Differences in change in coping styles between good responders, moderate responders and non-responders to pulmonary rehabilitation.

Pulmonary rehabilitation (PR) improves exercise tolerance and health status in patients with chronic obstructive pulmonary disease (COPD). Data on the effects of PR on coping styles are limited. Aim of the present study was to compare changes in coping styles between patients who had a good, moderate and no improvement in either exercise tolerance or health status after PR. Coping styles of 439 COPD patients undergoing PR were assessed by the Utrecht Coping List (UCL) at baseline and after PR. Patients' pulmonary function, six-minute walking distance (6MWD), St. George's Respiratory Questionnaire (SGRQ) and Hospital Anxiety and Depression Scale (HADS-A and HADS-D) were recorded. Good, moderate and non-responders were defined on the basis of minimally clinically important difference (MCID) for SGRQ total score and/or 6MWD. Overall, 54.0% of the patients fulfilled the criteria for good responders, while 22.1% were moderate responders. Change in passive reaction pattern coping style differed significantly between good responders and non-responders following PR (p < 0.001). Moreover, within the groups, changes in coping styles after PR occurred among the good responders, whereas the majority of moderate responders' and non-responders' coping styles were not significantly influenced by PR. Good responders decreased their passive reaction pattern coping style in contrast to non-responders after PR. In general, PR did not change the coping among moderate and non-responders. Further research is warranted to determine whether including interventions targeting coping styles may modify coping behaviour of COPD patients, as well as improvement in exercise tolerance or health status after PR.

Stoilkova-Hartmann A ，Janssen DJ ，Franssen FM ，Wouters EF ... -  《-》

Coping styles in patients with COPD before and after pulmonary rehabilitation.

Pulmonary rehabilitation (PR) improves physical and psychological symptoms in COPD patients. Patients' coping with daily symptoms and limitations may have more influence on important patient-centred outcomes than the impaired lung function. To date, it remains unknown whether and to what extent coping styles change following PR, and whether coping styles are associated with the outcomes of a comprehensive PR. Coping styles were assessed in 303 COPD patients before and after a PR programme using the Utrecht Coping List (UCL). Additionally, lung function, St. George's Respiratory Questionnaire (SGRQ), Hospital Anxiety and Depression Scale, anxiety (HADS-A) and depression (HADS-D) subscales and six-minute walking distance (6MWD) were recorded. The level of active confronting coping style increased (p < 0.05), whereas the levels of avoidance (p < 0.05), passive reaction pattern and reassuring thoughts coping styles decreased following PR (both p < 0.001). More than 50% of the patients changed their level of active confronting, passive reaction pattern or expressing emotions coping style. Coping styles and/or changes in coping styles after PR were related to changes in exercise tolerance, anxiety and depression, but were not related to changes in health status. Following PR, SGRQ total score, HADS-A and HADS-D scores decreased (all p < 0.001), while 6MWD increased (p < 0.05). Comprehensive PR results in change in coping styles of COPD patients. Coping styles are related to improvements in exercise tolerance, anxiety and depression, but they are not related with changes in health status after PR. Further studies are needed to evaluate the outcome of interventions actively targeting coping styles.

Stoilkova A ，Janssen DJ ，Franssen FM ，Spruit MA ，Wouters EF ... -  《-》

The relationship between coping styles and clinical outcomes in patients with COPD entering pulmonary rehabilitation.

Stoilkova A ，Wouters EF ，Spruit MA ，Franssen FM ，Janssen DJ ... -  《-》

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.

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. Retrospective case-control. Outpatient clinic, university center. COPD patients (N=102) that completed PR were initially evaluated. PR including whole-body and weight training for 12 weeks, 3 times per week. St. George Respiratory Questionnaire (SGRQ), 6-minute walk distance (6MWD), and FFM evaluation applied before and after PR. 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. 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.

Berton DC ，Silveira L ，Da Costa CC ，De Souza RM ，Winter CD ，Zimermann Teixeira PJ ... -  《-》

Changes in physical activity and sedentary behaviour following pulmonary rehabilitation in patients with COPD.

A more profound investigation about the responses in activity levels following pulmonary rehabilitation (PR) in patients with COPD is needed. We aimed to describe groups of patients with COPD according to patterns of change in physical activity and sedentary behaviour following PR. 90 patients with COPD (60% male; mean age 67 ± 8; median FEV1 47 (32-62) %pred) completed a comprehensive PR programme. A triaxial accelerometer was used to assess the time in sedentary behaviour, light activities and moderate-to-vigorous physical activity (MVPA). Additionally, exercise capacity, quality of life, and symptoms of anxiety and depression were assessed before and after PR. Six groups with different patterns of change in physical activity and sedentary behaviour were identified. The two most prevalent patterns were represented by good responders (increase in physical activity and reduction in sedentary behaviour, 34%) and poor responders (decrease in physical activity and increase in sedentary behaviour, 30%). Good responders had greater improvements in six-minute walk distance (6MWD) and symptoms of depression than poor responders (P < 0.05 for all). Strong correlation was found between changes in sedentary behaviour and changes in light activities (rs = -0.89; P < 0.0001). Changes in 6MWD correlated fairly with changes in sedentary behaviour (rs = -0.26), light activities (rs = 0.25), and MVPA (rs = 0.24); P < 0.05 for all. Different patterns of change in activity levels following PR can be found in patients with COPD. Focusing on light physical activities might be a potential strategy to make patients less sedentary, but for this to be achieved prior (or at least parallel) improvements in functional capacity seem to be necessary.

Mesquita R ，Meijer K ，Pitta F ，Azcuna H ，Goërtz YMJ ，Essers JMN ，Wouters EFM ，Spruit MA ... -  《-》