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Exercise rehabilitation in COPD and heart failure: comparison of two national audits

Amy V. Jones, Rachael A. Evans, Alexander S. Harrison, Lauren B. Sherar, Michael C. Steiner, Patrick Doherty, Sally J. Singh
ERJ Open Research 2022 8: 00131-2022; DOI: 10.1183/23120541.00131-2022
Amy V. Jones
1Dept of Respiratory Sciences, University of Leicester, Leicester, UK
2Centre for Exercise and Rehabilitation Sciences, NIHR Leicester Biomedical Research Centre-Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
3National Centre for Sports and Exercise Medicine, School of Sport and Exercise Sciences, Loughborough University, Loughborough, UK
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  • For correspondence: sally.singh@uhl-tr.nhs.uk
Rachael A. Evans
1Dept of Respiratory Sciences, University of Leicester, Leicester, UK
2Centre for Exercise and Rehabilitation Sciences, NIHR Leicester Biomedical Research Centre-Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
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Alexander S. Harrison
4Dept of Health Sciences, University of York, York, UK
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Lauren B. Sherar
3National Centre for Sports and Exercise Medicine, School of Sport and Exercise Sciences, Loughborough University, Loughborough, UK
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Michael C. Steiner
1Dept of Respiratory Sciences, University of Leicester, Leicester, UK
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Patrick Doherty
4Dept of Health Sciences, University of York, York, UK
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Sally J. Singh
1Dept of Respiratory Sciences, University of Leicester, Leicester, UK
2Centre for Exercise and Rehabilitation Sciences, NIHR Leicester Biomedical Research Centre-Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
3National Centre for Sports and Exercise Medicine, School of Sport and Exercise Sciences, Loughborough University, Loughborough, UK
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  • FIGURE 1
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    FIGURE 1

    Percentage of adults that enrolled and completed pulmonary rehabilitation (PR) and cardiac rehabilitation (CR). *: p≤0.05. Percentages calculated from those that were assessed for PR or CR. CHF: chronic heart failure; COPD: chronic obstructive pulmonary disease.

Tables

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  • TABLE 1

    Baseline demographics from completed pulmonary rehabilitation (PR) and cardiac rehabilitation (CR) audit datasets

    PRCR
    nCOPD (n=7223)nCOPD+CHF (n=190)nCHF (n=29 861)nCHF+COPD (n=3576)
    Age (years)722270.0 (64.0–76.0)19074.0 (68.0–80.0)*29 86172.0 (62.0–80.0)357673.0 (66.0–79.0)*
    BMI (kg·m−2)477526.8 (22.9–31.1)12327.8 (24.3–34.0)*13 76928.1 (24.9–32.4)150127.9 (24.3–32.6)*
    Sex (male, %)72233817 (52.8)190131 (68.9)*29 63820 168 (68.0)35582442 (68.6)
    Ethnicity (White British, %)72236357 (88.0)190166 (87.4)29 86121 181 (86.2)35762552 (91.2)*
    Smoking status705618612 8961507
      Current (%)1585 (22.5)29 (15.6)1148 (8.9)276 (18.3)*
      Former (%)5038 (71.4)141 (75.8)6336 (49.1)1032 (68.5)
      Never (%)433 (6.1)16 (8.6)5412 (42.0)199 (13.2)
    MRC scale72233 (3–4)1904 (3–4)*NA
    NYHA scaleNA28912 (2–3)3592 (2–3)*
    Diabetes (%)7223940 (13.0)19047 (24.7)*29 8619286 (31.1)35761041 (29.1)*
    Stroke (%)7223286 (4.0)19013 (6.8)29 8612753 (9.2)3576329 (9.2)
    Osteoporosis (%)7223550 (7.6)19017 (8.9)29 861803 (2.7)3576133 (3.7)*
    Hypertension (%)72232162 (29.9)19072 (37.9)*29 86114 916 (50.0)35761599 (44.7)*
    ISWT (m)3723199.9 (134.4)96154.2 (103.5)*2162277.2 (152.6)211225.9 (138.8)*
    6MWT (m)2789249.5 (114.9)74194.8 (101.0)*2556249.5 (119.3)343217.7 (105.0)*

    *: p≤0.05 Data presented as mean (standard deviation), frequency (%) or median (interquartile range). 6MWT: 6 min walk test; BMI: body mass index; CHF: chronic heart failure; COPD: chronic obstructive pulmonary disease; ISWT: incremental shuttle walk test; MRC: Medical Research Council dyspnoea scale; NA: not applicable; NYHA: New York Heart Association.

