The Impact of Pulmonary Rehabilitation on Dyspnea in Chronic Obstructive Pulmonary Disease
Condition: Chronic Obstructive Pulmonary Disease
MeSH terms: Lung Diseases; Lung Diseases, Obstructive; Pulmonary Disease, Chronic Obstructive; Dyspnea
Study type: Interventional

Summary: 
      Dyspnea (respiratory discomfort) and activity limitation are the most common symptoms of
      chronic obstructive pulmonary disease (COPD) and contribute importantly to a perceived poor
      quality of life. Recent international guidelines have stressed the importance of dyspnea
      alleviation and improvement exercise tolerance as a means of enhancing quality of life and
      other long term outcomes in this population. Modern pharmacotherapy is the first step in
      symptom management but the overall impact of bronchodilator therapy is relatively small.
      Exercise training remains the most effective treatment for ameliorating dyspnea and improving
      exercise endurance and was the main focus of this study.

      The main objectives of the study were:

        1. To conduct and compare detailed studies of respiratory mechanics during cycle exercise
           before and after exercise training (EXT) compared with an untrained control group. By
           multiple regression analysis, the investigators will establish the main contributors to
           dyspnea relief after EXT.

        2. To compare the magnitude of change in endurance during constant work rate cycle exercise
           with those measured during walk tests and the endurance shuttle walk test after EXT
           relative to control. To evaluate which test (constant work rate cycle, six-minute walk
           test, or endurance shuttle walk test) is the most sensitive test for measuring changes
           in endurance after EXT versus control.

        3. To compare the change in standardized dyspnea ratings (Borg Scale) during constant-load
           cycling with a variety of other activity-related dyspnea questionnaires. To evaluate
           which of these measurements is the most sensitive for examining changes in perceived
           discomfort during exercise.

        4. To evaluate the contribution of psychological factors (anxiety, fear, respiratory panic,
           self-efficacy) to the perceived improvement of symptoms following EXT. The investigators
           will use multiple regression analysis to examine associations between changes in
           perceived dyspnea and changes in anxiety and self-efficacy measured by validated
           questionnaires and Borg intensity ratings?
    


Intervention name(s): Pulmonary rehabilitation; Usual care
Intervention type(s): Other; Other
Intervention description(s): 8-week program, 3 supervised session per week; An 8-week control period (includes optimization of respiratory medications, instructions on how best to manage COPD, standard access to treatment in the event of an exacerbation, self-management education)
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: COPD; dyspnea; exercise; measurement; respiratory physiology