Effectiveness of pulmonary rehabilitation in exercise capacity and quality of life in chronic obstructive pulmonary disease patients with and without global fat-free mass depletion

Arch Phys Med Rehabil. 2013 Aug;94(8):1607-14. doi: 10.1016/j.apmr.2013.02.005. Epub 2013 Feb 14.


Objective: To investigate the effectiveness of pulmonary rehabilitation (PR) in exercise capacity and quality of life in patients with chronic obstructive pulmonary disease (COPD) with and without global fat-free mass (FFM) depletion.

Design: Retrospective case-control.

Setting: Outpatient clinic, university center.

Participants: COPD patients (N=102) that completed PR were initially evaluated.

Intervention: PR including whole-body and weight training for 12 weeks, 3 times per week.

Main outcome measures: St. George Respiratory Questionnaire (SGRQ), 6-minute walk distance (6MWD), and FFM evaluation applied before and after PR.

Results: Patients were stratified according to their FFM status measured by bioelectric impedance. They were considered depleted if the FFM index was ≤ 15 kg/m(2) in women and ≤ 16 kg/m(2) in men. From the initial sample, all depleted patients (n=31) composed the FFM depleted group. It was composed predominantly by women (68%) with a mean age ± SD of 64.4 ± 7.3 years and a forced expiratory volume in 1 second of 33.6%=-13.2% predicted. Paired for sex and age, 31 nondepleted patients were selected from the initial sample to compose the nondepleted group. Improvement in the 6MWD was similar in these 2 groups after PR. Both groups improved SGRQ scores, although the observed power was small and did not allow adequate comparison between depleted and nondepleted patients. There was no difference between groups in weight change, whereas FFM tended to be greater in depleted patients. This increase had no correlation with the 6MWD or the SGRQ.

Conclusions: Benefits of PR to exercise capacity were similar comparing FFM depleted and nondepleted COPD patients. Although FFM change tended to be greater in depleted patients, this increase had no definite relation with clinical outcomes.

Keywords: 6-minute walk distance; 6MWD; BMI; COPD; Exercise; FEV(1); FFM; FVC; HRQOL; MANOVA; MRC; Medical Research Council; Muscles; PR; Pulmonary disease; RM; Rehabilitation; SGRQ; St. George Respiratory Questionnaire; body mass index; chronic obstructive; chronic obstructive pulmonary disease; fat-free mass; forced expiratory volume in 1 second; forced vital capacity; health-related quality of life; multiple analysis of variance; pulmonary rehabilitation; repetition maximum.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Body Mass Index
  • Exercise Tolerance / physiology*
  • Female
  • Forced Expiratory Volume
  • Health Status
  • Humans
  • Male
  • Middle Aged
  • Muscular Atrophy / complications*
  • Muscular Atrophy / physiopathology
  • Muscular Atrophy / rehabilitation
  • Pulmonary Disease, Chronic Obstructive / complications*
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Pulmonary Disease, Chronic Obstructive / rehabilitation*
  • Quality of Life*
  • Retrospective Studies
  • Surveys and Questionnaires
  • Treatment Outcome
  • Vital Capacity