An investigation of the effects of pulmonary rehabilitation and the presence or absence of frailty in COPD patients

Takumi Nagayama, Michiko Tsuchiya, Yukio Nagasaka, Shota Kotani, Kunihiko Anami, Koji Iwai, Jun Horie, Takeshi Yamazaki
Purpose:

The aim of this study was to investigate the differences in the effects of PR based on the presence or absence of frailty in COPD patients.

Methods:

The study was a pre- and post-comparison trial of an intervention. It included 31 stable COPD patients (age 75 ± 8 years, 28 men, 90%) who underwent pulmonary rehabilitation (PR) at Rakuwakai Otowa Hospital from March 2021 to September 2024. According to the J-CHS criteria, the diagnostic criteria consisted of five items: (1) weight loss, (2) fatigue, (3) reduced physical activity, (4) slowness (delayed walking speed), and (5) frailty (muscle weakness). Patients who met three or more items were classified as the frailty group, those who met 1-2 items were classified as the pre-frailty group, and those who met none of the items were classified as the robust group. Measurements were taken for grip strength, knee extension strength, body composition, mMRC, respiratory function, 6-minute walk distance (6MWD), and the Nagasaki University ADL scale (NRADL). These measurements were conducted before PR (Before) and 12 weeks after PR (After). All participants underwent daily home exercises and outpatient PR once a week for 12 weeks. The analysis was conducted using repeated measures two-way ANCOVA (with frailty status and pre-post PR intervention as two factors, with age and gender as covariates) followed by multiple comparison tests. A significance level of 5% was set.

Results:

Based on the J-CHS criteria, participants were classified into three groups: the frail group (6 individuals, 19%), the pre-frail group (13 individuals, 42%), and the robust group (14 individuals, 45%). Significant differences in 6MWD were observed for the PR factor (F = 4.476, p = 0.045) and the frailty factor (F = 21.185, p 0.001), with no significant interaction effect (F = 0.001, p = 0.999). For mMRC, significant differences were found for the PR factor (F = 10.509, p = 0.003) and the frailty factor (F = 26.32, p 0.001), with no significant interaction effect (F = 0.187, p = 0.831). Regarding NRADL, no significant difference was observed for the PR factor (F = 1.447, p = 0.241); however, significant differences were found for the frailty factor (F = 16.456, p 0.001) and the interaction effect (F = 4.793, p = 0.018), with the frail group showing significantly lower values compared to the pre-frail and robust groups. No significant differences were found for the other variables.

Conclusion(s):

6MWD and mMRC showed the effectiveness of PR intervention regardless of frailty status. However, NRADL scores indicated a significant decrease in the frail group despite PR intervention.

Implications:

Frail COPD patients may require careful attention to potential ADL decline during PR interventions focused on exercise therapy.

Funding acknowledgements:
No funding approval was obtained for this study.
Keywords:
COPD
frailty
pulmonary rehabilitation
Primary topic:
Cardiorespiratory
Second topic:
Community based rehabilitation
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Institution: Kyoto Tachibana University、Rakuwakai Otowa Hospital Ethics Committee: Kyoto Tachibana University Ethics Committee、Rakuwa-kai Ethics Review Committee
Provide the ethics approval number:
21-15、23-00011
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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