Generic exercise rehabilitation for patients with chronic obstructive pulmonary disease and chronic heart failure
thesisposted on 24.02.2010, 09:56 by Rachael Andrea Evans
Background: Exertional breathlessness and fatigue are common disabling symptoms of patients with Chronic Obstructive Pulmonary Disease (COPD) and Chronic Heart Failure (CHF). The mechanisms behind these symptoms are similar including skeletal muscle dysfunction. Exercise training at least partially reverses the skeletal muscle abnormalities and improves exercise performance and health related quality of life in both conditions. Pulmonary rehabilitation, with exercise training as a core component, is an integral part of the management of COPD, but a service for CHF has not developed in the same way. The hypothesis, for the main studies described in this thesis, was that the successful model of pulmonary rehabilitation could be applied to patients with CHF and patients with COPD and CHF could be beneficially trained together. Methods: Two main studies were undertaken; 1) a randomised controlled trial of pulmonary rehabilitation (PR) vs. normal care (NC) in patients with CHF 2) a comparative observational study of PR between COPD and CHF. Alongside these studies, the outcome measures commonly used for COPD were applied to patients with CHF. Two pilot studies were performed investigating the effect of exercise training on other systemic manifestations of COPD and CHF. Results: Patients with CHF made significant improvements in exercise performance and health status with PR compared to NC. The improvements were similar to those seen in the patients with COPD. Measures of exercise performance and health status were applied successfully to patients with CHF. Conclusions: Patients with COPD and CHF can be successfully trained together demonstrating the feasibility of generic exercise rehabilitation for exertional breathlessness. Further work would need to investigate whether combined exercise programmes for COPD and CHF provides economies of scale for both populations. The work in this thesis highlights the possibility of organising services for chronic disease around a disability rather than an individual disease.