    • TABLE 2

      Propensity-matched pre and post data from pulmonary rehabilitation (PR) and cardiac rehabilitation (CR)

      PR
      COPD (n=116)COPD+CHF (n=116)
      nPrePostEffect sizenPrePostEffect size
      ISWT (m)41173.9 (135.8)233.2 (151.6)*0.439163.0 (115.4)200.4 (128.4)*0.3
      6MWT (m)19233.0 (97.8)281.2 (101.9)*0.522220.0 (89.8)264.0 (110.0)*0.5
      CRQ–dyspnoea332.7 (1.5)3.6 (1.4)*0.6302.7 (1.1)3.6 (1.4)*0.8
      CRQ–fatigue333.8 (1.4)4.4 (1.4)*0.4303.2 (1.5)3.9 (1.4)*0.5
      CRQ–emotion334.4 (1.3)5.1 (1.2)*0.5304.5 (1.4)5.1 (1.4)*0.4
      CRQ–mastery334.5 (1.3)5.2 (1.4)*0.5304.2 (1.4)5.2 (1.5)*0.7
      CAT3821.0 (8.3)15.9 (7.4)*0.63121.1 (8.1)17.3 (7.5)*0.5
      CR
      CHF (n=306)CHF+COPD (n=306)
      nPrePostEffect sizenPrePostEffect size
      ISWT (m)26239.2 (90.6)316.5 (109.6)*0.917293.5 (154.6)351.8 (187.3)*0.4
      6MWT (m)64248.7 (124.7)293.8 (102.1)*0.445247.8 (119.4)286.6 (98.6)*0.3
      WC (cm)64101.6 (15.7)101.9 (15.9)0.0234106.4 (14.3)104.7 (14.6)*0.1
      Systolic BP (mmHg)172126 (22.2)126 (21.0)0.02122121 (19.4)122 (18.1)0.1
      Diastolic BP (mmHg)17370 (12.6)69 (10.5)0.112268 (9.9)69 (11.2)0.1
      Total cholesterol (mmol·L−1)484.4 (1.12)4.0 (0.84)0.4314.2 (1.51)4.1 (1.25)0.1
      LDL (mmol·L−1)222.5 (0.85)2.1 (0.67)0.4132.1 (0.77)2.4 (0.97)0.3
      HDL (mmol·L−1)331.2 (0.36)1.3 (0.39)0.1191.2 (0.40)1.2 (0.36)0.1
      HDL:LDL273.8 (1.04)3.6 (1.04)0.2153.5 (0.93)3.7 (1.19)0.2
      TG (mmol·L−1)231.3 (0.46)1.3 (0.45)0.00141.6 (0.92)1.6 (0.72)0.00
      HbA1c (%)1148.6 (10.78)46.6 (8.31)0.2855.6 (19.87)47.4 (10.91)0.4
      HADS–anxiety1385.7 (4.4)4.9 (3.9)*0.2825.6 (3.6)5.3 (3.5)0.1
      HADS–depression1386.1 (3.8)4.6 (3.5)*0.4826.0 (3.6)4.9 (3.3)*0.3
      Minnesota5439.8 (20.4)33.5 (21.5)*0.33239.0 (24.3)32.3 (19.6)*0.3

      *: p≤0.05. Data presented as mean (standard deviation). 6MWT: 6-min walk test; BP: blood pressure; CAT: COPD Assessment Test; CHF: chronic heart failure; COPD: chronic obstructive pulmonary disease; CRQ: Chronic Respiratory Questionnaire; HADS: Hospital Anxiety and Depression Scale; HbA1c: glycated haemoglobin; HDL: high-density lipoprotein; ISWT: incremental shuttle walk test; LDL: low-density lipoprotein; Minnesota: Minnesota Living with Heart Failure questionnaire; NA: not applicable; TG: triglycerides; WC: waist circumference.

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        Supplementary material 00131-2022.SUPPLEMENT

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      Exercise rehabilitation in COPD and heart failure: comparison of two national audits
      Amy V. Jones, Rachael A. Evans, Alexander S. Harrison, Lauren B. Sherar, Michael C. Steiner, Patrick Doherty, Sally J. Singh
      ERJ Open Research Oct 2022, 8 (4) 00131-2022; DOI: 10.1183/23120541.00131-2022

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      Exercise rehabilitation in COPD and heart failure: comparison of two national audits
      Amy V. Jones, Rachael A. Evans, Alexander S. Harrison, Lauren B. Sherar, Michael C. Steiner, Patrick Doherty, Sally J. Singh
      ERJ Open Research Oct 2022, 8 (4) 00131-2022; DOI: 10.1183/23120541.00131-2022
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