Benefits of continued pulmonary rehabilitation compared to lung volume reduction surgery in patients with COPD

Purpose: To compare 6 minute walk distance and oxygen requirements throughout pulmonary rehabilitation (PR) prior to and following lung volume reduction surgery (LVRS) in patients with COPD. Methods: 21 patients with COPD, mean age 62, mean FEV1 .641L, accepted for LVRS underwent PR consisting of monitored/supervised exercise 5 days/week in preparation for surgery. The six minute walk test was done at evaluation (a) during rehab (b), preop (c) and 6 months post op (d). Mean time in pulmonary rehab from evaluation (a) to interval testing (b) was 17 weeks. Mean time in pulmonary rehab from that point (b) to preop (c) was an additional 7.7 weeks. RESULTS EVAL REHAB PREOP 6MO/POST (a) (b) (c) (d) Distance (ft) 724 975 1092 1387 % O2 @ rest 43% 52% 48% 0% O2 @ rest (L) .9 1.1 1.0 0 % O2 w/exer 81% 95% 95% 42% O2 w/exer (L) 2.5 3.5 3.6 2.1 Conclusions: There is an initial significant increase in six minute walk distance during rehab (a to b). Further improvement is noted preoperatively (b to c); however oxygen requirements at rest increased indicating progression of disease. Postoperatively there is significant improvement in walk distance. Oxygen requirements with exercise declined in spite of the increased level of activity. Clinical Implications: Benefits of LVRS are due to surgical intervention and not to continued rehab.