Application evaluation of cardiopulmonary exercise test to guide comprehensive pulmonary rehabilitation in patients with pneumoconiosis / 环境与职业医学

Background At present, the practice of pulmonary rehabilitation for pneumoconiosis in China is in a primary stage. The basis for formulating an individualized comprehensive pulmonary rehabilitation plan is still insufficient, which is one of the factors limiting the development of community-level rehabilitation work. Objective To formulate an exercise prescription based on maximum heart rate measured by cardiopulmonary exercise test (CPET), conduct an individualized comprehensive pulmonary rehabilitation program with the exercise prescription for patients with stable pneumoconiosis, and evaluate its role in improving exercise endurance and quality of life, thus provide a basis for the application and promotion of pulmonary rehabilitation. Methods A total of 68 patients were recruited from the Occupational Disease Prevention Hospital of Jinneng Holding Coal Industry Group Co., Ltd. from April to August 2022 , and were divided into an intervention group and a control group by random number table method, with 34 cases in each group. All the pneumoconiosis patients participated in a baseline test. The control group was given routine drug treatment, while the intervention group received multidisciplinary comprehensive pulmonary rehabilitation treatment on the basis of routine drug treatment, including health education, breathing training, exercise training, nutrition guidance, psychological intervention, and sleep management, whose exercise intensity was determined according to the maximum heart rate provided by CPET. The rehabilitation training lasted for 24 weeks. Patients were evaluated at registration and the end of study respectively. CPET was used to measure peak oxygen uptake per kilogram (pVO2/kg), anaerobic threshold (AT), carbon dioxide equivalent of ventilation (EqCO2), maximum metabolic equivalent (METs), and maximum work (Wmax). The modified British Medical Research Council Dyspnea Questionnaire (mMRC), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Pittsburgh Sleep Quality Index (PSQI), Chronic Obstructive Pulmonary Disease Assessment Test (CAT), and Short Form of Health Survey (SF-36) were used to evaluate the potential effect of the comprehensive pulmonary rehabilitation program. Results Among the included 68 patients, 63 patients were having complete data, then 31 cases were assigned in the control group and 32 cases in the interventional group. Before the intervention, there was no significant difference in pVO2/kg, AT, EqCO2, METs, or Wmax between the two groups (P>0.05). At the end of the trail, the indicators like pVO2/kg [(19.81±2.38) mL·(min·kg)−1], AT [(14.48±2.33) mL·(min·kg)−1], METs (5.64±0.69), and Wmax [(85.25±14) W] of patients in the intervention group were all higher than those [(13.90±2.37) mL·(min·kg)−1, (11.70±1.94) mL·(min kg)−1, (3.97±0.70), and (61.77±14.72) W, respectively] in the control group (P<0.001); there was no significant difference in EqCO2 between the two groups (P=0.083). Before the trial, there was no significant difference in mMRC, SAS, SDS, PSQI, or CAT scores between the two groups (P>0.05). At the end of the trail, the mMRC score (1.16±0.57), SAS score (27.93±2.12), SDS score (26.48±1.44), PSQI score (1.08±0.88), and CAT score (4.34±3.28) of patients in the intervention group were lower than those [(2.03±0.83), (35.87±6.91), (34.23±6.65), (5.37±3.03), and (13.87±7.53), respectively] in the control group (P<0.001). The SF-36 scores of bodily pain (94.13±10.72), general health (87.50±5.68), vitality (95.31±5.53), mental health (99.88±0.71), and health changes (74.22±4.42) in the intervention group were higher than those [(71.87±32.72), (65.81±15.55), (74.52±16.45), (86.97±16.56), and (29.84±13.50), respectively] in the control group (P<0.001), and no significant difference was found in social functioning and role emotional scores (P>0.05). Conclusion Comprehensive pulmonary rehabilitation can increase the oxygen intake and exercise endurance of pneumoconiosis patients, ameliorate dyspnea symptoms, elevate psychological state and sleep quality, and improve the quality of life.

A five-year follow-up report on lung imaging and exercise endurance of a patient with paraquat poisoning / 中华劳动卫生职业病杂志

A patient with paraquat poisoning was followed up for five years, and it was showed that the interstitial lesion areas in chest CT of this patient gradually decreased after acute period of the poisoning and no significant changes were found six months later. After that the density of the lesions gradually reduced, while the cystic air cavities slowly increased. In addition, the patient's exercise endurance gradually improved over time, and the lung function was close to the normal level five years after poisoning. The follow-up report helps clinicians to have a deeper understanding of the long-term outcome of paraquat poisoning.

