The short and long term effects of exercise training in non-cystic fibrosis bronchiectasis – a randomised controlled trial

Respiratory Research

Anne E Holland³  Philip J Thompson⁶  Robert G Stirling⁵  Linda Rautela²  Angela T Burge¹  Christine F McDonald²  Sue Jenkins⁶  Nola Cecins⁷  Catherine J Hill²  Annemarie L Lee⁴ 

[1] Alfred Health, Commercial Road, Melbourne 3004, Victoria, Australia;Austin Health, 145 Studley Road, Heidelberg 3084, Australia;Physiotherapy, La Trobe University, Melbourne 3086, Australia;Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, 161 Barry Street, Carlton 3010, Australia;Department of Medicine, Monash University, Melbourne 3800, Australia;Curtin University, Kent Street, Bentley, Perth 6102, Australia;Lung Institute of Western Australia and Centre for Asthma, Hospital Avenue, Nedlands, Perth 6009, Australia

关键词: Acute exacerbations;    Exercise capacity;    Quality of life;    Exercise training;    Bronchiectasis;   

Others  :  790331
DOI  :  10.1186/1465-9921-15-44

 received in 2014-01-24, accepted in 2014-04-01,  发布年份 2014

【 摘 要 】

Background

Exercise training is recommended for non-cystic fibrosis (CF) bronchiectasis, but the long-term effects are unclear. This randomised controlled trial aimed to determine the effects of exercise training and review of airway clearance therapy (ACT) on exercise capacity, health related quality of life (HRQOL) and the incidence of acute exacerbations in people with non-CF bronchiectasis.

Methods

Participants were randomly allocated to 8 weeks of supervised exercise training and review of ACT, or control. Primary outcomes of exercise capacity and HRQOL (Chronic respiratory disease questionnaire) and secondary outcomes of cough-related QOL (Leicester cough questionnaire) and psychological symptoms (Hospital anxiety and depression scale) were measured at baseline, following completion of the intervention period and at 6 and 12 months follow up. Secondary outcomes of the exacerbation rate and time to first exacerbation were analysed over 12 months.

Results

Eighty-five participants (mean FEV₁ 74% predicted; median Modified Medical Research Council Dyspnoea grade of 1 (IQR [1–3]) were included. Exercise training increased the incremental shuttle walk distance (mean difference to control 62 m, 95% CI 24 to 101 m) and the 6-minute walking distance (mean difference to control 41 m, 95% CI 19 to 63 m), but these improvements were not sustained at 6 or 12 months. Exercise training reduced dyspnoea (p = 0.009) and fatigue (p = 0.01) but did not impact on cough-related QOL or mood. Exercise training reduced the frequency of acute exacerbations (median 1[IQR 1–3]) compared to the control group (2[1–3]) over 12 months follow up (p = 0.012), with a longer time to first exacerbation with exercise training of 8 months (95% CI 7 to 9 months) compared to the control group (6 months [95% CI 5 to 7 months], p = 0.047).

Conclusions

Exercise training in bronchiectasis is associated with short term improvement in exercise capacity, dyspnoea and fatigue and fewer exacerbations over 12 months.

Trial registry

ClinicalTrials.gov (NCT00885521).

