Survival after pulmonary rehabilitation in patients with COPD: Impact of functional exercise capacity and its changes

Carlos A Camillo, Daniel Langer, Christian R. Osadnik, Lisa Pancini, Heleen Demeyer, Chris Burtin, Rik Gosselink, Marc Decramer, Wim Janssens, Thierry Troosters

Research output: Contribution to journalArticleResearchpeer-review

Abstract

The impact of rehabilitation-induced changes in 6-minute walk distance (6MWD) on the survival of patients with chronic obstructive pulmonary disease (COPD) has not been fully elucidated. This study sought to determine the association of baseline 6MWD and its changes after pulmonary rehabilitation (PR) with 5-year survival in patients with COPD. Patients who were referred to a 12-week outpatient PR program were followed up for 5 years postcompletion, and survival status was verified. Survival was analyzed according to four groups based upon initial 6MWD (6MWDi) and its changes (Δ6MWD) after PR (Group 1: 6MWDi ≥350 m and Δ6MWD ≥30 m; Group 2: 6MWDi ≥350 m and Δ6MWD <30 m; Group 3: 6MWDi <350 m and Δ6MWD ≥30 m; and Group 4: 6MWDi <350 m and Δ6MWD <30 m) via Kaplan-Meier analysis and log rank test. Cox regression was performed to identify possible confounders of mortality estimates. In total, 423 patients (with mean ± standard deviation of forced expiratory volume in the first second [FEV1] 43±16% predicted, age 65±8 years, and 6WMDi 381±134 m) underwent PR between 1999 and 2010. Survival rates decreased progressively from Group 1 to Group 4 (Group 1, 81%; Group 2, 69%; Group 3, 47%; Group 4, 27%; log rank test, P<0.05). 6MWDi ≥350 m (hazard ratio [HR] 0.39 [95% confidence interval {CI} 0.30-0.50]) and Δ6MWD ≥30 m (HR 0.66 [95% CI 0.51-0.85]) were strongly and independently associated with survival. Compared with Group 1, mortality risks progressively increased in Group 2 (HR 1.36 [95% CI 0.92-2.00]; not significant), Group 3 (HR 1.90 [95% CI 1.28-2.84]; P=0.001), and Group 4 (HR 3.28 [95% CI 2.02-5.33]; P<0.0001). Both poor 6MWD and lack of improvement >30 m after PR are associated with worse 5-year survival in patients with COPD.

Original languageEnglish
Pages (from-to)2671-2679
Number of pages9
JournalInternational Journal of Chronic Obstructive Pulmonary Disease
Volume11
DOIs
Publication statusPublished - 2016

Keywords

  • 6-minute walk test
  • chronic obstructive
  • exercise training
  • minimally important difference
  • mortality
  • pulmonary disease

