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PubMed1995

[Bicycle training by the method of the "free choice" of physical loading in the combined treatment of hypertension patients].

The trends in central hemodynamics and muscular performance were investigated in 107 patients with essential hypertension stage I and II. The intensity of bicycle exercise was either preset (50% of individual exercise tolerance) or decided individually by each examinee (39 and 68 patients of group 1 and 2, respectively). 12 bicycle trainings have improved myocardial contractility at rest and threshold muscular load, exercise tolerance in group 2. Group 1 hemodynamic and performance parameters changed insignificantly.

Adult↗

PubMed1992

[Cardiopulmonary exercise test for evaluating cardiac reserve in chronic congestive heart failure].

To evaluate whether maximal oxygen consumption (VO2 max) measured by cardiopulmonary exercise test (CAR-PET) reflects cardiac reserve in patients with congestive heart failure (CHF), supine bicycle CAR-PET and exercise hemodynamic measurements were performed simultaneously in 12 patients with CHF of NYHA II-IV. With increasing workload, VO2 and cardiac output elevated gradually, then plateaued, demonstrating that patients with CHF could reach VO2max. According to VO2max, patients were divided into 4 classes: including 2 patients of class A (VO2max: 24.5 +/- 2.29 ml.min-1/kg, mean +/- s mean), 3 of B (17.6 +/- 1.37 ml.min-1/kg), 5 of C (13.6 +/- 0.66 ml.min-1/kg) and 2 of D (6.5 +/- 1.64 ml.min-1/kg). Maximal cardiac indices were 8.79 +/- 2.35 L.min-1/m2 in class A, 5.82 +/- 0.97 L.min-1/m2 in B, 3.53 +/- 0.95 L.min-1/m2 in C and 2.21 +/- 1.56 L.min-1/m2 in D. No significant correlation between supine resting hemodynamic parameters and VO2max/kg was found, suggesting that exercise tolerance could not be predicted by the measurement of resting cardiac performance. Furthermore, VO2max correlated poorly with NYHA classification in these patients. However, cardiac output correlated linearly with VO2 during exercise, suggesting that VO2 max/kg is a good predictor for cardiac reserve in CHF(CI = 0.6809 +/- 0.2748 VO2/kg, n = 40, r = 0.84, P < 0.0001; CO = 1.1618 +/- 7.9065 VO2, n = 40, r = 0.84, P < 0.0001). The results also showed that VO2max/kg did not correlate with the changes of pulmonary capillary wedge pressure (PCWP), indicating that exercise tolerance in CHF depends more on cardiac output than on ventilatory consequence of pulmonary congestion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2005

Close coupling of systolic and diastolic function: combined assessment provides superior prediction of exercise capacity.

BACKGROUND: Isolated diastolic dysfunction is thought to account for approximately 50% of cases of heart failure. We tested the hypotheses that (1) the use of different methods for assessing systolic and diastolic function may contribute to the apparent frequency with which they are dissociated and (2) that combined assessment of systolic and diastolic function is superior to either one alone. METHODS AND RESULTS: A total of 110 patients underwent echocardiography with tissue Doppler imaging (TDI) of the mitral annulus before maximal exercise testing. The correlation between left ventricular (LV) ejection fraction (EF) and exercise capacity was weak (r = 0.199). Among patients with EF greater than 55%, those with normal exercise capacity (>7 METs) had a higher systolic velocity of the mitral annulus than those achieving less than 7 METs (9.6 +/- 0.3 versus 7.5 +/- 0.4 cm/s, P = .001). The mitral annular systolic (Sa) and early diastolic (Ea) velocities each correlated moderately with exercise tolerance (r = 0.40 and 0.49, respectively). Sa and Ea correlated highly with each other (r = 0.79, P < .001). The sum of isovolumic contraction and relaxation times measured from TDI correlated moderately with exercise duration (r = -0.59). A combined index of systolic and diastolic function that includes isovolumic contraction and relaxation times and ejection time had the best correlation with achieved METs (r = -0.73, P < .001). A TDI index of cardiac performance higher than 0.52 had excellent sensitivity (86%) and specificity (100%) for predicting reduced exercise tolerance lower than 7 METs. CONCLUSION: When assessed with the same technique, LV systolic and diastolic function are tightly linked. A TDI-derived combined index of myocardial performance is the best predictor of exercise capacity.

Adult↗

PubMed2006

Rate control in atrial fibrillation: looking beyond the average heart rate.

