Pulmonary Rehabilitation Exercise Package for Enhancing Health in Elderly COPD Patients With Frailty: An Experimental Study.

Abstract

Background: Frailty may result in decreased physical functioning and worsen the prognosis of chronic diseases. Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of concurrent frailty. Although pulmonary rehabilitation has demonstrated improvements in COPD outcomes, its impact on patients with frailty and COPD remains unclear.

Purpose: This study was designed to examine the effects of the pulmonary rehabilitation exercise package (PREP) on frailty, dyspnea, lower extremity muscular endurance (LEME), and walking ability (WA) in older adult COPD patients with frailty.

Methods: A single-blind experimental design was used to study 100 elderly COPD patients with frailty, randomly assigned to either the experimental or control group. The experimental group (EG) received the PREP intervention, while the control group (CG) received routine care. The Clinical Frail Scale (CFS) was used to measure frailty, the Modified Medical Research Council scale was used to measure dyspnea, LEME was measured using the 30-second chair stand test, and functional exercise capacity (i.e., walking ability or WA) was measured using the 6-minute walk distance. All measurements were taken at three time points: baseline (preintervention), 1 week postintervention, and 1 month postintervention. Between-group and within-group differences and variations in repeated measurements over time were compared using independent t tests, paired t tests, and generalized estimating equations (GEE).

Results: A total of 91 participants completed the study, with 9 participants lost to follow-up. No significant between-group differences were found at baseline in terms of characteristics, frailty, dyspnea, LEME, and WA. Applying difference-in-differences, the EG outperformed the CG in terms of dyspnea and WA at both 1-week and 1-month follow-ups, while the EG significantly outperformed the CG on all measures at the 1-month follow-up. Within-group comparisons also revealed significant improvements in the EG compared with the CG. Using GEE to examine the interaction, the EG demonstrated significantly better improvements in dyspnea, LEME, and WA than the CG at the 1-month mark.

Conclusions/implications for future practice: The results show that PREP has the potential to significantly improve health in older adults with frailty and COPD by addressing frailty, dyspnea, LEME, and WA. PREP may be implemented as a subacute health care model to manage COPD-related debilitation in hospital settings.