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Open Access Highly Accessed Research article

Does pulmonary rehabilitation address cardiovascular risk factors in patients with COPD?

Nichola S Gale1, James M Duckers2, Stephanie Enright1, John R Cockcroft3, Dennis J Shale2 and Charlotte E Bolton24*

Author Affiliations

1 Department of Physiotherapy, School of Healthcare Studies, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK

2 Section of Respiratory Medicine, School of Medicine, Wales Heart Research Institute, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK

3 Wales Heart Research Institute, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK

4 NIHR Nottingham Respiratory Biomedical Research Unit, School of Clinical Sciences, University of Nottingham, Nottingham, NG5 1PB, UK

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BMC Pulmonary Medicine 2011, 11:20  doi:10.1186/1471-2466-11-20

Published: 21 April 2011

Abstract

Background

Patients with COPD have an increased risk of cardiovascular disease. Whilst pulmonary rehabilitation has proven benefit for exercise tolerance and quality of life, any effect on cardiovascular risk has not been fully investigated. We hypothesised that pulmonary rehabilitation, through the exercise and nutritional intervention, would address these factors.

Methods

Thirty-two stable patients with COPD commenced rehabilitation, and were compared with 20 age and gender matched controls at baseline assessment. In all subjects, aortic pulse wave velocity (PWV) an independent non-invasive predictor of cardiovascular risk, blood pressure (BP), interleukin-6 (IL-6) and fasting glucose and lipids were determined. These measures, and the incremental shuttle walk test (ISWT) were repeated in the patients who completed pulmonary rehabilitation.

Results

On commencement of rehabilitation aortic PWV was increased in patients compared with controls (p < 0.05), despite mean BP, age and gender being similar. The IL-6 was also increased (p < 0.05). Twenty-two patients completed study assessments. In these subjects, rehabilitation reduced mean (SD) aortic PWV (9.8 (3.0) to 9.3 (2.7) m/s (p < 0.05)), and systolic and diastolic BP by 10 mmHg and 5 mmHg respectively (p < 0.01). Total cholesterol and ISWT also improved (p < 0.05). On linear regression analysis, the reduction in aortic PWV was attributed to reducing the BP.

Conclusion

Cardiovascular risk factors including blood pressure and thereby aortic stiffness were improved following a course of standard multidisciplinary pulmonary rehabilitation in patients with COPD.

Keywords:
COPD; pulmonary rehabilitation; arterial stiffness