Cite this

Camillo, Carlos A ; Langer, Daniel ; Osadnik, Christian R. ; Pancini, Lisa ; Demeyer, Heleen ; Burtin, Chris ; Gosselink, Rik ; Decramer, Marc ; Janssens, Wim ; Troosters, Thierry. / Survival after pulmonary rehabilitation in patients with COPD : Impact of functional exercise capacity and its changes. In: International Journal of Chronic Obstructive Pulmonary Disease. 2016 ; Vol. 11. pp. 2671-2679.
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title = "Survival after pulmonary rehabilitation in patients with COPD: Impact of functional exercise capacity and its changes",
abstract = "The impact of rehabilitation-induced changes in 6-minute walk distance (6MWD) on the survival of patients with chronic obstructive pulmonary disease (COPD) has not been fully elucidated. This study sought to determine the association of baseline 6MWD and its changes after pulmonary rehabilitation (PR) with 5-year survival in patients with COPD. Patients who were referred to a 12-week outpatient PR program were followed up for 5 years postcompletion, and survival status was verified. Survival was analyzed according to four groups based upon initial 6MWD (6MWDi) and its changes (Δ6MWD) after PR (Group 1: 6MWDi ≥350 m and Δ6MWD ≥30 m; Group 2: 6MWDi ≥350 m and Δ6MWD <30 m; Group 3: 6MWDi <350 m and Δ6MWD ≥30 m; and Group 4: 6MWDi <350 m and Δ6MWD <30 m) via Kaplan-Meier analysis and log rank test. Cox regression was performed to identify possible confounders of mortality estimates. In total, 423 patients (with mean ± standard deviation of forced expiratory volume in the first second [FEV1] 43±16{\%} predicted, age 65±8 years, and 6WMDi 381±134 m) underwent PR between 1999 and 2010. Survival rates decreased progressively from Group 1 to Group 4 (Group 1, 81{\%}; Group 2, 69{\%}; Group 3, 47{\%}; Group 4, 27{\%}; log rank test, P<0.05). 6MWDi ≥350 m (hazard ratio [HR] 0.39 [95{\%} confidence interval {CI} 0.30-0.50]) and Δ6MWD ≥30 m (HR 0.66 [95{\%} CI 0.51-0.85]) were strongly and independently associated with survival. Compared with Group 1, mortality risks progressively increased in Group 2 (HR 1.36 [95{\%} CI 0.92-2.00]; not significant), Group 3 (HR 1.90 [95{\%} CI 1.28-2.84]; P=0.001), and Group 4 (HR 3.28 [95{\%} CI 2.02-5.33]; P<0.0001). Both poor 6MWD and lack of improvement >30 m after PR are associated with worse 5-year survival in patients with COPD.",
keywords = "6-minute walk test, chronic obstructive, exercise training, minimally important difference, mortality, pulmonary disease",
author = "Camillo, {Carlos A} and Daniel Langer and Osadnik, {Christian R.} and Lisa Pancini and Heleen Demeyer and Chris Burtin and Rik Gosselink and Marc Decramer and Wim Janssens and Thierry Troosters",
note = "Camillo, Carlos A Langer, Daniel Osadnik, Christian R Pancini, Lisa Demeyer, Heleen Burtin, Chris Gosselink, Rik Decramer, Marc Janssens, Wim Troosters, Thierry ENG New Zealand 2016/11/09 06:00 Int J Chron Obstruct Pulmon Dis. 2016 Oct 26;11:2671-2679. eCollection 2016.",
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Survival after pulmonary rehabilitation in patients with COPD : Impact of functional exercise capacity and its changes. / Camillo, Carlos A; Langer, Daniel; Osadnik, Christian R.; Pancini, Lisa; Demeyer, Heleen; Burtin, Chris; Gosselink, Rik; Decramer, Marc; Janssens, Wim; Troosters, Thierry.

In: International Journal of Chronic Obstructive Pulmonary Disease, Vol. 11, 2016, p. 2671-2679.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Survival after pulmonary rehabilitation in patients with COPD

T2 - Impact of functional exercise capacity and its changes

AU - Camillo, Carlos A

AU - Langer, Daniel

AU - Osadnik, Christian R.

AU - Pancini, Lisa

AU - Demeyer, Heleen

AU - Burtin, Chris

AU - Gosselink, Rik

AU - Decramer, Marc

AU - Janssens, Wim

AU - Troosters, Thierry

N1 - Camillo, Carlos A Langer, Daniel Osadnik, Christian R Pancini, Lisa Demeyer, Heleen Burtin, Chris Gosselink, Rik Decramer, Marc Janssens, Wim Troosters, Thierry ENG New Zealand 2016/11/09 06:00 Int J Chron Obstruct Pulmon Dis. 2016 Oct 26;11:2671-2679. eCollection 2016.