PURPOSE OF REVIEW: The aim of this article is to provide a perspective on rate control in atrial fibrillation which emphasizes patient wellbeing (exercise tolerance, symptoms, quality of life) over attempts to reduce resting or exercise heart rate to an arbitrary range. RECENT FINDINGS: Recent trials of rhythm versus rate control strategies of treatment in patients with atrial fibrillation suggest that rate control is a viable first line strategy in many patients. The adverse consequences of atrial fibrillation with rapid ventricular response are partly due to factors other than rate itself, such as irregularity of ventricular response, and variable changes in autonomic nervous system output. Digoxin, calcium channel blockers, and beta-blockers cause a similar reduction in resting heart rate. Beta blockers are the most potent at reducing exercise heart rate, followed by calcium channel blockers and digoxin. Exercise tolerance is occasionally improved by digoxin, sometimes improved by calcium channel blockers and not improved by (and sometimes decreased by) beta-blockers. Information about quality of life with different rate control regimens is sparse. SUMMARY: Rate control in atrial fibrillation provides important benefits to patients in terms of symptoms, quality of life and prevention of late consequences of uncontrolled rate (such as tachycardia induced cardiomyopathy). Restricting treatment objectives to achievement of a specific heart rate range on resting or exercise electrocardiogram may result in lack of patient benefit or worsened symptoms. Understanding the nuances of rate control when treating individual patients and interpreting existing evidence allows patients to experience the most benefit from this treatment strategy.

Anti-Arrhythmia Agents↗

PubMed2005

Case report: inspiratory muscle training in chronic critically ill patients--a report of two cases.

BACKGROUND AND PURPOSE: Inspiratory muscle weakness and fatigue has been documented following prolonged mechanical ventilation despite successful weaning from mechanical ventilation. This report describes the application of inspiratory muscle training in two patients following successful discharge from an intensive care unit (ICU) after prolonged mechanical ventilation. METHODS: Both patients undertook inspiratory muscle training in conjunction with standard physiotherapy rehabilitation. RESULTS: Improvements in inspiratory muscle strength and endurance, exercise tolerance and functional performance following twice-daily inspiratory muscle training were recorded. In both cases, an improvement in maximal inspiratory pressure (MIP) and maximal tolerated inspiratory load (MIP(load)) was found following training. CONCLUSION: These positive results indicate further research is needed to investigate the effect of inspiratory muscle training on respiratory function, exercise tolerance and functional performance, for the possible inclusion of inspiratory muscle training into the physiotherapy management of patients following prolonged mechanical ventilation.

Activities of Daily Living↗

PubMed1992

A clinical exercise system for paraplegics using functional electrical stimulation.

A low cost clinical exercise system was developed for the spinal cord injured, based on a bicycle ergometer and electrical stimulation. A pilot project was conducted, using the system, to examine the effects of stimulation induced cycling in long term paraplegics. The project comprised 2 phases of exercise, a strengthening phase involving a 12 week programme of electrical stimulation to the quadriceps and hamstrings and a 12 week cycling phase. Physiological, morphological and biochemical parameters were measured for each subject, at the beginning of the programme and following each phase. Results showed that a programme of stimulation induced lower limb exercise increased the exercise tolerance of all patients, as determined by a progressive increase in exercise time, cycling rate and exercise load. The enhanced exercise tolerance was a result of increases in local muscle strength and endurance. Increases in thigh muscle area and joint range of motion were recorded and all incomplete subjects reported an improvement in functional capabilities and general wellbeing.

Adult↗

PubMed1996

Exertional hyperpnea in patients with chronic heart failure is a reversible cause of exercise intolerance.

