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The domains Social Functioning, Health Perceptions, and Life Satisfaction were assessed using
questions from the Medical Outcomes Study 36-item
short-form healthy survey (SF-36).29 Disease-specific
health-related quality of life was assessed by means
of the Airways Questionnaire 20 (AQ-20) 30-32 in nine
patients. The respective validated Brazilian versions
were administered by a trained physiotherapist.
Statistical analysis
Statistical analysis was performed on SigmaStat
Program for Windows (version 3.0, Jandel Scientific,
CA, USA). The normality of the data (KolmogorovSmirnov test with Lilliefors correction) and the homogeneity of variances (Levene median test) were
tested. Then, the data were compared using One
Way Repeated Measures ANOVA or Friedmans
ANOVA on Ranks, followed by Tukeys test. The results were expressed as mean standard deviation
(SD) and the level of significance was set at 5%.
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Results
Outcome measurements
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Vol. 49 - No. 4
From June 2002 to September 2010, 41 consecutive COPD patients who were admitted in our pulmonary rehabilitation program agreed to participate
in the study. Five patients were excluded because
of low-adherence (N.=3) and disease exacerbation
(N.=2). Thirty-six patients (14 females and 22 males)
completed the study and all were receiving inhaled
beta 2-agonist agents, 21 patients were receiving inhaled steroids, and 10 patients were receiving tiotropium therapy. Five patients were using continuous
supplemental oxygen during exercise. The pharmacologic treatment during the period of the study was
standardized and followed the GOLD recommendations for all patients.1 Patients were stable at the time
of entry into the exercise program, and none had
clinical evidence of cardiovascular or neuromuscular diseases limiting their exercise capacity. Baseline
characteristics of the patients are presented in Table
I. There were no significant differences in these variables over the time-points of the study.
There was a significant improvement in hemodynamics, demonstrated by the gradual reduction
in heart rate, blood pressure and MvO2 (double
product) starting from the 12th month. Lipid profile
showed reduction of low density lipids and increase
493
N.=36
Age (y)
Female (N. %)
Body mass index (kg/m2)
FEV1 (% predicted)
FEV1/FVC (%)
PEF (Lpm)
SpO2 (%)
RV (% predicted)
TLC (% predicted)
DLCO (% predicted)
61.727.62
14 (39)
23.104.56
35.699.58
64.065.19
196.3961.64
932
15646
11525
7515
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Values are meanSD unless otherwise stated, of thirty six patients. BMI:
body mass index; FEV1: forced expiratory volume at one second; FVC:
forced vital capacity; PEF: peak expiratory flow; SpO2: peripheral arterial
oxygen saturation; RV: residual volume; TLC: Total lung capacity; DLCO: diffusing capacity of the lung for carbon monoxide.
Pre-training
HR (bpm)
SP (mmHg)
DP (bpm x mmHg)
TOT-CHOL(mg/dL)
HDL-CHOL(mg/dL)
LDL-CHOL(mg/dL)
CASTELLI I
CASTELLI II
TRIGLYCERIDES (mg/dL)
GLYCEMIA(mg/dL)
96.510.4
144.910.6
14027.782127.12
216.723.9
45.714.3
115.917.8
5.11.2
2.70.7
97.810.7
96.48.8
Post-training
6th month
12th month
80.76.5*
131.57.5*
1624.031202.62*
187.217.2*
54.714.0*
104.410.9*
3.60.8*
2.00.5*
84.4 14.2*
85.36.8*
76.17.5*
124.98.8*
9543.751403.81*
170.614.9*
58.913.5*
100.18.5*
3.20.7*
1.80.4*
82.813.1*
84.27.1*
18th month
71.54.4*
117.36.5*
8397.08794.98*
174.116.2*
62.411.2*
93.88.3*
2.90.5*
1.50.3*
80.013.0*
81.27.0*
24th month
68.6 3.1*
112.44.7*
7713.89595.25*
169.919.5*
65.410.4*
91.46.5*
2.70.5*
1.40.3*
75.29.7*
78.56.7*
Values are meansSD of thirty six patients. HR: heart rate; SP: systolic pressure; DP: double product; TOT-CHOL: total cholesterol; HDL-CHOL: high-density
lipoprotein cholesterol; LDL-CHOL: low-density lipoprotein cholesterol. *Statistically different from pre-training; statistically different from 6 months; statistically different from 12 months.
Table III.Exercise tolerance, dyspnea, body mass index and respiratory muscle strength.
Pre-training
6-MINWD (m)
BODE
BMI
BORG SCALE
MIP (cmH2O)
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321.977.1
5.61.6
23.14.6
4.31.0
75.06.6
Post-training
6th month
12th month
18th month
422.678.9*
4.61.3*
21.83.3
2.90.7*
85.08.2*
459.575.1*
483.367.7*
4.11.5*
22.42.7
2.40.5*
90.48.6*
3.31.0*
22.72.3
1.90.7*
93.88.1*
24th month
516.973.9*
3.10.9*
232.1
1.50.6*
105.48.6*
Values are meansSD of thirty six patients. 6-MINWD: distance in the six-minute walk distance test; BODE: multidimensional grading system; BMI: body
mass index; MIP: maximal inspiratory pressure. *Statistically different from pre-training; Statistically different from 6 months; Statistically different from 12
months. Statistically different from 18 months.
Table IV.Outcomes of general health-related (SF-36) and disease-specific quality of life (AQ-20) questionnaires after the exercise
training program.
Pre-training
SF-36
AQ-20
31.09.6
87.85.9
Post-training
6th month
52.611.3*
74.64.5
12th month
18th month
24th month
56.910.4*
69.06.2
62.27.9*
66.87.3*
64.43.9*
74.43.9
SF-36 values are meansSD of 36 patients. AQ-20 values are meanSD of nine patients. *Statistically different from pretraining. Statistically different from 6
months; Statistically different from 12 months.
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Vol. 49 - No. 4
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Conclusions
A 24-month pulmonary rehabilitation program
leads to a progressive improvement in quality of
life, dyspnea and exercise tolerance, and reduces
cardiovascular risk factors in patients with chronic
obstructive pulmonary disease.
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means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use is
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not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, logo,
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