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Pulmonary rehab helps even the most obese

Even the extremely obese with COPD benefit from pulmonary rehabilitation

OnMedica staff

Thursday, 20 May 2010

Pulmonary rehabilitation is effective for both obese and slim people with chronic obstructive pulmonary disease (COPD), shows UK research presented at the American Thoracic Society 2010 international conference.

Researchers from the University Hospitals of Leicester reported that obese patients with COPD could gain as much as slim patients from pulmonary rehabilitation, even though they have, on average, lower exercise capacity.

Neil Greening and colleagues compared the effects of pulmonary rehabilitation between obese and non-obese patients. They recruited patients with clinical and spirometric COPD, and classified them by BMI, from normal weight (BMI 21-25kg/m2) to extreme obesity (BMI >40 kg/m2); they recorded baseline characteristics. These people then participated in a pulmonary rehabilitation programme. The research team assessed improvements in patients’ exercise performance and endurance, and their health status (chronic respiratory questionnaire).

“We found that obese people with COPD are more disabled in terms of exercise capacity, despite having less severe airflow obstruction. However, they do just as well with rehab, including those with extreme obesity,” said Dr Greening. “There is no difference between obesity subgroups in the proportion of patients achieving a clinically significant improvement in the incremental shuttle walk test.”

The researchers expected to find that the pulmonary rehabilitation regimen would lead to some improvement, but found that, unexpectedly, they saw no difference in training effects between normal weight and extremely obese patients.

“Patients with COPD, irrespective of body mass, improve following a pulmonary rehabilitation programme. Therefore extremely obese patients with COPD should still be considered for enrolment,” said Dr Greening. He expressed concern that some clinicians might discriminate against the very obese, and may as a result emphasise weight loss over exercise.

Dr Greening added that it remains unclear why obesity confers a survival benefit on people with COPD. “We know that obesity is linked with medical complications such as diabetes and heart disease, so how it can lead to a survival advantage in other diseases such as COPD or chronic kidney disease is puzzling. The reasons for this are currently unknown and further research is needed.”

“The effects of pulmonary rehabilitation on extreme obesity in COPD” (Session A27, Sunday, May 16; Abstract 1342)

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