BACKGROUND: Hyperpnea in chronic heart failure occurs even in the absence of considerable impairment of lung function. It is caused by altered respiratory pattern with rapid shallow breathing and ventilation-perfusion mismatch, so far thought to be irreversible. OBJECTIVES: To test the underlying pathophysiologic disorders and the reversibility of this hyperpnea, i.e., the increased ventilatory response to exercise and its impact on exercise tolerance, 17 patients with chronic heart failure were evaluated before and 4 weeks after adjustment of heart failure therapy with diuretics and ACE inhibitors, and results were compared with normal volunteers. METHODS: Ventilatory response to exercise was measured during treadmill exercise by calculation of the slope of the linear relation between minute ventilation (VE) and carbon dioxide output (VCO2) and compared to NYHA class, oxygen consumption at the gas exchange anaerobic threshold (VO2 AT), maximal oxygen uptake (VO2 max) and ventilation of physiological dead space. RESULTS: VE vs VCO2 slope was related to severity of heart failure (NYHA class). Elevation of VE vs VCO2 slope was strongly correlated to elevated ventilation of physiologic dead space. Patients were divided into responders (significant decrease of VE vs VCO2 slope of at least 5 l/l I CO2) and nonresponders (decrease of VE vs VCO2 slope less than 5 I or increase). Responders revealed an increase of VO2 AT (7.4 +/- 2.6 to 11.7 +/- 2.1 ml O2/kg/min; p = 0.01) and VO2 max (11.2 +/- 2.8 to 17.4 +/- 5.3; p = 0.005), while nonresponders showed a non significant decrease of oxygen consumption (VO2 AT 9.6 +/- 3.7 to 9.0 +/- 3.7; peak VO2 14.6 +/- 6.1 to 14.4 +/- 6.4), despite adjusted heart failure therapy. CONCLUSION: Exercise hyperpnea in heart failure is mainly caused by ventilation of excess physiologic dead space and strongly contributes to severity of symptoms. Ventilatory response to exercise can be improved by adjustment of heart failure therapy in a considerable proportion of patients. Improvement is associated with an increase in aerobic capacity. Ventilation-perfusion mismatch is a major and modifiable factor determining exercise tolerance in patients with chronic heart failure.

Carbon Dioxide↗

PubMed2005

Relationship between breath-hold time and physical performance in patients with cystic fibrosis.

Rehabilitation including physiotherapy is an important part of the treatment used to help improve the quality of life of patients with cystic fibrosis (CF). The aim of this study was to determine the value of the breath-hold time as an index of exercise tolerance in patients with CF. Eighteen patients in different states of CF were included. The breath-hold time was measured in all patients. The fitness level was assessed by means of a progressive exercise test on a cycle-ergometer. During the test, oxygen uptake (VO(2)) and carbon dioxide elimination (VCO(2)) were measured breath by breath. The VO(2) and working capacity (WC) were computed at the anaerobic threshold (AT) and at peak. Duration of breath-hold was 24.7 +/- 2.87 (mean +/- SEM) seconds, varying between 10 and 58. The breath-hold time (BHT) displayed a significant correlation with VO(2) (r = 0.898), WC (r = 0.899) at the AT, and the peak VO(2) (r = 0.895). Regression equations were: VO(2) at the AT (ml/kg) = 5.53 + 0.42 x BHT and WC at the AT (watt/kg) = 0.56 + 0.38 x BHT Our results suggest that the voluntary breath-hold time might be a useful index for prediction of the exercise tolerance of CF patients.

Adolescent↗

PubMed2005

[A new test (VITTORIO Test) for functional fitness assessment in rehabilitation after cardiac surgery].

An adequate assessment of physical function (PF) in Cardiac Rehabilitation (CR) plays a central role in early detection of physical limitations. Traditionally exercise tolerance has been used as an indicator of overall PF. However exercise tolerance has been shown to poorly predict patients' ability to perform daily-life activities. The goal of the present study is to evaluate a new test, named VITTORIO TEST, for assessing various component of daily activities among patients in CR after cardiac surgery. VITTORIO test consists in 8 items that assess lower and upper extremity strength and flexibility, agility, dynamic balance, aerobic capacity. 500 patients (359 males; 141 females) admitted to CR programs following cardiac surgery (349 coronary artery bypass surgery; 151 valvular surgery) were enrolled in the study. They were evaluated with an initial test (T1) (10.7 +/- 6.3 days after cardiac surgery) and a final test (T2) after an in-hospital intensive training program (mean length 16.8 +/- 6.6 days) consisting in stretching, large muscle group and aerobic activity, resistance exercises. Statistical analysis showed a significant improvement of all items at the end of the rehabilitation program. Old patients (>70 years) and particularly females demonstrate exercise improvement comparable to that of younger subjects especially regards lower extremity strength and aerobic capacity. VITTORIO test is inexpensive, simple and easy to perform by the patient. Through the identification and the measurement of different aspects of physical disability, it allows a personalized rehabilitation exercise program. It could be used as an outcome measure of CR programs.

Aged↗

PubMed1982

The reasonable workup before recommending medical or surgical therapy: an overall strategy.

