Fraility Reduced by Pulmonary Rehabilitation in Older COPD Patients

Fraility is Common in Elderly

Background: Frailty is common as people age.  It is defined as a person having at least three of the following characteristics:
  • Low physical activityelderly-man

  • Muscle weakness

  • Slowed performance

  • Fatigue or poor endurance

  • Unintentional weight loss

In a press release, Dr. Matthew Maddocks, of King’s College London said: “Frailty affects one in ten over-65s, and one in four over-80s. We now have a good understanding of how to measure frailty through various tests.” Dr. Maddocks is the first author of the article published online in the journal Thorax. 2016 Jun 12. pii: thoraxjnl-2016-208460. doi: 10.1136/thoraxjnl-2016-208460. Study: Researchers recruited 816 outpatients with COPD between 2011 and 2015. The mean age of participants was 70 years old.  To assess frailty, measurements in weight loss, exhaustion, low physical activity, slowness and weakness were measured before and after pulmonary rehabilitation. The 8-week program consisted of exercise and multidisciplinary education, comprising topics such as physical activity and exercise, medication use, diet, smoking cessation, and coping strategies. Results: More than 25% of the participants with COPD referred for rehabilitation were frail. The frail participants had double the odds of not finishing the rehabilitation program because of  worsened condition or admission to hospital. The frail participants who completed the rehabilitation program scored consistently better in measures of breathlessness, exercise performance, physical activity and health status compared to those not classified as frail. 61% of the frail participants were no longer classified as frail at the end of the program. Conclusions: The authors concluded that people with COPD respond favorably to pulmonary rehabilitation, and such programs could reverse their frailty. My Comments: COPD can speed health decline and lead to frailty especially if those with COPD are inactive.  Fraility can cause a greater risk for falls, disability, hospitalization and death. This study provides additional support for participation in pulmonary rehabilitation if you have COPD. You should search online or ask your health care provider about a program in your area.

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.