Avaliação da capacidade de exercício em pacientes com doença pulmonar avançada submetidos à reabilitação pulmonar pré-transplante de pulmão

Abstract

The benefits of pulmonary rehabilitation in patients with chronic lung disease are well documented. The impact of the pulmonary rehabilitation in patients with advanced lung disease waiting lung transplant needs to be clarified. The primary objective of this study was to evaluate the exercise capacity of patients with advanced lung disease after a pulmonary rehabilitation program at the Lung Transplantation Section of the Hospital das Clínicas of the Federal University of Minas Gerais. The secondary objective was to verify the impact of the program in the the scores of dyspnea, prognosis of patients with chronic obstructive pulmonary disease and quality of life. The patients were evaluated by a multidisciplinary team and the physical therapy evaluation included measures of muscular endurance and application of the quality of life questionnaire. Exercise capacity was measured by the change in the walked distance in the six-minute walk test, dyspnea index was measured by the modified Medical Research Council scale, the prognostic score according to the BODE index for chronic obstructive pulmonary disease patients and quality of life was assessed by the Medical Outcomes Study 36-item Short-Form Health Survey. The data were collected before and after 36 pulmonary rehabilitation sessions that included endurance training, muscle strength and educational guidelines. In addition, we analyzed the presence of a correlation between the variation of Medical Outcomes Study 36-item Short-Form Health Survey and of the walked distance in the six-minute walk test, the variation of the walked distance in the six-minute walk test in a group of disease, according to the reported minimal clinically important difference in the literature (50m) and the potential association among some variables and the significant improvement in distance in the six-minute walk test. Amongst 140 patients referred to the Pulmonary Rehabilitation Unit 29 patients completed the program. The mean age was 51.9 ± 9.8 years, 55.2% female, BMI 23,3 ± 6,2 (kg/m2) and 11 patients (37.9%) were taking oxygen for at least 15h/day. There were 18 (62.1%) patients diagnosed with chronic obstructive pulmonary disease, six (20.7%) with intersticial lung disease and five (17.2%) with bronchiectasis. There was a significant improvement in the walked distance in the six-minute walk test (340.2 ± 151.5m vs. 444.8 ± 111.9m; p < 0.001), with an average increase of 104.7m. The number of patients with mMRC 4 reduced from 13 (44.7%) to 5 (17.3%) and patients with BODE index 1 and 2 increased from 3 (16.7%) to 12 (66.7%). Regarding the Medical Outcomes Study 36-item Short-Form Health Survey, there was clinical and significant improvement in the areas limited by physical (36 points, p = 0.001), social (21 points, p = 0.008) and emotional aspects (30 points; p = 0.005). There was no correlation between the variation of the SF-36 and that one of the walked distance in the six-minute walk test. Five patients (17.2%) got a variation in the walked distance in the six-minute walk test of less than 50m. Thus, it was not possible to build a multivariate model to verify if there were variables associated with this significant improvement in walked distance in the six-minute test. In conclusion, pulmonary rehabilitation results in increased exercise capacity, decrease of dyspnea perception and a better quality of life for patients with advanced lung disease who are in an ongoing evaluation for lung transplantation. In COPD patients, there was a improvement in the prognostic score.