Exercise training in patients with chronic respiratory failure due to kyphoscoliosis: a randomized controlled trial.

BACKGROUND: Research has provided evidence for the safety, feasibility, and efficacy of exercise training in patients with COPD. However, little is known about the impact of exercise training in patients with chronic respiratory failure due to kyphoscoliosis. We evaluated the effect of an exercise training program on exercise capacity, muscle strength, dyspnea, and quality-of-life indices in subjects with chronic respiratory failure due to kyphoscoliosis. METHODS: The 34 subjects were clinically stable, had been receiving nighttime home mechanical ventilation for ≥ 6 months, and were randomly assigned to the exercise group (n = 17) or the control group (n = 17). The exercise group conducted cycle and strength training on 3 non-consecutive days per week for 12 weeks. We measured pulmonary function, exercise capacity, peripheral muscle strength, dyspnea scores, and quality of life. RESULTS: Statistical analysis was carried out on the data from 16 subjects in the exercise group and in 11 subjects in the control group. Three of the lung-function parameters in the exercise group significantly changed: PaCO2 (P = .04), inspiratory pressure (P = .03), and expiratory pressure (P = .04); and endurance time (P = .002) and shuttle walk distance (P = .001) increased significantly. The exercise group had significantly greater improvements in peripheral muscle strength, dyspnea, and quality of life. CONCLUSIONS: In patients with chronic respiratory failure due to kyphoscoliosis, exercise training improved exercise capacity, peripheral muscle strength, dyspnea, and quality of life. (Deutschen Register Klinischer Studien DRKS00000443).

Factors associated with quality of life in patients with chronic respiratory failure due to kyphoscoliosis.

OBJECTIVES: Patients with chronic respiratory failure due to kyphoscoliosis (CHRF-KS) constitute a specific population with impaired health-related quality of life (HRQL). Thus far, no studies have examined factors related to HRQL. The objective of the present study was to identify clinical, functional and exertion-related factors associated with HRQL. METHODS: We investigated 27 patients (12 males). Respiratory function tests, dyspnea ratings, peripheral and respiratory muscle function and exercise testing were performed. The Chronic Respiratory Disease Questionnaire (CRDQ) was used to assess HRQL. Bivariate correlations were used to investigate the relationships between CRDQ dimensions and the clinical, functional and exertion-related characteristics of the study participants. RESULTS: The general characteristics of the study sample were as follows: age: 61 (IQR: 12) years, FVC: 32.6% (IQR: 10.2) and pCO2: 48 mmHg (IQR: 8.7). Peripheral muscle strength, dyspnea and exercise capacity were identified as significant factors associated with poorer HRQL. The CRDQ dimensions of fatigue and emotional function showed greater correlations with the patients' general characteristics. Dyspnea CRDQ scores did not correlate with dyspnea in any of the scales used. CONCLUSION: Of the various factors examined, dyspnea, exercise capacity and peripheral muscle strength have been identified as significant factors associated with HRQL in CHRF-KS patients.

Shuttle walking versus maximal cycle testing: clinical correlates in patients with kyphoscoliosis.

A cross-sectional prospective design was used to compare the effectiveness of the shuttle walking test (SWT) and the maximal cycle ergometry test (CET) to assess the functional capacity of patients with chronic hypercapnic respiratory failure due to severe kyphoscoliosis. Twenty-four patients completed both the SWT and CET. Heart rate, blood pressure, leg fatigue, chest pain and dyspnea (Borg's scale) were measured immediately after each test. Correlation coefficients and Bland-Altman analysis were used to compare the two methods. Borg's dyspnea, leg and chest pain after exercise were not significantly different between tests. Only heart rate (SWT 130[20.7] versus CET 116[28.75]; p = 0.048) and diastolic blood pressure (SWT: 85.5[13.75] versus CET 95[17.5]; p = 0.021) were slightly but significantly different between the two protocols. There was a good positive correlation between the distance walked in SWT and maximal oxygen consumption (r = 0.675; p < 0.001). SWT and CET testing elicited similar clinical and hemodynamic responses. SWT is a feasible measure of functional capacity in this patient group.