Preoperative pulmonary rehabilitation in patients with COPD awaiting lung volume reduction surgery

Purpose: To measure change in exercise capacity (as measured by the six minute walk test), oxygen requirements with exercise (w/exer), and dyspnea in patients with COFD during pulmonary rehabilitation in preparation for lung volume reduction surgery (LVRS). Methods: 35 patients, mean age 63, best mean FEV1 .769L (25% of predicted) participated in a monitored, supervised exercise program 5 days/week with a goal of 30 minutes continuous treadmill walking. SaO2 was maintained at 90% or greater with supplemental oxygen (O2) and patients were pushed to target heart rate range (220-age) (75-85%). Patients exercised a minimum of six weeks. The six minute walk test and Mahler's Dyspnea Index (DI) were administerd at evaluation and prior to surgery (preop). Results: EVAL PREOP Distance (ft) 945 1177 # on O2 rest 18 18 O2 rest (L) 1.0 1.2 # on O2 w/exer 29 33 O2 exercise (L) 3.2 4.3 DI 3.4 +3. Conclusions: Significant improvement was noted in six minute walk distance during preop pulmonary rehabilitation and this was associated with an increase in oxygen requirements. Oxygen requirements and number of patients needing oxygen with exercise increased during this time period. Patients noted a minor improvement in dyspnea during preop rehab. Clinical Implications: Intensive pulmonary rehab results in improvement in exercise capacity and dyspnea. Oxygen requirements at rest increase indicating progression of disease.