Pulmonary rehab just as effective for elderly COPD patients as it is for younger patients

Over the years, there has been a bias in pulmonary rehab studies to exclude evaluating the impact of a pulmonary rehab program on elderly COPD patients (those 70+ years of age). A study just published in the March/April 2010 edition of the Journal of Cardiopulmonary Rehabilitation and Prevention demonstrates that pulmonary rehab for elderly COPD patients is just as effective in improving physical conditioning, reducing shortness of breath, improving quality of life and decreased hospital admissions. (Sundararajan, L. et al. Effectiveness of Outpatient Pulmonary Rehabilitation in Elderly Patients with Chronic Obstructive Pulmonary Disease. Journal of Cardiopulmonary Rehabilitation and Prevention 2010; 30: 116-120)

The U.K. based research team highlighted their belief as to why this bias exists as follows, “There have been suggestions that older patients are ‘too old,’ would not tolerate aggressive treatment, or would have limited ability to improve exercise capacity because of the physiological effects of aging and comorbid illness.”

So the team set out to investigate whether the basis of this bias was valid. They combed through two U.K. hospital pulmonary rehab records from 1998-2003 to select out a group of 70+ aged adults (yielding 102 patients with a mean age of 76) and another group of <70 aged adults (yielding 98 patients with a mean age of 61). The combined 200 patients had all been through the same 6 week pulmonary rehab program consisting of 2 days/week in-clinic endurance training (30 minutes each day) and 1 additional day per week on their own outside of the clinic. The researchers compared the two groups’ improvement in physical conditioning, perceived breathlessness, perceived quality of life, and subsequent hospital admissions.

The retrospective study’s results showed that both the under-70 and over-70 groups experienced notable improvements on all measurements. For example, in the shuttle-walk test, the over-70 group saw a 20% increase in distance walked while the under-70 group experienced a 33% increase – both significant jumps. The shuttle walk test is a standard test used by respiratory care professionals to measure physical conditioning whereby patients walk as far as possible within a specific period of time – the farther you walk in the time allotted, the better your physical conditioning. Both groups demonstrated very similar levels of improvement in the other measures examined including perceived breathlessness, quality of life, subsequent hospital admissions and length of subsequent hospital stays.

So, in effect, the researchers demonstrated that the bias among respiratory care professionals to exclude the elderly from pulmonary rehab research was misplaced. As the research team noted, “The physiological effects of aging, including worsening cardiovascular status with reduction in aerobic endurance, changes in body composition such as skeletal muscle atrophy and weakness, and bone loss, DO RESPOND TO EXERCISE TRAINING (our emphasis added). Thus, it should not be surprising that elderly patients are capable of similar improvements from PR (pulmonary rehab) as are younger patients.”

We wholeheartedly agree. In our opinion, COPD patients of any age can benefit from a pulmonary rehab-style exercise program. Whether you are 45 or 75, we recommend pursuing an ongoing exercise program. The best place to start is by asking your doctor to refer you to a pulmonary rehab program in your area. If your doctor won’t prescribe it or there is no such program in your area, go to your local fitness center or community center and ask to speak to a fitness instructor who is certified in structuring exercise programs for people with chronic health conditions.

We would also encourage you to consider purchasing our Breathe Better for Life guide (http://www.breathebetterforlife.com/) which, among other things, provides a detailed 8 week endurance and strength training exercise program that is tailored for those with breathing difficulties. The program we recommend is based on guidelines established by the American Thoracic Society, European Respiratory Society and the American College of Sports Medicine. Our program also explains how you can establish your baseline physical condition at home and how you can monitor your progress over time. Whether you choose to follow our recommended program or not, the guide may serve as a valuable resource for you to discuss an exercise program with your doctor.

If none of those options appeal to you, please consider at least starting and maintaining a regular walking program (3-5 days a week, 30 minutes to 60 minutes per walking session). A number of research studies have demonstrated that COPD patients and smokers can benefit from such a walking program. Though the conditioning benefits won’t be as great from a simple walking program as you can achieve from an endurance/strength training program of moderate to vigorous intensity you can still improve how you feel and breathe.

In the end, no matter your age or current physical condition, you have the capacity to make a meaningful difference in how you breathe and live. So don’t let physician bias stop you from at least trying!