Predictors of Change in Exercise Capacity after Simple Outpatient-based Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease

前言：慢性阻塞性肺病患者常發生運動能力下降及生活品質不佳之狀況。胸腔復原運動可以改善運動能力、生活品質以及喘之症狀等，但胸腔復原運動對運動能力改善之預估因子，其所知卻有限。所以，我們希望藉由我們的分析，可以確定胸腔復原運動對慢性阻塞性肺病患者的幫助，進一步更分析胸腔復原運動對運動能力改善之預估因子。方法：共有43位慢性阻塞性肺病患者接受我們的胸腔復原運動。我們在復原運動前後測量其肺功能、六分鐘走路測試、運動心肺功能與呼吸問卷量表(St. George's Respiratory Questionnaire, SGRQ)。藉由多元迴歸分析以評估運動能力改善之預估因子。結果：經過六週的胸腔復原運動，病患之六分鐘走路距離（由461.1±86.2至505.5±78.4公尺, p<0.001）、最大氧氣消耗量（由15.0±3.8 至16.8±4.2 ml/min/kg, p<0.05）、最大運動瓦數（由73.5±22.3 至78.0±22.0 瓦, p<0.05）以及SGRQ呼吸問卷量表均有顯著進步。藉由多元迴歸分析，我們發現SGRQ之活動指數、體重、年齡、氧脈與潮氣末二氧化碳分壓?胸腔復原運動對於運動能力改善的重要因子。結論：胸腔復原運動確實可以改善患者之運動能力與生活品質。復原前的SGRQ之活動指數、體重、年齡、氧脈與潮氣末二氧化碳分壓?運動能力改善的預估因子。
Introduction: Patients with chronic obstructive pulmonary disease (COPD) often experience decreased exercise capacity and quality of life (QoL). Pulmonary rehabilitation programs (PRPs) can improve exercise capacity, QoL and dyspnea in COPD patients, but little is known about the predictive factors associated with the change in exercise capacity after PRPs. The aims of this study were to confirm the benefits of PRPs and define the predictive factors associated with the change in exercise capacity after PRPs. Methods: 43 patients of COPD were arranged to our PRPs. The baseline and post-PRP status were evaluated with spirometry, 6MWD, cardiopulmonary exercise test, and St. George's Respiratory Questionnaire (SGRQ). Stepwise multiple regression analysis was used to evaluate factors predictive of change in the 6MWD. Results: After 6 weeks of PRPs, there were significant improvements in 6MWD (from 461.1±86.2 m to 505.5±78.4 m, p<0.001), peak VO2 (from 15.0±3.8 ml/min/kg to 16.8±4.2 ml/min/kg, p<0.05), maximal work rate (from 73.5±22.3 watt to 78.0±22.0 watt, p <0.05) and scores on the SGRQ (total, activity, symptoms and impact, all p<0.001). Stepwise multiple regression analysis revealed that SGRQ activity, body weight, age, peak oxygen pulse (O2P) and PETCO2 were significant determinants of change in exercise capacity. Conclusions: PRPs are effective in patients with COPD in increasing exercise capacity and QoL. Baseline SGRQ activity, body weight, age, peak O2P and PETCO2 significantly contribute to the change in exercise capacity after PRPs.