【 授权许可】

   
2014 Lee et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Barker A: Bronchiectasis. N Engl J Med 2002, 346:1383-1393.
• [2]King P, Holdsworth SR, Freezer N, Villanueva E, Holmes PW: Characteristation of the onset and presenting clinical features of adult bronchiectasis. Respir Med 2006, 100:2183-2189.
• [3]Martinez Garcia M, Perpina Tordera M, Roman Sanchez P, Soler Cataluna JJ: Quality of life determinants in patients with clinically stable bronchiectasis. Chest 2005, 128:739-745.
• [4]Olveira C, Olveira G, Gaspar I, Dorado A, Cruz I, Soriguer F, Quittner AL, Espildora F: Depression and anxiety symptoms in bronchiectasis: associations with health-related quality of life. Qual Life Res 2013, 22:597-605.
• [5]Chang A, Bilton D: Exacerbation in cystic fibrosis: 4-Non cystic fibrosis bronchiectasis. Thorax 2008, 63:269-276.
• [6]Finklea J, Khan G, Thomas S, Song J, Myers D, Arroliga AC: Predictors of mortality in hospitalised patients with acute exacerbation of bronchiectasis. Respir Med 2010, 104:816-821.
• [7]Martinez-Garcia M, Soler-Cataluna J, Perpina-Tordera M, Roman-Sanchez P, Soriano J: Factors associated with lung function decline in adult patients with stable non-cystic fibrosis bronchiectasis. Chest 2007, 132:1565-1572.
• [8]Seitz AE, Olivier KN, Adjemian J, Holland SM, Prevots R: Trends in bronchiectasis among medicare beneficiaries in the United States, 2000 to 2007. Chest 2012, 142:432-439.
• [9]Seitz AE, Olivier KN, Steiner CA, Montes De Oca R, Holland SM, Prevots DR: Trends and burden of bronchiectasis-associated hospitalizations in the United States, 1993–2006. Chest 2010, 138:944-949.
• [10]Australian Institute of Health and Welfare: Asthma, chronic obstructive pulmonary disease and other respiratory diseases in Australia, 2010. [http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines webcite]
• [11]Joish V, Spilsbury-Cantalupo M, Operschall E, Luong B, Boklage S: Economic burden of non-cystic fibrosis bronchiectasis in the first year after diagnosis from a US health plan perspective. Appl Health Econ Health Policy 2013, 11:299-304.
• [12]Ringshausen FC, de Roux A, Pletz MW, Hamalainen N, Welte J, Rademacher J: Bronchiectasis-associated hospitalisation in Germany, 2005–2011 - a population-based study of disease burden and trends. PLoS One 2013, 8:e71109.
• [13]Pasteur M, Bilton D, Hill A, Stockley RA, Wilson R, Pasteur MC, Herriot R, Hansel DM, Bush A, Cornford C, Willcox L, Bilton D, Parry GW, Sonnappa S, Wallis C, French J, Sinfield F, Harvey A, Bott J, Pryor J, Hill AT, Greenstone M, Cunningham S, Spencer DA, Emmanue X, Kalima P, Heslop K, Elborn S, Carr S, Cole B: British Thoracic Society guidelines for non-CF bronchiectasis. Thorax 2010, 65:i1-i58.
• [14]Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, Hill K, Holland A, Lareau SC, Man MD, Pitta F, Sewell L, Raskin J, Bourbeau J, Crouch R, Franssen FM, Casaburi R, Vercoulen JH, Vogiatzis I, Gosselink R, Clini EM, Effing TW, Maltais F, Van Der Palen J, Troosters T, Janssen DJ, Collins E, Garcia Aymerich J, Brooks D, Fahy BF, et al.: An official American thoracic society/European respiratory society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013, 188:e13-e64.
• [15]Ong H, Lee A, Hill C, Holland AE, Denehy L: Effects of pulmonary rehabilitation in bronchiectasis: a retrospective study. Chron Respir Dis 2011, 8:21-30.
• [16]Zan Zellar M, Caetano P, Amorim A, Viana P, Martins P, Gaspar L, Hespanhol V, Gomes I: Pulmonary rehabilitation in patients with bronchiectasis: pulmonary function, arterial blood gases and the 6-minute walk test. J Cardiopulm Rehabil Prev 2012, 32:278-283.
• [17]Newall C, Stockley R, Hill S: Exercise training and inspiratory muscle training in patients with bronchiectasis. Thorax 2005, 60:943-948.
• [18]Mandal P, Sidhu M, Kope L, Pollock W, Stevenson LM, Pentland JL, Turnbull K, MacQuarrie S, Hill AT: A pilot study of pulmonary rehabilitation and chest physiotherapy versus chest physiotherapy alone in bronchiectasis. Respir Med 2012, 106:1647-1654.
• [19]Griffiths T, Phillips C, Davies S, Davies S, Burr ML, Campbell IA: Cost effectiveness of an outpatient multidisciplinary pulmonary rehabilitation program. Thorax 2001, 56:779-784.
• [20]Lee A, Cecins N, Hill C, Holland AE, Rautela L, Stirling RG, Thompson P, McDonald CF, Jenkins S: The effects of pulmonary rehabilitation in patients with non-cystic fibrosis bronchiectasis: protocol for a randomised controlled trial. BMC Pulm Med 2010, 10:1-7. BioMed Central Full Text
• [21]Mahler D, Wells C: Evaluation of clinical methods for rating dyspnea. Chest 1998, 93:580-586.
• [22]Global initative for chronic obstructive lung disease: Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease 2013. [http://www.goldcopd.com/ webcite]
• [23]Global Initiative for Asthma (GINA): Global Strategy for Asthma Management and Prevention 2012. [http://www.ginasthma.org/ webcite]
• [24]Pryor JA, Prasad SA: Physiotherapy problems. In Physiotherapy for Respiratory and Cardiac problems. Edited by Pryor JA, Prasad S. United Kingdom: Elsevier; 2008:398-394.
