[Physical activity and pulmonary rehabilitation]. / Activités physiques et réadaptation respiratoire.

INTRODUCTION: Physical activity in daily life (PA) in patients with chronic respiratory disease is reduced. Inactivity is associated with an increased risk of hospitalisation and mortality. Even though pulmonary rehabilitation (PR) is associated with improved quality of life (fewer symptoms, greater exercise capacity…), its benefits with regard to PA remain unclear. STATE OF THE ART: For each patient, it is important during a respiratory rehabilitation (RR) programme to evaluate PA and its determinants. Only programs aimed at improved self-management and including educational therapy (ETP) have shown a short-term increase of PA following PR. Several studies have reported better long-term adherence when professionals help the patient to construct a personalised PA project, with regular follow-up and an array of activities (local facilities, urban walking…) chosen by the patient and adapted to the environment. PERSPECTIVES: The ongoing SARS-CoV2 pandemic has highlighted the importance of human interaction, even at a distance using information and communication technologies, as a means of sustaining patient motivation. Future controlled and randomized studies should focus on the long-term impact on PA of innovative strategies in patients with chronic respiratory diseases. Moreover, it would be interesting to quantify the socioeconomic impact as well as the sustainable health benefits of the different strategies outlined in this review. CONCLUSION: It is not possible to offer a single solution likely to maintain RR benefits over an extended lapse of time. However, follow-up with an ETP and/or regular and customized support during the post-training period facilitates the long-term adoption of active behavior.

Six-minute stepper test: a valid clinical exercise tolerance test for COPD patients.

INTRODUCTION: Exercise tolerance testing is an integral part of the pulmonary rehabilitation (PR) management of patients with chronic obstructive pulmonary disease (COPD). The 6-minute stepper test (6MST) is a new, well-tolerated, reproducible exercise test, which can be performed without any spatial constraints. OBJECTIVE: The aim of this study was to compare the results of the 6MST to those obtained during a 6-minute walk test (6MWT) and cardiopulmonary exercise testing (CPET) in a cohort of COPD patients. METHODS: Ninety-one COPD patients managed by outpatient PR and assessed by 6MST, 6MWT, and CPET were retrospectively included in this study. Correlations between the number of steps on the 6MST, the distance covered on the 6MWT, oxygen consumption, and power at the ventilatory threshold and at maximum effort during CPET were analyzed before starting PR, and the improvement on the 6MST and 6MWT was compared after PR. RESULTS: The number of steps on the 6MST was significantly correlated with the distance covered on the 6MWT (r=0.56; P<0.0001), the power at maximum effort (r=0.46; P<0.0001), and oxygen consumption at maximum effort (r=0.39; P<0.005). Performances on the 6MST and 6MWT were significantly improved after PR (570 vs 488 steps, P=0.001 and 448 vs 406 m, respectively; P<0.0001). Improvements of the 6MST and 6MWT after PR were significantly correlated (r=0.34; P=0.03). CONCLUSION: The results of this study show that the 6MST is a valid test to evaluate exercise tolerance in COPD patients. The use of this test in clinical practice appears to be particularly relevant for the assessment of patients managed by home PR.