Spine curvature and the cardiopulmonary exercise endurance of adolescents with idiopathic scoliosis / 中华物理医学与康复杂志

Objective:To quantify any correlation between the severity of spinal curvature of an adolescent with idiopathic scoliosis and their cardiopulmonary exercise endurance.Methods:The cardiopulmonary exercise test (CPET) results and the full-length spinal X-rays in a standing position of 64 adolescents with idiopathic scoliosis were reviewed retrospectively. Independent t-tests were used to compare the two datasets obtained from those with left or right thoracic scoliosis. The correlation between the Cobb angle and cardiopulmonary exercise endurance was analyzed using Pearson correlation coefficients, multiple factor linear regression and two-stage linear regression.Results:After adjusting for gender, age, height and weight, the multiple linear regression analysis showed that the Cobb angle was significantly negatively correlated with maximum tidal volume (β=-0.013) and significantly positively correlated with the rate of respiration (β=0.421). The relationship between the Cobb angle and cardiopulmonary exercise endurance was non-linear. With a Cobb angle > 34°, a 1° increase reduces cardiopulmonary exercise endurance by a factor of 1.4 on average. At smaller Cobb angles the corresponding increase is about 0.87 times.Conclusions:The Cobb angle is a negative predictor of ventilation during exercise among adolescents with idiopathic scoliosis. The more severe a patient′s spinal curvature, the lower the cardiopulmonary exercise endurance is likely to be.

Effect of Polysaccharides from Root， Stem， Leaf and Fruit of Schisandra chinensis on Exercise Endurance in D-galactose-induced Aging Mice / 中国实验方剂学杂志

ObjectiveTo observe the effect of polysaccharides from root， stem， leaf and fruit of Schisandra chinensis on exercise endurance in the aging mice induced by D-galactose. MethodMale ICR mice were randomly assigned into six groups： blank control group， model group， root polysaccharide group， stem polysaccharide group， leaf polysaccharide group and fruit polysaccharide group. The mice were administrated with distilled water or root， stem， leaf and fruit polysaccharide （total sugar content of 35 mg·kg-1） by gavage. Thirty minutes after the administration， the blank control group was subcutaneously injected with normal saline， and the other groups with D-galactose （300 mg·kg-1）， once daily for 6 weeks. The anti-fatigue effects were evaluated by rotarod test， forelimb grip strength test， and weight-loaded swimming test. The fatigue and oxidation indicators such as blood urea nitrogen （BUN）， serum lactic acid （LD）， lactic dehydrogenase （LDH）， creatine kinase （CK）， superoxide dismutase （SOD）， malondialdehyde （MDA）， glutathione peroxidase （GSH-Px）， and reactive oxygen species （ROS） were measured by chemical colorimetry. The protein levels of pro-apoptotic protein B cell lymphoma-2 （Bcl-2）-associated X protein （Bax）， anti-apoptotic Bcl-2 and cleaved cysteinyl aspartate-specific protease-3 （cleaved Caspase-3） in mouse skeletal muscle were detected by Western blot. ResultIn the rotarod test， the time on rod was shorter in the model group than in the blank control group （P<0.01） and the root， stem and fruit polysaccharide groups （P<0.01）. In the forelimb grip strength test， the forelimb grip strength in the model group was lower than that in the blank control group （P<0.01） and the root， stem， leaf and fruit polysaccharide groups （P<0.01）. In the weight-loaded swimming test， the weight-loaded swimming time in the model group was shorter than that in the blank control group （P<0.01） and the root， stem， leaf and fruit polysaccharide groups （P<0.01）. Compared with those in the blank control group， the BUN， LD， LDH and CK levels significantly increased in the model group （P<0.05， P<0.01）. The increases in BUN and LDH levels were decreased by the root， stem and fruit polysaccharides （P<0.05， P<0.01） and those in LD and CK by the root， stem， leaf and fruit polysaccharides （P<0.05， P<0.01）. Compared with the blank control group， the model group showed decreased SOD and GSH-Px activities （P<0.01） and increased MDA and ROS content （P<0.01）. Compared with the model group， the root， stem， and fruit polysaccharide increased the SOD activity （P<0.05， P<0.01） and decreased ROS content （P<0.01）. The root and stem polysaccharides decreased the MDA content （P<0.01） and increased the GSH-Px activity （P<0.05， P<0.01）. Compared with the blank control group， the model group showed up-regulated protein levels of Bax and cleaved Caspase-3 and down-regulated protein level of Bcl-2 （P<0.01）. Compared with the model group， the root， and stem polysaccharides down-regulated the protein levels of cleaved Caspase-3 （P<0.05） and up-regulated protein level of Bcl-2 （P<0.01）. ConclusionThe polysaccharides from the root， stem， leaf， and fruit of S. chinensis have anti-fatigue effect in D-galactose-induced aging mice. The polysaccharides may exert such effect by improving the antioxidant capacity and inhibiting the apoptosis of skeletal muscle cells.

