Pulmonary rehabilitation reduces depression in COPD patients

A new study published in the journal Chronic Respiratory Disease revealed that COPD patients who underwent an intensive 4-week inpatient pulmonary rehabilitation program reported significantly lower feelings of depression in addition to recording improved physical conditioning and higher self-reported quality of life.

This study confirms previous pulmonary rehabilitation research results with regard to its reported findings with a twist. Most past pulmonary rehab studies have examined the effectiveness of 8-12 week outpatient programs where COPD patients attend 2-3 one-hour sessions each week.

In this Norway based study, the 161 study subjects participated in a hospital-inpatient program for 4 weeks where patients attended pulmonary rehabilitation sessions 7.5 hours a day, 5 days a week over the 4 week period. The program components were similar to outpatient programs (guided/observed exercise, breathing & airway clearing training, and counseling regarding nutrition, medication use and other related health topics).

At the outset of the study, the COPD patients were tested for their exercise capacity using common a respiratory diagnostic tool known as the 6 minute walk test (where patients are asked to walk as far as they can within a 6 minute time limit – the resulting measure is called the 6-minute walk distance or 6MWD). Patients also completed health quality of life questionnaires and a depression/anxiety questionnaire commonly used by researchers to assess patient perceptions of well being (the St. George’s Respiratory Questionnaire and the Hospital Anxiety and Depression Scale, respectively). At the end of the 4 week period, the patients went through this battery of tests again and then researchers compared the pre and post study measures to judge if patients experienced improvement on some or all. (Bratas O, et al. Pulmonary rehabilitation reduces depression and enhances health-related quality of life in COPD patients - especially in patients with mild or moderate disease. Chron Respir Dis. 2010;7(4):229-37)

Not surprisingly, given past rehab study results, exercise capacity improved as measured by the 6 minute walk test. The mean improvement in 6MWD after the 4-week rehab program was 44 meters, or 12% (according to the study team, an increase of 35 meters or more is considered clinically significant).

On the Health Quality of Life survey, the COPD patients in the study showed statistically significant improvement between their pre and post study questionnaires in one particular component, the “psychosocial impact” component. According to the study team, the impact section, “measures aspects of social functioning and psychosocial disturbances caused by airway disease.” In other words, patients rate their perception of how COPD impacts their ability to interact with others.

It was in the depression/anxiety survey results where the biggest statistical improvement of the pulmonary rehab program was reported by study participants. At the outset of the study, 27% of the COPD patients in the study recorded scores on the anxiety/depression questionnaire that suggested a depression diagnosis. At the end of the 4-week pulmonary rehab program, only 16% showed results suggesting a depression diagnosis. This represented a 39% reduction in study participants with a possible depression diagnosis after completing the pulmonary rehab program.

Commenting on the improvements in the “psychosocial impact” and depression scores, the study authors commented, “In general, it is not clear which components of a pulmonary rehabilitation program specifically contribute to reduction of psychological distress. However, the components exercise, disease education and psychosocial support in the present rehabilitation program may have contributed, separately or combined to reducing depression.”

We suspect that in the process of improving physical condition through pulmonary rehabilitation-style exercise programs, COPD patients develop a greater sense of control over their breathing pattern and greater confidence in their ability to participate in everyday activities. The greater sense of control and improved confidence in turn help reduce depression (i.e. less sense of helplessness and greater participation/enjoyment of normal daily activities).

For COPD patients who haven’t tried pulmonary rehabilitation, we highly recommend you ask your physician to refer you to a program in your area. While it will not be as short/intensive as the program reported in this study, a traditional outpatient program confers many of the same benefits. For COPD patients who are unable to gain entry to a pulmonary rehab program (and sadly, that represents about 99% of COPD patients given the limited number of available programs and restrictive Medicare/insurance admission guidelines), you can achieve many of the same benefits by beginning and maintaining a regular exercise program.

Consult your physician for an exercise program that is appropriate for your individual circumstance. If your physician does not have a program to recommend, we suggest you consider purchasing our Breathe Better for Life guidebook and CD-ROM. We’ve developed an exercise program based on the principles of pulmonary rehabilitation as outlined by the American Thoracic Society and the European Respiratory Society. We’ve further tweaked these guidelines to include exercise recommendations from the American College of Sports Medicine for people with chronic respiratory conditions.

Whatever path you choose, we strongly believe that regular physical exercise is one of the best proactive steps a COPD patient (or anyone who suffers from chronic shortness of breath) can undertake. Not only will you likely benefit from improved physical conditioning and reduced shortness of breath, you may also see significant improvements in your perceived quality of life, mood and outlook.