Effects of Physical Exercise on Walking Distance and Functional Limitations in Patients with Chronic Dyspnea

Abstract

Background and Objectives: Chronic dyspnea is a common clinical manifestation in patients suffering from cardiovascular and respiratory diseases globally, representing an independent predictor of mortality for these patients. In addition, it may be a symptom associated with other conditions such as anemia, physical deconditioning, or anxiety. Methods: A prospective study was conducted, between 1 January 2021 and 30 June 2022, at the Medical Recovery Section from "Dr. Pop Mircea Municipal Hospital Pop Mircea" in Marghita. A total of 163 consecutive patients with chronic dyspnea of various etiologies were evaluated for inclusion in the study. Patients who met the inclusion criteria followed a personalized physical training program of variable duration (between 20 and 40 min) up to the limit of exercise tolerance (grade 3-4 modified Borg scale or up to 70% of maximum heart rate, calculated with the formula 220 age in years); the first 10 days, the training was supervised by a physiotherapist, then patients followed a program of 30 min of exercise 5 days/week at home for 3 months. Assessments, performed at inclusion and after 3 months of training, consisted of the 6 min walk test (6MWT) and the London Chest Activity of Daily Living (LCADL) scale. Results: Pulmonary etiology is the most common cause of dyspnea in the cohort (61.65%). The number of patients without ventilatory defects is 56, or 38.35%. The mean value of initial functional limitation (LCADL1) improved significantly after 3 months (LACDL2) of rehabilitation treatment (38% versus 26.5%); at the same time, the mean walking distance (6MWT) increased by 76 m. Conclusions: An adequate rehabilitation program and sedentary lifestyle change significantly reduce the functional limitation of the patient with chronic dyspnea and increase walking distance. Predictors for 6MWT gait test are age, LCADL score, dyspnea level, and cardiac etiology of chronic dyspnea.

Keywords: chronic dyspnea; functional limitation; physical workout; walking distance.

Figure 1

CONSORT flow diagram of the study.

Figure 2

Evolution of the parameters assessed between the 2 determinations: (a). 6 min walk test; (b). LCADL score. m—meter; 6MWT 1—6 min walk test, first evaluation; 6MWT 2—6 min walk test, second evaluation; LCADL 1—London Chest Activity of Daily Living, first evaluation; LCADL 2—London Chest Activity of Daily Living, second evaluation; black vertical lines—confidence intervals (95%).

Figure 3

Evolution of LCADL score by domains. (a). Personal care. (b). Domestic activities. (c). Performing physical training. (d). Performing leisure activities. London Chest Activity of Daily Living domain scores: SELF-CARE 1—first evaluation; SELF-CARE 2—second evaluation; DOMESTIC 1—first evaluation; DOMESTIC 2—second evaluation; PHYSICAL 1—first evaluation; PHYSICAL 2—second evaluation; LEISURE 1—first evaluation; LEISURE 2—second evaluation; black vertical lines—confidence intervals (95%).

Figure 4

Mean values of the 6MWT test according to etiology. (a). Initially; (b). After 3 months. 6MWT1—6 min walk test, first evaluation; 6MWT2—6 min walk test, second evaluation; black vertical lines—confidence intervals (95%).

Figure 5

6MWT test results differentiated by etiology. black vertical lines—confidence intervals (95%).

Figure 6

(a). 6MWT−LACDL1 score correlation; (b). 6MWT–LACDL2 score correlation. (c). 6MWT–Age correlation. m—meter; 6MWT—6 min walk test; LCADL1—London Chest Activity of Daily Living, first evaluation; LCADL2—London Chest Activity of Daily Living, second evaluation; blue dotted lines—confidence intervals (95%); green dotted lines—prediction intervals (95%).

Figure 7

(a). Regression diagram 6MWT—modified Borg scale. (b). Regression diagram 6MWT—chronic dyspnea etiology. (a). blue line—confidence intervals (95%); dotted line—prediction intervals (95%); (b). dotted line—prediction intervals (95%); black lines—confidence intervals (95%).