Study on the Benefit of Postoperative Exercise Rehabilitation in Patients with Lung Cancer Complicated with Chronic Obstructive Pulmonary Disease / 中国肺癌杂志

BACKGROUND@#Chronic obstructive pulmonary diseases (COPD) affects 45%-63% of lung cancer patients worldwide. Lung cancer patients complicated with COPD have decreased cardiopulmonary function and increased perioperative risk, and their postoperative exercise endurance and lung function are significantly lower than those with conventional lung cancer. Previous studies have shown that postoperative exercise training can improve the exercise endurance of unselected lung cancer patients, but it is unclear whether lung cancer patients with COPD can also benefit from postoperative exercise training. This study intends to explore the effects of postoperative exercise training on exercise endurance, daily activity and lung function of lung cancer patients with COPD.@*METHODS@#Seventy-four patients with non-small cell lung cancer (NSCLC) complicated with COPD who underwent pneumonectomy in the lung cancer center of West China Hospital of Sichuan University from August 5, 2020 to August 25, 2021 were prospectively analyzed. They were randomly divided into exercise group and control group; The patients in the two groups received routine postoperative rehabilitation in the first week after operation, and the control group was given routine nursing from the second week. On this basis, the exercise group received postoperative exercise rehabilitation training for two weeks. Baseline evaluation was performed 3 days before operation and endpoint evaluation was performed 3 weeks after operation.@*RESULTS@#The exercise endurance, daily activity and pulmonary function test results of the two groups decreased from baseline to the end point. However, after the operation and intervention program, the maximum oxygen consumption of Cardiopulmonary Exercise Test and the walking distance of 6-Minute Walking Test in the exercise group were significantly better than those in the control group [(13.09±1.46) mL/kg/min vs (11.89±1.38) mL/kg/min, P=0.033; (297±46) m vs (243±43) m, P=0.041]. The average number of we-chat steps in the exercise group was also significantly better than that in the control group (4,381±397 vs 3,478±342, P=0.035). Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) in the exercise group were better than those in the control group, but the difference did not reach a statistically significant level [(1.76±0.19) L vs (1.60±0.28) L, P=0.084; (1.01±0.17) L vs (0.96±0.21) L, P=0.467].@*CONCLUSIONS@#Postoperative exercise rehabilitation training can improve exercise endurance and daily activity ability of patients with lung cancer complicated with COPD and promote postoperative rehabilitation.

Effect of home-based cardiac tele-rehabilitation on quality of life, disease burden status,cardiac function and exercise endurance of patients after percutaneous coronary intervention / 中国实用护理杂志

Objective@#To explore the effect of home-based cardiac tele-rehabilitation on quality of life, disease burden status,cardiac function and exercise endurance of patients after percutaneous coronary intervention (PCI).@*Methods@#A total of 106 patients after PCI from January to December in 2018 in Heart Disease Center of Shiyan People′s Hospital, Hubei Province were randomly divided into observation group and control group according to the order of discharge, there were 53 cases in each group. The control group received routine rehabilitation care, and the observation group received home-based cardiac tele-rehabilitation on the basis of routine nursing. 6 minutes walking test(6MWT), anerobic threshold, oxygen peak and left ventricular ejection fraction(LVEF) in two groups were measured at 3 months after the intervention, the SF-12 scale and Family Burden Scale of Disease (FBS) scale were also scored.@*Results@#After 3 months of intervention, the 6MWT, anerobic threshold, oxygen peak, physiological total score and psychological total score of SF-12 scale, and FBS score was (596.26±79.35) m, (14.65±1.82) ml·kg-1·min-1, (25.86±3.46) ml·kg-1·min-1, (47.46±9.86) points, (50.68±9.82) points, (18.94±6.61) points in the observation group, and (532.65±76.57) m, (12.95±1.87) ml·kg-1·min-1, (21.95±3.28 ) ml·kg-1·min-1, (43.28±8.21) points, (48.26±9.69) points, ( 21.75±7.18) points in the control group. The difference between the two groups was statistically significant (t value was -0.317-6.034, all P<0.05).@*Conclusions@#Home-based cardiac tele-rehabilitation can improve the quality of life, exercise endurance and can help to reduce the disease burden status on patients after PCI.