The workup of a patient with chronic ischemic heart disease (IHD) before the selection of medical-surgical or medical therapy depends on multiple objective and subjective factors. These include symptoms, extent of anatomic disease (degree of coronary arteriosclerosis and left ventricular abnormalities), objective evidence of ischemia, extent of left ventricular dysfunction, and recent intercurrent ischemic events. In a minority of patients, a single factor is of overwhelming importance; e.g., the presence of severe left main coronary artery narrowing in a symptomatic patient indicates surgery is a better choice, whereas evidence of advanced left ventricular dysfunction suggests that surgery is likely to be risky and of limited help to the patient. In most instances, multiple factors should be considered before making a recommendation. The patient should be placed in the appropriate clinical subset and the objective factors that are most important in determining survival should be evaluated. Hence, an exercise electrocardiographic study to evaluate symptoms and exercise tolerance in a patient with angina pectoris and radioventriculographic studies with exercise to estimate left ventricular performance in a patient who complains of fatigue and breathlessness are superior to the subjective interpretations of routine clinical examinations. Asymptomatic patients and those with excellent exercise tolerance pose the most difficult decisions. Perhaps serial (even annual) noninvasive evaluation is appropriate in such patients in light of the current uncertainty about how to manage them. Laboratory tests should be used selectively, systematically and sequentially. The high cost of many of the examinations is reason to avoid duplication. When noninvasive evaluation can answer the question being posed and the cost of hospitalization avoided, this should be done. However, there is little reason to perform noninvasive examinations that do not answer the clinical question being asked; hence, in many patients it is appropriate to proceed directly to coronary arteriography rather than to perform a variety of "screening" examinations before this procedure.

Angina Pectoris↗

PubMed1986

Glycogen depletion patterns in the muscle of standardbred trotters after exercise of varying intensities and durations.

The glycogen depletion patterns in the gluteus muscle of Standardbred horses were studied under different trotting intensities. After racing significant glycogen depletion was found in all Type I and IIA fibres and in a varying percentage of Type IIB fibres, depending on the individual horse. When horses performed exercise over a short distance (5 to 8 km) at three different speeds, glycogen depletion was difficult to detect for the faster speeds (10 and 8 m/sec) but notably involved a major proportion of Type I fibres at the slowest speed (6 m/sec). When exercise was prolonged over a greater distance a larger proportion of Type IIA fibres were depleted at faster speeds (8 m/sec) than at slower speeds over the same distance. However, when slow trotting was continued over even greater distances, a gradual increase in the percentage of glycogen depleted Type IIA fibres was noticed. Very significant glycogen depletion in all three fibre types was seen in all horses where a near maximal exercise tolerance test was performed 3 h after the longest and slowest exercise run. In a further study of glycogen depletion, during a near maximal exercise tolerance test on a graded treadmill with consecutively increasing velocity, depletion was seen in a proportion of all three fibre types with the highest proportion being Type I and the lowest Type IIB.

Animals↗

PubMed2001

Laryngeal paralysis: a study of 375 cases in a mixed-breed population of horses.

Referred cases (n = 375) of laryngeal paralysis (1985-1998) from a mixed-breed equine population included 351 (94%) cases of recurrent laryngeal neuropathy (RLN) (idiopathic laryngeal hemiplegia) and 24 cases (6%) of laryngeal paralysis from causes other than RLN. Laryngeal movements were classified endoscopically into one of 6 grades, in contrast to the usual 4 grades. The RLN cases had a median grade 4 laryngeal paralysis, of which 96% were left-sided, 2% right-sided and 2% bilaterally affected. RLN cases included 204 (58%) Thoroughbred, 96 (27%) Thoroughbred-cross, 23 (7%) draught, 16 (5%) Warmbloods and 10 (3%) other breeds, including only 4 (1%) ponies. The median age of RLN cases at referral was 6 years (range 2-12) and their median height was 170.2 cm. The work of RLN horses included National Hunt racing (42%), flat racing (1%), hunting (19%), eventing (16%) and miscellaneous work (22%). Reported presenting signs in RLN-affected horses included abnormal exercise-related respiratory sounds in 90% and reduced exercise tolerance in only 64%. However, many horses were referred before their exercise tolerance could be fully assessed. Forty percent of the RLN cases had intercurrent disorders, including 10% with additional upper respiratory and 7% with lower respiratory tract diseases. The 24 nonidiopathic RLN cases included 12 with bilateral laryngeal paralysis, 11 (92%) of which were ponies. Bilateral laryngeal paralysis occurred with hepatic encephalopathy in 7 cases and following general anaesthesia in 2 cases. The 12 cases of acquired unilateral laryngeal paralysis included 7 caused by guttural pouch mycosis.

