The Effects of Exercise Training in Patients With Persistent Dyspnea Following Pulmonary Embolism: A Randomized Controlled Trial.

Humans Quality of Life Exercise Exercise Therapy Pulmonary Embolism / complications Exercise Tolerance Dyspnea / etiology Pulmonary Disease, Chronic Obstructive / complications
dyspnea exercise training pulmonary embolism quality of life rehabilitation

Journal

Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335

Informations de publication

Date de publication:
10 2023
Historique:
received: 22 01 2023
revised: 25 04 2023
accepted: 25 04 2023
medline: 23 10 2023
pubmed: 7 5 2023
entrez: 6 5 2023
Statut: ppublish

Résumé

Persistent dyspnea, functional limitations, and reduced quality of life (QoL) are common following pulmonary embolism (PE). Rehabilitation is a potential treatment option, but the scientific evidence is limited. Does an exercise-based rehabilitation program improve exercise capacity in PE survivors with persistent dyspnea? This randomized controlled trial was conducted at two hospitals. Patients with persistent dyspnea following PE diagnosed 6 to 72 months earlier, without cardiopulmonary comorbidities, were randomized 1:1 to either the rehabilitation or the control group. The rehabilitation program consisted of two weekly sessions of physical exercise for 8 weeks and one educational session. The control group received usual care. The primary end point was the difference in Incremental Shuttle Walk Test between groups at follow-up. Secondary end points included differences in the Endurance Shuttle Walk Test (ESWT), QoL (EQ-5D and Pulmonary Embolism-QoL questionnaires) and dyspnea (Shortness of Breath questionnaire). A total of 211 subjects were included: 108 (51%) were randomized to the rehabilitation group and 103 (49%) to the control group. At follow-up, participants allocated to the rehabilitation group performed better on the ISWT compared with the control group (mean difference, 53.0 m; 95% CI, 17.7-88.3; P = .0035). The rehabilitation group reported better scores on the Pulmonary Embolism-QoL questionnaire (mean difference, -4%; 95% CI, -0.09 to 0.00; P = .041) at follow-up, but there were no differences in generic QoL, dyspnea scores, or the ESWT. No adverse events occurred during the intervention. In patients with persistent dyspnea following PE, those who underwent rehabilitation had better exercise capacity at follow-up than those who received usual care. Rehabilitation should be considered in patients with persistent dyspnea following PE. Further research is needed, however, to assess the optimal patient selection, timing, mode, and duration of rehabilitation. ClinicalTrials.gov; No.: NCT03405480; URL: www. gov.

Sections du résumé

BACKGROUND
Persistent dyspnea, functional limitations, and reduced quality of life (QoL) are common following pulmonary embolism (PE). Rehabilitation is a potential treatment option, but the scientific evidence is limited.
RESEARCH QUESTION
Does an exercise-based rehabilitation program improve exercise capacity in PE survivors with persistent dyspnea?
STUDY DESIGN AND METHODS
This randomized controlled trial was conducted at two hospitals. Patients with persistent dyspnea following PE diagnosed 6 to 72 months earlier, without cardiopulmonary comorbidities, were randomized 1:1 to either the rehabilitation or the control group. The rehabilitation program consisted of two weekly sessions of physical exercise for 8 weeks and one educational session. The control group received usual care. The primary end point was the difference in Incremental Shuttle Walk Test between groups at follow-up. Secondary end points included differences in the Endurance Shuttle Walk Test (ESWT), QoL (EQ-5D and Pulmonary Embolism-QoL questionnaires) and dyspnea (Shortness of Breath questionnaire).
RESULTS
A total of 211 subjects were included: 108 (51%) were randomized to the rehabilitation group and 103 (49%) to the control group. At follow-up, participants allocated to the rehabilitation group performed better on the ISWT compared with the control group (mean difference, 53.0 m; 95% CI, 17.7-88.3; P = .0035). The rehabilitation group reported better scores on the Pulmonary Embolism-QoL questionnaire (mean difference, -4%; 95% CI, -0.09 to 0.00; P = .041) at follow-up, but there were no differences in generic QoL, dyspnea scores, or the ESWT. No adverse events occurred during the intervention.
INTERPRETATION
In patients with persistent dyspnea following PE, those who underwent rehabilitation had better exercise capacity at follow-up than those who received usual care. Rehabilitation should be considered in patients with persistent dyspnea following PE. Further research is needed, however, to assess the optimal patient selection, timing, mode, and duration of rehabilitation.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov; No.: NCT03405480; URL: www.
CLINICALTRIALS
gov.

Identifiants

DOI: 10.1016/j.chest.2023.04.042 PMID: 37149257
pubmed: 37149257
pii: S0012-3692(23)00643-8
doi: 10.1016/j.chest.2023.04.042
pii:
doi:

Banques de données

ClinicalTrials.gov
['NCT03405480']

Types de publication

Randomized Controlled Trial Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

981-991

Commentaires et corrections

Type : CommentIn

Informations de copyright

Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

Auteurs

Øyvind Jervan (Ø)

Department of Cardiology, Østfold Hospital, Kalnes, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address: Oyvind.Jervan@so-hf.no.

Stacey Haukeland-Parker (S)

Department of Physical Medicine and Rehabilitation, Østfold Hospital, Kalnes, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

Jostein Gleditsch (J)

Department of Radiology, Østfold Hospital, Kalnes, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

Mazdak Tavoly (M)

Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.

Frederikus A Klok (FA)

Department of Medicine, Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.

Kjetil Steine (K)

Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Akershus University Hospital, Lørenskog, Norway.

Hege Hølmo Johannessen (HH)

Department of Physical Medicine and Rehabilitation, Østfold Hospital, Kalnes, Norway; Department of Health and Welfare, Østfold University College, Fredrikstad, Norway.

Martijn A Spruit (MA)

Department of Research and Development, Ciro, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.

Dan Atar (D)

Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.

René Holst (R)

Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.

Anders Erik Astrup Dahm (AE)

Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Hematology, Akershus University Hospital, Lørenskog, Norway.

Per Anton Sirnes (PA)

Østlandske Hjertesenter, Moss, Norway.

Knut Stavem (K)

Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway; Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.

Waleed Ghanima (W)

Clinic of Internal Medicine, Østfold Hospital, Kalnes, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Hematology, Oslo University Hospital, Oslo, Norway.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › The Effects of Exercise Training in Patients...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Mesures épidémiologiques › Démographie › État de santé › Qualité de vie › The Effects of Exercise Training in Patients...
questionsmedicales.fr › Activités humaines › Exercice physique › The Effects of Exercise Training in Patients...
questionsmedicales.fr › Thérapeutique › Techniques de physiothérapie › Traitement par les exercices physiques › The Effects of Exercise Training in Patients...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Embolie et thrombose › Embolie › Embolie pulmonaire › The Effects of Exercise Training in Patients...
questionsmedicales.fr › Phénomènes physiologiques de l'appareil locomoteur et du système nerveux › Phénomènes physiologiques du système locomoteur › Tolérance à l'effort › The Effects of Exercise Training in Patients...
questionsmedicales.fr › États, signes et symptômes pathologiques › Signes et symptômes › Signes et symptômes respiratoires › Dyspnée › The Effects of Exercise Training in Patients...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Caractéristiques de la maladie › Maladie chronique › Broncho-pneumopathie chronique obstructive › The Effects of Exercise Training in Patients...