Efectividad de un programa de entrenamiento físico individualizado domiciliario (PEFID), en el rendimiento de extremidades inferiores en pacientes con enfermedad pulmonar obstructiva crónica avanzada

Abstract

OBJECTIVES: o Main: 1º. To analyse the effectiveness of the Individualised Home Physical Training Programme (PEFID), administered over a period of one year to outpatients with advanced COPD, using as outcome measures the subtests of the SPPB short physical performance battery: four-metre walk speed test (4MGS), and five-repetition sit-to-stand test (5STS). 2º. To assess whether the Home Exercise Programme (EDP) improves quadriceps muscle strength measured by dynamometry (FMC). o Secondary objetive: - To assess the evolution of symptoms (dyspnoea) and quality of life at the beginning and at the end of the programme in patients receiving the PDE programme. METHODOLOGY Quasi-experimental study, with prospective recruitment of patients with advanced COPD, followed for one year and recruited from a Pneumology service belonging to a medical-surgical area hospital (Morales Meseguer General University Hospital in Murcia), Two groups of patients were generated: o Study Group (SG): constituted by cohort of patients with a diagnosis of COPD During a period of 1 year, the recruited patients were included in the PEFID programme. Conditions for inclusion were: - Advanced COPD: all patients included had severe respiratory functional impairment: FEV1≤ 50% or very severe: ≤ 30%; of baseline values; according to the Global COPD Initiative recommendations. Post-bronchodilator percentage of forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) <70% and FEV1 <50% of baseline. - Stable COPD: all patients when included in the study were COPD patients in a clinically stable COPD situation, outside a period of at least six weeks prior to inclusion, with no exacerbation or hospitalisation. o Control group (CG): formed from a database of 137 outpatients with advanced COPD, severe respiratory functional impairment (FEV1≤ 50% or very severe: ≤ 30%; from baseline values (GOLD, 2023) using statistical matching techniques by sociodemographic, clinical, pulmonary and non-respiratory variables and followed for the same period of time. CONCLUSIONS: 1ª. After the application of an Individualised Physical Training at Home Programme (PEFID) to patients with advanced COPD, one year after the start, the performance of the lower limbs improved as assessed by the short physical performance battery (SPPB), the four-metre walk speed test (4MGS) and the five repetitions sit to stand test (5STS). 2ª. The Programme (PEFID) improved the strength of the quadriceps measured by dynamometry (FMC). 3ª. Symptoms, as assessed by the modified Medical Research Council dyspnoea test (mMRC), improved one year after the start of the programme in the group of patients with advanced COPD who received the PEFID programme. 4ª. Health-related quality of life as assessed by the COPD clinical questionnaire (CCQ) improved at one year after baseline in the group of patients with advanced COPD who received the (PEFID) programme. 5ª. The Individualised Physical Training at Home Programme (PEFID) may be more accessible to patients than traditional pulmonary rehabilitation programmes administered in health centres, and had a successful implementation with few losses over the one-year follow-up. 6ª. The tools used to evaluate the results of the implementation of the programme (PEFID) are technically simple and easy to apply in routine clinical practice. 7ª. The programme (PEFID) represents a possible alternative to traditional face-to-face respiratory rehabilitation programmes, although new prospective studies in COPD patients are needed to consolidate these approaches.