'Effects of Structured Outpatient Pulmonary Rehabilitation Intervention on Exercise Capacity and Quality of Life in Patients With Severe Chronic Obstructive Pulmonary Disease: A Randomized Controlled Study'

Chronic obstructive pulmonary disease ranks among the top five causes of unnatural deaths in India and its prevalence continues to increase. Widespread habit of smoking and the use of biomass fuels have led to such a high prevalence of COPD. The loss of physical capacity and the adverse psychosocial effects of the disorder contribute greatly to morbidity and mortality. Medicines have a limited role in improving the lung functions and physical capacity in patients with COPD. Pulmonary rehabilitation (PR) aims to return the patient with chronic obstructive pulmonary disease (COPD) to the highest level of independent functioning. This is achieved by providing individually tailored exercise training schedules, education and psychosocial support.

Pulmonary Rehabilitation has been defined by the American and the European Thoracic Societies as "a comprehensive intervention based on a thorough patient assessment followed by patient tailored therapies that include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors." COPD is now considered a multi-systemic disease with frequent co-morbidities and hence the optimal management of this complex group of patients requires integrated care principles, pulmonary rehabilitation being the core component.

Patients with chronic obstructive pulmonary disease (COPD) often decrease their physical activity because exercise can worsen dyspnea. The progressive deconditioning associated with inactivity initiates a vicious cycle, with dyspnea becoming problematic at ever lower physical demands. Pulmonary rehabilitation aims to break the cycle. Benefits of pulmonary rehabilitation include decreased dyspnea, improved health-related quality of life, fewer days of hospitalization, and decreased health-care utilization.

As yet, there are no controlled studies on the use and effectiveness of pulmonary rehabilitation in the Indian setting and the optimum training regimen. This study aims to look at any improvements in the exercise capacity by means of objective incremental and field exercise tests, quality of life using validated questionnaires, severity of dyspnea, lung functions and nutritional parameters in patients who are diagnosed with severe forms of COPD after they have undergone a structured exercise training program.

Primary Objective • To assess the effect of structured outpatient pulmonary rehabilitation intervention on the six minute walk distance and health related quality of life in patients with chronic obstructive pulmonary disease.