Animals↗

PubMed1981

Ergometric and hemodynamic studies on a new cardiotonic agent AR-L 115 BS.

The cardiotonic agent, 2-[(2-methoxy-4-methylsulfinyl)phenyl]-1H-imidazol[4,5-b]pyridine (AR-L 115BS), increases cardiac contractility and lowers cardiac pre- and afterload. These properties were shown to favourably influence hemodynamics at rest and under exercise in patients with coronary heart disease and angina pectoris. Although it reduces pre- and afterload, unlike isosorbide dinitrate it does not improve exercise tolerance in symptom limited ergometry. There was, however, no worsening of exercise tolerance. It appears that the decrease in oxygen consumption due to a decreased pre- and afterload is compensated for by an increase in oxygen requirement during contractility.

Angina Pectoris↗

PubMed1975

Calf blood flow in intermittent claudication.

Calf blood flow was correlated with severity of symptoms in 24 patients with intermittent claudication. Calf blood flow was measured (Whitney strain gauge) at three levels of demand--at rest, after exercise ("open"), and after exercise with total vascular occlusion by a tourniquet about the thigh ("closed"). The results showed significant correlation between the patients' reported capacity to walk and measured exercise tolerance on an ergometer (P less than or equal to .01). The coefficients of correlation between exercise tolerance and calf blood flow (resting, postopen or postclosed exercise) or the vascular reserve (difference between postopen and postclosed exercise hyperemia) were not significant. It is concluded that capacity for walking in cases of intermittent claudication is not a reliable index of the calf blood flow. The relationship between these factors would be clearer if the patients pain threshold and calf tissue metabolic activity were known also.

Adult↗

PubMed2004

A meta-analysis of the effect of angiotensin-converting enzyme inhibitors on functional capacity in patients with symptomatic left ventricular systolic dysfunction.

AIM: To determine by meta-analysis whether angiotensin-converting enzyme (ACE) inhibitors improve exercise tolerance in patients with symptomatic left ventricular systolic dysfunction (LVSD). METHODS AND RESULTS: After literature search 13 multi-centre double blind parallel group trials that evaluated the effect of ACE inhibitors vs. placebo on exercise duration were selected. Ninety-four percent of patients were in New York Heart Association class II-IV. The studies were combined using the Cochrane meta-analysis program (Review manager version 4.1). Analyses according to treatment period, exercise protocols and publication periods were performed. Treatment with ACE inhibitor over 4-12 weeks resulted in a beneficial effect on exercise duration (P=0.003 and P=0.0008 for 4- and 12-weeks treatment, respectively), but the magnitude of improvements did not exceed 30 s corresponding to only 5% compared with placebo. CONCLUSION: In addition to the pronounced effect on mortality and morbidity in patients with symptomatic LVSD, ACE inhibitors have improving effect on functional capacity measured as exercise tolerance time.

Angiotensin-Converting Enzyme Inhibitors↗

PubMed2005

Exercise stress testing in subacute stroke patients using a combined upper- and lower-limb ergometer.

OBJECTIVE: To assess functional cardiopulmonary exercise tolerance in a subset of patients with residual neurologic deficits after stroke by exercise stress testing using the Power Trainer, a combined upper- and lower-limb ergometer. DESIGN: Prospective, observational study using a convenience sample. SETTING: Clinical locomotor laboratory in a tertiary rehabilitation hospital. PARTICIPANTS: Thirty subjects undergoing rehabilitation an average of 7.3 weeks after stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Percentage of age-predicted maximal heart rate (APMHR) achieved and rate-pressure product (RPP). RESULTS: Thirty subjects completed stress tests. Twelve of the 30 subjects were taking beta-blocker medications. Mean maximum heart rate +/- standard deviation achieved was 119+/-21 beats/min, equal to 75%+/-11% of APMHR. Ten subjects achieved 85% of APMHR or greater. Those not taking a beta-blocker attained 80%+/-10% of APMHR. The percentage increase in RPP from rest to maximal exercise for the whole group was 117%+/-44%. Four subjects developed cardiopulmonary signs or symptoms. Exercise prescriptions were provided to patients using the Karvonen formula. Overall subject satisfaction with the Power Trainer was high. CONCLUSION: The Power Trainer can be used safely to assess cardiopulmonary exercise tolerance in a select subset of patients with neurologic impairments secondary to stroke. This information can be extrapolated for proper exercise prescription and may contribute to the investigation of coronary artery disease in this high-risk population.

