.Methods: Seventy-one patients with COPD participated in home-based PR with NMES (Group NMES [GNMES]), while 117 patients participated in home-based PR with the UEPEs (Group UEPE [GUEPE]). NMES was applied for 30 minutes twice a day, every day. The endurance exercises in GUEPE began with a minimum 10-minute session at least 5 days a week, with the goal being 30–45 minutes per session. Three upper and lower limb muscle strengthening exercises lasting 10–15 minutes were also proposed to both the groups for daily practice. Moreover, PR in both the groups included a weekly 90-minute session based on an educational needs assessment. The sessions comprised endurance physical exercise for GUEPE, NMES for GNMES, resumption of physical daily living activities, therapeutic patient education, and psychosocial support to facilitate health behavior changes. Before and after PR, functional mobility and physical exercise capacity, anxiety, depression, and HRQoL were evaluated at home.Results: The study revealed that NMES significantly improved functional mobility (−18.8% in GNMES and −20.6% in GUEPE), exercise capacity (+20.8% in GNMES and +21.8% in GUEPE), depression (−15.8% in GNMES and −30.1% in GUEPE), and overall HRQoL (−7.0% in GNMES and −18.5% in GUEPE) in the patients with COPD, regardless of the group (GNMES or GUEPE) or severity of airflow obstruction. Moreover, no significant difference was observed between the groups with respect to these data (P>0.05).Conclusion: Home-based PR including self-monitored NMES seems feasible and effective for severely disabled COPD patients with severe exercise intolerance. Keywords: pulmonary rehabilitation, global management program, severity of airflow obstruction, chronic obstructive pulmonary disease, NMES

JM Grosbois,1,2 C Riquier,3 B Chehere,4 J Coquart,5 H Béhal,6 F Bart,2 B Wallaert,2,3 C Chenivesse3 1FormAction Santé, Pérenchies, France; 2Department of Respiratory Medicine, Centre Hospitalier Germon et Gauthier, Béthune, France; 3Department of Respiratory Medicine Immunology and Allergy, Centre Hospitalier Universitaire de Lille, Competence Center for rare lung diseases, University Lille 2, Lille, France; 4EA 7369, URePSSS, Multidisciplinary Research Unit in Sport Health Society, University Lille 2, Lille, France; 5Faculty of Sport Sciences, Sports and Physical Activity, Center for Ecology and Transformation, University of Rouen, Mont Saint Aignan, France; 6Department of Statistical Methods and Biostatistics, Centre Hospitalier Universitaire de Lille, University of Lille Nord, Lille, France Introduction: Exercise tolerance testing is an integral part of the pulmonary rehabilitation (PR) management of patients with chronic obstructive pulmonary disease (COPD). The 6-minute stepper test (6MST) is a new, well-tolerated, reproducible exercise test, which can be performed without any spatial constraints.Objective: The aim of this study was to compare the results of the 6MST to those obtained during a 6-minute walk test (6MWT) and cardiopulmonary exercise testing (CPET) in a cohort of COPD patients.Methods: Ninety-one COPD patients managed by outpatient PR and assessed by 6MST, 6MWT, and CPET were retrospectively included in this study. Correlations between the number of steps on the 6MST, the distance covered on the 6MWT, oxygen consumption, and power at the ventilatory threshold and at maximum effort during CPET were analyzed before starting PR, and the improvement on the 6MST and 6MWT was compared after PR.Results: The number of steps on the 6MST was significantly correlated with the distance covered on the 6MWT (r=0.56; P

Jean Marie Grosbois,1,2 Alice Gicquello,3 Carole Langlois,4 Olivier Le Rouzic,3 Frédéric Bart,2 Benoit Wallaert,2,3 Cécile Chenivesse5 1FormAction Santé, rue Pietralunga, Pérenchies, 2Service de Pneumologie, CH Béthune, 3Service de Pneumologie et Immunoallergologie, Centre des Compétences des Maladies Pulmonaires Rares, Hôpital Calmette, CHRU Lille, 4Unité de Biostatistiques, CHRU Lille, 5AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale, Boulevard de l’Hôpital, Paris, France Introduction: Personalized, global pulmonary rehabilitation (PR) management of patients with COPD is effective, regardless of the place in which this rehabilitation is provided. The objective of this retrospective observational study was to study the long-term outcome of exercise capacity and quality of life during management of patients with COPD treated by home-based PR.Methods: Home-based PR was administered to 211 patients with COPD (mean age, 62.3±11.1 years; mean forced expiratory volume in 1 second, 41.5%±17.7%). Home-based PR was chosen because of the distance of the patient’s home from the PR center and the patient’s preference. Each patient was individually managed by a team member once a week for 8 weeks with unsupervised continuation of physical exercises on the other days of the week according to an individual action plan. Exercise conditioning, therapeutic patient education, and self-management were included in the PR program. The home assessment comprised evaluation of the patient’s exercise capacity by a 6-minute stepper test, Timed Up and Go test, ten times sit-to-stand test, Hospital Anxiety and Depression score, and quality of life (Visual Simplified Respiratory Questionnaire, VQ11, Maugeri Respiratory Failure 28).Results: No incidents or accidents were observed during the course of home-based PR. The 6-minute stepper test was significantly improved after completion of the program, at 6 months and 12 months, whereas the Timed Up and Go and ten times sit-to-stand test were improved after PR and at 6 months but not at 12 months. Hospital Anxiety and Depression and quality of life scores improved after PR, and this improvement persisted at 6 months and 12 months.Conclusion: Home-based PR for unselected patients with COPD is effective in the short term, and this effectiveness is maintained in the medium term (6 months) and long term (12 months). Home-based PR is an alternative to outpatient management provided all activities, such as exercise conditioning, therapeutic education, and self-management are performed. Keywords: pulmonary rehabilitation, home, COPD, quality of life, anxiety, depression, self-management