Vasileios Andrianopoulos1, Rainer Gloeckl2, Tessa Schneeberger3, Inga Jarosch4, Ioannis Vogiatzis5, Emily Hume6, Rembert A Koczulla7, Klaus Kenn8. 1. Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau Am Koenigssee, Germany. Electronic address: vasileios.andrianopoulos@web.de. 2. Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau Am Koenigssee, Germany. Electronic address: RGloeckl@schoen-klinik.de. 3. Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau Am Koenigssee, Germany. Electronic address: TSchneeberger@schoen-klinik.de. 4. Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau Am Koenigssee, Germany. Electronic address: IJarosch@schoen-klinik.de. 5. Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University Newcastle, United Kingdom. Electronic address: ioannis.vogiatzis@northumbria.ac.uk. 6. Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University Newcastle, United Kingdom. Electronic address: emily.c.hume@northumbria.ac.uk. 7. Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau Am Koenigssee, Germany; Department of Pulmonary Rehabilitation, Philipps University Marburg, Marburg, Germany; German Centre of Lung Research (DZL), Giessen-Marburg, Germany. Electronic address: RKoczulla@schoen-klinik.de. 8. Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau Am Koenigssee, Germany; Department of Pulmonary Rehabilitation, Philipps University Marburg, Marburg, Germany; German Centre of Lung Research (DZL), Giessen-Marburg, Germany. Electronic address: KKenn@schoen-klinik.de.
Abstract
BACKGROUND: Cognitive impairment might interfere with the efficacy of Pulmonary Rehabilitation (PR) in Chronic Obstructive Pulmonary Disease (COPD). We aimed to identify differential responses to PR between cognitively impaired (CI) and cognitively normal (CN) COPD patients by assessing health status and exercise capacity. METHODS: Sixty patients (FEV1: 47 ± 15%) were classified as CI or CN according to the Montreal Cognitive Assessment (MoCA ≤25points) and completed a 3-week inpatient PR program. Cognitive function (neuropsychological battery), health-status (36-Item Short Form Survey [SF-36]), and exercise capacity (6-min walk test [6MWT], cycle-endurance test [CET]) were assessed before and after PR. Responsiveness to PR was estimated by mean change (delta-value [Δ]) and the d-Effect Size (ES). RESULTS: Twenty-five COPD patients (42%) presented evidence of mild CI prior to PR. Both, CI and CN patients significantly improved global cognitive function, health status (the majority of SF-36 components), and exercise capacity (6MWT and cycle endurance) in response to PR. Compared to CN, CI patients did not improve SF-36 subdomains of "role emotional" and "bodily pain", and demonstrated a lower magnitude of improvement in 6MWT ([Δ]: 25 m; ES: 0.21) compared to CN ([Δ]: 46 m; ES: 0.54). CONCLUSIONS: PR has favorable effects on global cognitive function, health status, and exercise capacity in both CI and CN COPD patients. There was no concrete evidence to indicate interference of cognitive impairment to PR effectiveness.
BACKGROUND: Cognitive impairment might interfere with the efficacy of Pulmonary Rehabilitation (PR) in Chronic Obstructive Pulmonary Disease (COPD). We aimed to identify differential responses to PR between cognitively impaired (CI) and cognitively normal (CN) COPD patients by assessing health status and exercise capacity. METHODS: Sixty patients (FEV1: 47 ± 15%) were classified as CI or CN according to the Montreal Cognitive Assessment (MoCA ≤25points) and completed a 3-week inpatient PR program. Cognitive function (neuropsychological battery), health-status (36-Item Short Form Survey [SF-36]), and exercise capacity (6-min walk test [6MWT], cycle-endurance test [CET]) were assessed before and after PR. Responsiveness to PR was estimated by mean change (delta-value [Δ]) and the d-Effect Size (ES). RESULTS: Twenty-five COPD patients (42%) presented evidence of mild CI prior to PR. Both, CI and CN patients significantly improved global cognitive function, health status (the majority of SF-36 components), and exercise capacity (6MWT and cycle endurance) in response to PR. Compared to CN, CI patients did not improve SF-36 subdomains of "role emotional" and "bodily pain", and demonstrated a lower magnitude of improvement in 6MWT ([Δ]: 25 m; ES: 0.21) compared to CN ([Δ]: 46 m; ES: 0.54). CONCLUSIONS: PR has favorable effects on global cognitive function, health status, and exercise capacity in both CI and CN COPD patients. There was no concrete evidence to indicate interference of cognitive impairment to PR effectiveness.