Aged↗

PubMedDate not supplied

A comparison of captopril and digoxin in the treatment of patients with mild-to-moderate chronic congestive heart failure.

In a double-blind study, 116 patients (mean age, 57.6 years) with mild-to-moderate chronic congestive heart failure who were in sinus rhythm were randomly assigned to receive 25 mg of captopril twice daily (up to 50 mg twice daily, if needed) plus hydrochlorothiazide (HCTZ) (group 1) or 0.1 mg of digoxin twice daily plus HCTZ (group 2) for 12 months. During a 3- to 4-week pretreatment stabilization period, group 1 received a mean of 37.7 mg of HCTZ daily and group 2 received 34.9 mg daily. After 6 weeks and 12 months of treatment, improvement was noted in both treatment groups on five measures of cardiac function: exercise tolerance, left ventricular end-diastolic diameter (LVEDD), ejection fraction, blood pressure, and heart rate. At 12 months, significantly greater improvement was noted in group 1 than in group 2 in exercise tolerance (from 329 seconds at baseline to 445 seconds at 12 months in group 1 and from 353 to 427 seconds in group 2; P < 0.05); LVEDD (from 60.5 to 56.5 mm in group 1 and from 60.3 to 57.9 mm in group 2; P < 0.05); and blood pressure (from 103.5 to 95.6 mm Hg in group 1 and from 101.9 to 97.0 mm Hg in group 2; P < 0.03). Clinical severity (New York Heart Association class) improved in both groups; 52% of the patients in group 1 and 41% in group 2 dropped an average of one functional class (P < 0.01). The results indicate that captopril combined with a diuretic is an effective initial treatment for patients with mild-to-moderate congestive heart failure.

Aged↗

PubMed1995

Effects of pulmonary rehabilitation on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To compare the effects of comprehensive pulmonary rehabilitation with those of education alone on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease. DESIGN: Randomized clinical trial. SETTING: University medical center. PATIENTS: 119 outpatients with chronic obstructive pulmonary disease that was stable while patients received a standard medical regimen. INTERVENTION: Patients were randomly assigned to either an 8-week comprehensive pulmonary rehabilitation program or to an 8-week education program. Pulmonary rehabilitation consisted of twelve 4-hour sessions that included education, physical and respiratory care instruction, psychosocial support, and supervised exercise training. Monthly reinforcement sessions were held for 1 year. The education group attended four 2-hour sessions that included video-tapes, lectures, and discussions but not individual instruction or exercise training. MEASUREMENTS: Pulmonary function, maximum exercise tolerance and endurance, gas exchange, symptoms of perceived breathlessness and muscle fatigue with exercise, shortness of breath, self-efficacy for walking, depression, general quality of well-being, and hospitalizations associated with pulmonary diseases. Patients were followed for 6 years. RESULTS: Compared with education alone, comprehensive pulmonary rehabilitation produced a significantly greater increase in maximal exercise tolerance (+1.5 metabolic equivalents [METS] compared with +0.6 METS [P < 0.001]; maximal oxygen uptake, +0.11 L/min compared with +0.03 L/min [P = 0.06]), exercise endurance (+10.5 minutes compared with +1.3 minutes [P < 0.001]), symptoms of perceived breathlessness (score of -1.5 compared with +0.2 [P < 0.001]) and muscle fatigue (score of -1.4 compared with -0.2 [P < 0.01]), shortness of breath (score of -7.0 compared with +0.6 [P < 0.01]), and self-efficacy for walking (score of +1.4 compared with +0.1 [P < 0.05]). There were slight but nonsignificant differences in survival (67% compared with 56% [P = 0.32]) and duration of hospital stay (-2.4 days/patient per year compared with +1.3 days/patient per year [P = 0.20]). Measures of lung function, depression, and general quality of life did not differ between groups. Differences tended to diminish after 1 year of follow-up. CONCLUSIONS: Comprehensive pulmonary rehabilitation significantly improved exercise performance and symptoms for patients with moderate to severe chronic obstructive pulmonary disease. Benefits were partially maintained for at least 1 year and tended to diminish after that time.

Aged↗