Effect of Pulmonary Rehabilitation on Pulmonary Function and Activities of Daily Living in Patients with Chronic Schizophrenia Complicated with Pulmonary Infection at Stable Stage / 中国康复理论与实践

@#Objective To explore the effect of pulmonary rehabilitation on activities of daily living(ADL)and pulmonary function in patients with chronic schizophrenia complicated with pulmonary infection at stable stage. Methods From January,2014 to July,2017,62 patients with chronic schizophrenia complicated with pulmonary infec-tion at stable stage were randomly divided into control group(n=31)and observation group(n=31).Both groups accepted routine medication,while the observation group received pulmonary rehabilitation for two months in ad-dition.The distance of 6-Minute Walk Test(6MWT),the modified Barthel index(MBI),modified British Medi-cal Research Council Dyspnea Scale (mMRC), C-reactive protein (CRP), Zung Anxiety Self-Rating Scale and Zung Depression Self-Rating Scale were compared before and after training. Results The total effective rate was higher in the observation group than in the control group(χ2=5.415,P=0.020).Com-pared with the control group,the distance of 6MWT increased(t=5.463,P=0.008),the score of MBI increased(t=2.142, P=0.028), the score of mMRC decreased (t=3.689, P=0.013), and the level of CRP decreased (t=-2.179,P=0.031)in the observation group.The scores of Zung Anxiety Self-Rating Scale(t=5.048,P=0.009) and Zung Depression Self-Rating Scale(t=-1.388,P=0.045)both decreased. Conclusion An early implementation of pulmonary rehabilitation could improve ADL and the exercise endurance,and reduce the incidence of infection in patients with chronic schizophrenia complicated with pulmonary infection at stable stage.

Influence of Circadian Rhythm Disruptions on Exercise Endurance, Blood Pressure and Heart Rate after Exercise in Rats / 中国康复理论与实践

Objective To observe the influence of circadian rhythm disruptions on exercise capability in rats. Methods A total of 30 spontaneously hypertensive rats (SHR) and age and weight matched homologous normal blood pressure WKY rats were randomly divided into normal circadian rhythm group (control group), twelve hours cir-cadian rhythm disruption group (observation group 1), six hours circadian rhythm disruption group (observation group 2). Each group included ten SHR rats and WKY rats, changing the light/dark time to construct circadian rhythm disruption model. Exercise endurance, blood pressure and heart rate after exhaustion were measured be-fore and one, two and three months after modeling. Results The interaction of time and circadian rhythm was significant on the exhaustion time of SHR rats (F=2.409, P=0.047). After three months of modeling, the exhaustion time of the control group was more than that of the obser-vation groups 1 and 2 (F=4.290, P=0.032). The interaction of time and circadian rhythm was not significant on the exhaustion time of WKY rats (F=0.717, P=0.638), there was no significant difference in the exhaustion time among groups (P>0.05). For SHR rats, after three months of modeling, the systolic pressure, diastolic pressure and mean arterial pressure after exhaustion of the observation group 1 were higher than those of the control group and the observation group 2 (P<0.05), the heart rate of the observation groups 1 and 2 was higher than that of the control group (P<0.05). But there was no significant difference in the systolic pressure, diastolic pressure, average arterial pressure and heart rate of WKY rats among groups (P>0.05). Conclusion Circadian rhythm disruptions can reduce the exercise endurance of SHR rats, which may be related to the cardiovascular function impairment.

