Pulmonary rehabilitation, physical activity and aortic stiffness in COPD

Abstract

Background: Patients with chronic obstructive pulmonary disease (COPD) have elevated cardiovascular risk, and cardiovascular disease is a major cause of death in COPD. The current literature indicates that changes in cardiovascular risk during pulmonary rehabilitation (assessed using aortic stiffness) are heterogeneous suggesting that there may be sub-groups of patients who do and do not benefit.

Objectives: To investigate the characteristics of COPD patients who do and do not experience aortic stiffness reduction during pulmonary rehabilitation, examine how changes relate to physical activity and exercise capacity, and assess whether changes in aortic stiffness are maintained at 6 weeks following rehabilitation.

Methods: We prospectively measured arterial stiffness (aortic pulse-wave velocity), exercise capacity (Incremental Shuttle Walk Test) and physical activity (daily step count) in 92 COPD patients who started a six week pulmonary rehabilitation programme, 54 of whom completed rehabilitation, and 29 of whom were re-assessed six weeks later.

Results: Whilst on average there was no influence of pulmonary rehabilitation on aortic stiffness (pre- vs. post pulse-wave velocity 11.3 vs. 11.1 m/s p = 0.34), 56% patients responded with a significant reduction in aortic stiffness. Change in aortic stiffness (absolute and/or percentage) during rehabilitation was associated with both increased physical activity (rho = - 0.30, p = 0.042) and change in exercise capacity (rho = - 0.32, p = 0.02), but in multivariable analysis most closely with physical activity. 92% of the responders who attended maintained this response six weeks later.

Conclusion: Elevated aortic stiffness in COPD is potentially modifiable in a subgroup of patients during pulmonary rehabilitation and is associated with increased physical activity.

Trial registration: ClinicalTrials.gov Identifier: NCT03003208. Registered 26/12/ 2016.

Keywords: And pulmonary rehabilitation; Aortic stiffness; COPD.

Fig. 1

Consort diagram

Fig. 2

Individual changes in aortic pulse wave velocity (aPWV) before and after pulmonary rehabilitation. Solid line and circles represent the mean

Fig. 3

Scatter plots demonstrating correlations between absolute ∆aPWV and ∆ISWT after completing PR (a – rho = − 0.32, p = 0.020) and between ∆aPWV% and average PA during the six weeks PR (b – rho = − 0.30, p = 0.042)