PY - 2016

Y1 - 2016

N2 - The impact of rehabilitation-induced changes in 6-minute walk distance (6MWD) on the survival of patients with chronic obstructive pulmonary disease (COPD) has not been fully elucidated. This study sought to determine the association of baseline 6MWD and its changes after pulmonary rehabilitation (PR) with 5-year survival in patients with COPD. Patients who were referred to a 12-week outpatient PR program were followed up for 5 years postcompletion, and survival status was verified. Survival was analyzed according to four groups based upon initial 6MWD (6MWDi) and its changes (Δ6MWD) after PR (Group 1: 6MWDi ≥350 m and Δ6MWD ≥30 m; Group 2: 6MWDi ≥350 m and Δ6MWD <30 m; Group 3: 6MWDi <350 m and Δ6MWD ≥30 m; and Group 4: 6MWDi <350 m and Δ6MWD <30 m) via Kaplan-Meier analysis and log rank test. Cox regression was performed to identify possible confounders of mortality estimates. In total, 423 patients (with mean ± standard deviation of forced expiratory volume in the first second [FEV1] 43±16% predicted, age 65±8 years, and 6WMDi 381±134 m) underwent PR between 1999 and 2010. Survival rates decreased progressively from Group 1 to Group 4 (Group 1, 81%; Group 2, 69%; Group 3, 47%; Group 4, 27%; log rank test, P<0.05). 6MWDi ≥350 m (hazard ratio [HR] 0.39 [95% confidence interval {CI} 0.30-0.50]) and Δ6MWD ≥30 m (HR 0.66 [95% CI 0.51-0.85]) were strongly and independently associated with survival. Compared with Group 1, mortality risks progressively increased in Group 2 (HR 1.36 [95% CI 0.92-2.00]; not significant), Group 3 (HR 1.90 [95% CI 1.28-2.84]; P=0.001), and Group 4 (HR 3.28 [95% CI 2.02-5.33]; P<0.0001). Both poor 6MWD and lack of improvement >30 m after PR are associated with worse 5-year survival in patients with COPD.

AB - The impact of rehabilitation-induced changes in 6-minute walk distance (6MWD) on the survival of patients with chronic obstructive pulmonary disease (COPD) has not been fully elucidated. This study sought to determine the association of baseline 6MWD and its changes after pulmonary rehabilitation (PR) with 5-year survival in patients with COPD. Patients who were referred to a 12-week outpatient PR program were followed up for 5 years postcompletion, and survival status was verified. Survival was analyzed according to four groups based upon initial 6MWD (6MWDi) and its changes (Δ6MWD) after PR (Group 1: 6MWDi ≥350 m and Δ6MWD ≥30 m; Group 2: 6MWDi ≥350 m and Δ6MWD <30 m; Group 3: 6MWDi <350 m and Δ6MWD ≥30 m; and Group 4: 6MWDi <350 m and Δ6MWD <30 m) via Kaplan-Meier analysis and log rank test. Cox regression was performed to identify possible confounders of mortality estimates. In total, 423 patients (with mean ± standard deviation of forced expiratory volume in the first second [FEV1] 43±16% predicted, age 65±8 years, and 6WMDi 381±134 m) underwent PR between 1999 and 2010. Survival rates decreased progressively from Group 1 to Group 4 (Group 1, 81%; Group 2, 69%; Group 3, 47%; Group 4, 27%; log rank test, P<0.05). 6MWDi ≥350 m (hazard ratio [HR] 0.39 [95% confidence interval {CI} 0.30-0.50]) and Δ6MWD ≥30 m (HR 0.66 [95% CI 0.51-0.85]) were strongly and independently associated with survival. Compared with Group 1, mortality risks progressively increased in Group 2 (HR 1.36 [95% CI 0.92-2.00]; not significant), Group 3 (HR 1.90 [95% CI 1.28-2.84]; P=0.001), and Group 4 (HR 3.28 [95% CI 2.02-5.33]; P<0.0001). Both poor 6MWD and lack of improvement >30 m after PR are associated with worse 5-year survival in patients with COPD.

KW - 6-minute walk test

KW - chronic obstructive

KW - exercise training

KW - minimally important difference

KW - mortality

KW - pulmonary disease

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