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Variability in Quality of Life Outcomes Following a Pulmonary Rehabilitation Program in Patients With COPD

Porto, Elias F. PT, PhD; Castro, Antonio A. M. PT, PhD; Cortopassi, Felipe PT, RPFT, MBA; de Souza, Gerson F. PT, PhD; Jardim, José R. MD, PhD

Journal of Cardiopulmonary Rehabilitation and Prevention: March 2018 - Volume 38 - Issue 2 - p 118–123
doi: 10.1097/HCR.0000000000000292
Pulmonary Rehabilitation

Purpose: Pulmonary rehabilitation (PR) improves exercise tolerance in patients with chronic obstructive pulmonary disease. However, it is unclear why some patients do not improve quality of life during a training program. Our objective was to evaluate the differences between patients with chronic obstructive pulmonary disease who improve and those who do not improve quality of life during a pulmonary rehabilitation program.

Methods: Seventy-three patients underwent a PR program. All patients trained at 80% (legs) and 50% (arms) of their maximum load. Incremental and endurance tests, 6-min walk test, and health-related quality of life with the St George Respiratory Questionnaire (SGRQ) were measured. We subdivided the groups based on a decrease ≥4 points in the pre- and post-PR SGRQ total score (G1); <4-point change in the SGRQ total score (G2); and an increase in scores ≥4 points (G3).

Results: Exacerbation frequency (P = .004) and SGRQ total scores (P < .001) were lower in G1 and G2 than in G3. G1 (P = .0007) and G2 (P = .0005) significantly improved 6-min walk test distance. Before PR, G1 and G2 walked greater distances than G3 (P = .003); however, the difference was no longer significant after PR (P = .34). A significant load increase was seen after PR for the 3 groups (P < .05). We found a significant correlation between the SGRQ and the Charlson index (r = 0.78, P < .0001), exacerbation frequency (r = 0.72, P < .0001), and basal dyspnea index (r = −0.48, P < .0001).

Conclusion: Patients whose quality of life did not improve after comprehensive PR presented a higher number of disease-related exacerbations with comorbidities.

This study showed clinical differences between 73 patients with chronic obstructive pulmonary disease who improved and those who did not improve health-related quality of life after a comprehensive pulmonary rehabilitation program. There were more disease-related exacerbations and comorbidities associated with decreased healthrelated quality of life after pulmonary rehabilitation.

Pulmonary Rehabilitation Center, Respiratory Division, Escola Paulista de Medicina, Federal University of Sao Paulo (Unifesp/Lar Escola Sao Francisco), São Paulo, Brazil (Drs Porto, Castro, de Souza, and Jardim and Mr Cortopassi); Adventist University, São Paulo, Brazil (Drs Porto and Castro); Federal University of Pampa, Rio Grande do Sul, Brazil (Dr Castro); Pulmonary Department, State University of Rio de Janeiro, Rio de Janeiro, Brazil (Mr Cortopassi).

Correspondence: Elias F. Porto, PT, PhD, Adventist University, São Paulo, SP, Brazil (

All authors have read and approved the article.

The authors declare no conflicts of interest.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.