Improvement effect of aerobic exercise on haemodynamics and exercise endurance of male old patients with simple obesity / 吉林大学学报(医学版)

Objective:To investigate the effects of 12-week low intensity aerobic exercise on the body composition,haemodynamics and exercise endurance of the male old patients with simple obesity,and to provide evidence for conducting special exercise prescription.Methods:Forty-six male old simple obesity patients were divided into control group (n=19) and exercise group (n=27) according to subjective will.The subjects in control group maintained daily life while those in exercise group performed a 12-week low intensity aerobic exercise.Before and after experiment,the rest heart rates and blood pressures were measured,the maximal oxygen intake (VO2max),maximal power (MP) and exhaust time (ET) were detected by symptom limited graded exercise test,the heart rate curve and blood pressure curve were depicted,and the body composition was determined by body composition analyzer.Results:Compared with before experiment,the fat mass,the percentage of fat body,rest heart rate and blood pressure of the patients in exercise group were decreased (P＜0.05),the VO2 MP and ET were increased (P＜0.05),and the heart rate curve and blood pressure curve during exercise test shifted right;but the indicators in control group showed no significant changes (P＞0.05).Compared with control group,the fat mass,percentage of body fat,rest heart rate and blood pressure were decreased (P＜0.05) and the VO2 MP and ET were increased (P＜ 0.05) in exercise group after experiment.Conclusion:Low intensity aerobic exercise of 12-week may effectively improve the haemodynamic abnormality,reduce the body composition and enhance the exercise endurance.

Improvement effect of aerobic exercise on haemodynamics and exercise endurance of male old patients with simple obesity / 吉林大学学报(医学版)

Objective:To investigate the effects of 12-week low intensity aerobic exercise on the body composition,haemodynamics and exercise endurance of the male old patients with simple obesity,and to provide evidence for conducting special exercise prescription.Methods:Forty-six male old simple obesity patients were divided into control group (n=19) and exercise group (n=27) according to subjective will.The subjects in control group maintained daily life while those in exercise group performed a 12-week low intensity aerobic exercise.Before and after experiment,the rest heart rates and blood pressures were measured,the maximal oxygen intake (VO2max),maximal power (MP) and exhaust time (ET) were detected by symptom limited graded exercise test,the heart rate curve and blood pressure curve were depicted,and the body composition was determined by body composition analyzer.Results:Compared with before experiment,the fat mass,the percentage of fat body,rest heart rate and blood pressure of the patients in exercise group were decreased (P＜0.05),the VO2 MP and ET were increased (P＜0.05),and the heart rate curve and blood pressure curve during exercise test shifted right;but the indicators in control group showed no significant changes (P＞0.05).Compared with control group,the fat mass,percentage of body fat,rest heart rate and blood pressure were decreased (P＜0.05) and the VO2 MP and ET were increased (P＜ 0.05) in exercise group after experiment.Conclusion:Low intensity aerobic exercise of 12-week may effectively improve the haemodynamic abnormality,reduce the body composition and enhance the exercise endurance.

Voluntary stand-up physical activity enhances endurance exercise capacity in rats

Involuntary physical activity induced by the avoidance of electrical shock leads to improved endurance exercise capacity in animals. However, it remains unknown whether voluntary stand-up physical activity (SPA) without forced simulating factors improves endurance exercise capacity in animals. We examined the eff ects of SPA on body weight, cardiac function, and endurance exercise capacity for 12 weeks. Twelve male Sprague-Dawley rats (aged 8 weeks, n=6 per group) were randomly assigned to a control group (CON) or a voluntary SPA group. The rats were induced to perform voluntary SPA (lifting a load equal to their body weight), while the food height (18.0 cm) in cages was increased progressively by 3.5 every 4 weeks until it reached 28.5 cm for 12 weeks. The SPA group showed a lower body weight compared to the CON group, but voluntary SPA did not affect the skeletal muscle and heart weights, food intake, and echocardiography results. Although the SPA group showed higher grip strength, running time, and distance compared to the CON group, the level of irisin, corticosterone, genetic expression of mitochondrial biogenesis, and nuclei numbers were not affected. These findings show that voluntary SPA without any forced stimuli in rats can eff ectively reduce body weight and enhance endurance exercise capacity, suggesting that it may be an important alternative strategy to enhance endurance exercise capacity.

Effects of Aerobic Exercise on Skeletal Muscle Glycogen and Exercise Endurance in Rats with Chronic Heart Failure / 中国康复理论与实践

