Post on 25-May-2020
transcript
Dr B. Egger
Service de Pneumologie
Hôpital de Rolle
• COPD/rehabilitation introduction
• COPD rehabilitation programs :• Benefits• Components/Modalities
• COPD and congestive heart failure
• COPD and ischemic heart disease
• COPD and pulmonary hypertension
Planning
• COPD/rehabilitation introduction
• COPD rehabilitation programs :• Benefits• Components/Modalities
• COPD and congestive heart failure
• COPD and ischemic heart disease
• COPD and pulmonary hypertension
Planning
Eur Respir Rev 2014; 23: 131
COPD Comorbidities
AJRCCM 2013; 188: e13
Pulmonary rehabilitation
BODE Index
NEJM 2004; 350: 1005
BODE 0-2
BODE 3-4
BODE 5-6
BODE >7
Indications
AJRCCM 2013; 188: e13
AJRCCM 2006; 173: 1390
Arch Phys Med Rehab 2005; 86: 1788
• Unstable or limiting disease !
Resiratory, Cardiac or Psychatric diseases
Orthopedic or neurologic diseases
Contraindications
• COPD/rehabilitation introduction
• COPD rehabilitation programs :• Benefits• Components/Modalities
• COPD and congestive heart failure
• COPD and ischemic heart disease
• COPD and pulmonary hypertension
Planning
Respiratory Research 2005; 6:54
Hospitalizations
Respiratory Research 2005; 6:54
Distance
Respiratory Research 2005; 6:54
Quality of life
Respiratory Research 2005; 6:54
Survival
ERJ 2005; 20: 630
• Berry et al.: 151 patients, 12 weeks:
- COPD: mild 99 patients - moderate 36 patients - severe 16 patients
AJRCCM 1999; 160: 1248
Severity of the lung disease
AJRCCM 2005; 172: 19
Clin Chest Med 2014; 35: 391
• COPD/rehabilitation introduction
• COPD rehabilitation programs :• Benefits• Components/Modalities
• COPD and congestive heart failure
• COPD and ischemic heart disease
• COPD and pulmonary hypertension
Planning
Components
• Comorbidities management• Self Management
AJRCCM 2013; 188: e13
J Appl Physiol; 115: 16
Types
Clin Chest Med 2014; 35: 303
Chest 2005; 127: 105
Inpatients:
• during min. 2-3 weeks, idealy 4 weeks
Outpatients:
• 6-26 weeks (min. 20 sessions)
• combination of supervised and self-managed sessions
Duration
J CardioPulm Rehab Prev 2016; 36: 75
J CardioPulm Rehab Prev 2016; 36: 75
J CardioPulm Rehab Prev 2015; 35: 163
J CardioPulm Rehab Prev 2009; 29: 126
E. Lynne Geddes et al., Resp Med 2008
Respiratory muscles training
Proc Am Thorac Soc 2006; 3: 66
Low intensity rehabilitation
Journal Cardio Pulm Rehab 2008; 28: 79
Clin Chest Med 2014; 35: 313
• COPD/rehabilitation introduction
• COPD rehabilitation programs :• Benefits• Components/Modalities
• COPD and congestive heart failure
• COPD and ischemic heart disease
• COPD and pulmonary hypertension
Planning
AJRCCM 2006; 173: 1390
Arch Phys Med Rehab 2005; 86: 1788
• Unstable or limiting disease !
Resiratory, Cardiac or Psychatric diseases
Orthopedic or neurologic diseases
Contraindications
Leading causes of mortality
R. Rodriguez-Roisin et al. Lancet 2009
R. Rodriguez-Roisin et al. Lancet 2009
Protective effect
• COPD/rehabilitation introduction
• COPD rehabilitation programs :• Benefits• Components/Modalities
• COPD and congestive heart failure
• COPD and ischemic heart disease
• COPD and pulmonary hypertension
Planning
J Appl Physiol; 115: 16
Muscle impairment
J Appl Physiol; 115: 16
J CardioPulm Rehab Prev 2007; 27: 368
• COPD/rehabilitation introduction
• COPD rehabilitation programs :• Benefits• Components/Modalities
• COPD and congestive heart failure
• COPD and ischemic heart disease
• COPD and pulmonary hypertension
Planning
Cardiovasc Drugs Ther 2015; 29: 147
FH Rutten et al., Arch Intern Med 2010
β-blockers
• COPD/rehabilitation introduction
• COPD rehabilitation programs :• Benefits• Components/Modalities
• COPD and congestive heart failure
• COPD and ischemic heart disease
• COPD and pulmonary hypertension
Planning
• Common rehabilitation program for 3 weeks (inpatient) - stable patients
• Additionnal exercise program 7d a week at low workloads (10-60W)
• Interval bicycle ergometer training (30’’ lower – 60’’ higher workload) during 10-25’/d = 60-80% of the heart rate reached during initial peak O2 uptake
• Intensity increased (individual tolerability and improvement)
• Limited by: peak HR (< 120 bpm) – satO2 > 85% - subjective physicalexertion
• 60’ of walking 5 d/week (flat and uphill) accompanied by a physiotherapist
• Dumbbell training with low weights (0.5-1 kg)
• 30’ of respiratory training (stretching, breathing techniques…)
• At home : Training manuel + bicycle 15-30’ pd + respiratory exercise + dumbbell 15-30’ + walk twice a week + supervised by phone
Exercise Training Program
• after 3 weeks : + 85 +/- 56 m + 12 +/- 37 m• after 15 weeks : + 96 +/- 61 m - 15 +/- 54 m
D. Mereles et al.; Circulation 2006, 114: 1482
Pr Training Gr Control Gr
Delta = 111 meters
• COPD and comorbidities
• Benefits: survival, QoL, dyspnea, exercise capacity…
• PR Components: more than exercise
• PR Modalities: endurance, resistance, arms training, interval training, inspiratory muscles, low intensity, neurostimulation, other
• Cardiac heart failure, ischemic heart disease, pulmonary hypertension:
• special considerations/focus for training, b-blockers => « protective » effect of the COPD
Conclusions
Thanks