• [25]Alison J, Barrack C, Cafarella P, Frith P, Hanna C, Hill CJ, Holland AE, Jenkins S, Meinhardt J, McDonald CF, McKeough Z, Patman S, Ross J, Seale H, Shoemaker C, Spencer L, Allan H, Banks S, Barrett S, Beeley H, Blake J, Boden I, Cecins N, Cockram J, Herd K, Hill K, Langdon C, Lee AL, Leung R, McNamara R, et al.: Pulmonary rehabilitation toolkit. [http://www.pulmonaryrehab.com.au webcite]
• [26]Nici L, Donner C, Wouters E, Zuwallack R, Ambrosino N, Bourbeau J, Carone M, Celli B, Engelen M, Fahy B, Garvey C, Goldstein R, Gosselink R, Lareau S, MacIntye N, Maltais F, Morgan M, O'Donnell D, Prefault C, Reardon J, Rochester C, Schols A, Singh S, Troosters T, on behalf of the ATS/ERS Pulmonary rehabilitation writing committee: American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med 2006, 173:1390-1413.
• [27]Hill K, Jenkins SC, Cecins N, Philippe DL, Hillman DR, Eastwood PR: Estimating maximal work rate during incremental cycle ergometry testing from six-minute walk distance in patients with chronic obstructive pulmonary disease. Arch Phys Med Rehabil 2008, 89:1782-1787.
• [28]Holland A, Hill C, Conron M, Munro P, McDonald CF: Short term improvement in exercise capacity and symptoms following exercise training in interstitial lung disease. Thorax 2008, 63:549-554.
• [29]Australian Government, Department of Health: Physical Activity guidelines. 2013. [http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines#guidelines_adults webcite]
• [30]Singh S, Morgan M, Scott S, Walters D, Hardman AE: Development of a shuttle walking test of disability in patients with chronic airway obstruction. Thorax 1992, 47:1019-1024.
• [31]Williams J, Singh S, Sewell L, Guyatt GH, Morgan MD: Development of a self-reported Chronic Respiratory Questionnaire (CRQ-SR). Thorax 2001, 56:954-959.
• [32]American Thoracic Society: Guidelines for the 6-minute walk test. Am J Respir Crit Care Med 2002, 166:111-117.
• [33]Murray M, Turnbull K, MacQuarrie S, Pentland JL, Hill AT: Validation of the Leicester Cough Questionnaire in non-cystic fibrosis bronchiectasis. Eur Respir J 2009, 34:125-131.
• [34]Zigmond A, Snaith R: The hospital anxiety and depression scale. Acta Pyschiatr Scand 1983, 67:361-370.
• [35]Hawthorn G, Osborne R: Population norms and meaningful differences for the Assessment of Quality of Life (AQOL) measures. Aust NZ J Public Health 2005, 29:136-142.
• [36]Lachin JM: Statistical considerations in the intent-to-treat principle. Control Clin Trials 2000, 21:167-189.
• [37]Miller ME, Morgan TM, Espeland MA, Emerson SS: Group comparisons involving missing data in clinical trials: a comparison of estimates and power (size) for some simple approaches. Stat Med 2001, 20:2383-2397.
• [38]Schultz KF, Altman DG, Moher D, the CONSORT Group: CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med 2010, 8:18. BioMed Central Full Text
• [39]Santamato A, Ranieri M, Panza F, Frisardi V, Marvulli R, Filoni S, Cisari C, Fiore P: Pulmonary rehabilitation for patients with bronchiectasis: case reports. Eur J Phys Rehabil Med 2012, 48:293-298.
• [40]Akimoto T, Kumai Y, Hayashi E, Hayashi E, Murakami H, Soma R, Kuno S, Kono I: Effects of 12 months of exercise training on salivary secretory IgA levels in elderly subjects. Brit J Sports Med 2003, 37:76-79.
• [41]Dwyer T, Alison J, McKeough ZJ, Daviskas E, Bye PT: Effects of exercise on respiratory flow and sputum properties in patients with cystic fibrosis. Chest 2011, 139:870-877.
• [42]Angrill J, Agusti C, de Celis R, Rano A, Gonzalez J, Sole T, Xaubet A, Rodriguez-Roison R, Torres A: Bacterial colonisation in patients with bronchiectasis: microbiological pattern and risk factors. Thorax 2002, 57:15-19.
• [43]Loebinger MR, Wells AU, Hansell DM, Chinyanganya N, Devaraj A, Meister M, Wilson R: Mortality in bronchiectasis: a long-term study assessing the factors influencing survival. Eur Respir J 2009, 34:843-849.
• [44]Puhan M, Chandra D, Mosenifar Z, Ries A, Make B, Hansel NN, Wise RA, Sciurba F: The minimal important difference of exercise tests in severe COPD. Eur Respir J 2011, 37:784-790.
• [45]King PT, Holdsworth SR, Freezer NJ, Vallanueva E, Farmer MW, Guy P, Holmes PW: Lung diffusing capacity in adult bronchiectasis: a longitudinal study. Respir Care 2010, 55:1686-1692.
• [46]King PT, Holdsworth SR, Freezer NJ, Villanueva E, Gallaher M, Holmes PW: Outcome in adult bronchiectasis. Int J of Chron Obstruct Pulmon Dis 2005, 2:27-34.
• [47]Tantucci C, Modina D: Lung function decline in COPD. Int J of Chron Obstruct Pulmon Dis 2012, 7:95-99.
• [48]Ley B, Collard HR, King TE Jr: Clinical course and prediction of survival in idiopathic pulmonary fibrosis. Am J Resp Crit Care Med 2011, 183:431-440.
• [49]Beauchamp M, Janaudis-Ferreira T, Goldstein R, Brooks D: Optimal duration of pulmonary rehabilitation for individuals with COPD - a systematic review. Chron Respir Dis 2011, 8:129-140.
• [50]Pitta F, Troosters T, Probst V, Langer D, Decramer M, Gosselink R: Are patients with COPD more active after PR. Chest 2008, 134:273-280.
• [51]Wempe J, Wijkstra P: The influence of rehabilitation on behaviour modification in COPD. Patient Educ Couns 2004, 52:237-241.