@#Objective To observe the effects of 8-week aerobic exercise on skeletal muscle glycogen content and exercise endurance and investigate the possible mechanism in rats with chronic heart failure. Methods 30 Sprague-Dawley rats were submitted to heart failure sedentary (H) group, heart failure traning (HT) group and sham operation (S) group. The heart failure model was established with coronary artery ligation. HT group performed an 8-week treadmill running. The skeletal muscle glycogen content was determined with anthracenone, exercise endurance with exhaust duration of graded exhausted exercise test, glucose uptake rate, activity of glycogen synthase (GS) and glycogen phosphorylase (GP) with radicisotope, protein expression of total GS, phospho-GS (p-GS), total GP and phospho-GP (p-GP) with Western Blotting. Correlation analysis was conducted between glycogen content and exhaust duration. Results The skeletal muscle glycogen, exhaust duration, glucose uptake rate, GS activity and p-GP protein reduced (P<0.05), while serum insulin, GP activity and p-GS protein raised (P<0.05) in the H group compared with those in the S group. The skeletal muscle glycogen, exhaust duration, glucose uptake rate, GS activity and p-GP protein increased (P<0.05), while serum insulin, GP activity and p-GS protein decreased (P<0.05) in the HT group compared with those in the H group. There was positive correlation between glycogen content and exhaust duration (P<0.05). Conclusion Prolonged aerobic exercise enhanced skeletal muscle glycogen content and exercise endurance in rats with chronic heart failure, which may be related to the improvement of insulin sensitivity, muscle glucose uptake, increase of glycogen synthesis and decrease of glycogen breakdown.

Effects of Aerobic Exercise on Skeletal Muscle Glycogen and Exercise Endurance in Rats with Chronic Heart Failure / 中国康复理论与实践

Objective To observe the effects of 8-week aerobic exercise on skeletal muscle glycogen content and exercise endurance and investigate the possible mechanism in rats with chronic heart failure. Methods 30 Sprague-Dawley rats were submitted to heart failure sed-entary (H) group, heart failure traning (HT) group and sham operation (S) group. The heart failure model was established with coronary ar-tery ligation. HT group performed an 8-week treadmill running. The skeletal muscle glycogen content was determined with anthracenone, exercise endurance with exhaust duration of graded exhausted exercise test, glucose uptake rate, activity of glycogen synthase (GS) and gly-cogen phosphorylase (GP) with radicisotope, protein expression of total GS, phospho-GS (p-GS), total GP and phospho-GP (p-GP) with Western Blotting. Correlation analysis was conducted between glycogen content and exhaust duration. Results The skeletal muscle glyco-gen, exhaust duration, glucose uptake rate, GS activity and p-GP protein reduced (P<0.05), while serum insulin, GP activity and p-GS pro-tein raised (P<0.05) in the H group compared with those in the S group. The skeletal muscle glycogen, exhaust duration, glucose uptake rate, GS activity and p-GP protein increased (P<0.05), while serum insulin, GP activity and p-GS protein decreased (P<0.05) in the HT group compared with those in the H group. There was positive correlation between glycogen content and exhaust duration (P<0.05). Conclu-sion Prolonged aerobic exercise enhanced skeletal muscle glycogen content and exercise endurance in rats with chronic heart failure, which may be related to the improvement of insulin sensitivity, muscle glucose uptake, increase of glycogen synthesis and decrease of glycogen breakdown.

The effects of pulmonary rehabilitation on the hospitalization rates and exercise endurance of patients with moderate or severe chronic obstructive pulmonary disease / 中华物理医学与康复杂志

Objective To investigate the effects of exercise therapy and health education on the hospitalization and exercise endurance of patients with moderate or severe chronic obstructive pulmonary disease (COPD).Methods A total of 86 patients with moderate or severe but stable COPD were divided randomly into an observation group (n=46) and a control group (n=40).The patients in both groups accepted general respiratory medical therapy.The patients in the observation group also accepted additional pulmonary rehabilitation therapy which consisted of exercise and health education while the patients in the control group only accepted health education and rehabilitation training guidance by telephone instead of standardized pulmonary rehabilitation therapy.The average recurrence of hospitalization,length of stay,and total bed time of all of the patients was tracked for a year before and after enrolment.Their 6 minute walking distance (6MWD) and quality of life (QOL) as reflected by using a scale recommended by the Chinese Society of Respiratory Disease before and after entering the study were evaluated.Results There was no significant difference between the groups in the year before entering the study in terms of their average frequency of hospitalization,length of stay or total bed time.In the year after enrollment average frequency of recurrence requiring hospitalization,length of stay and total bed time in the observation group all decreased significantly compared with the previous year,and all were significantly lower than in the control group.There were no significant differences between the groups in average 6MWD or average QOL score at entry,but in the subsequent year both groups' results improved significantly.Conclusion Long term pulmonary rehabilitation can not only enhance exercise endurance,it also improves QOL and relieves the economic burden of COPD patients on society.