Multidisciplinary Geriatric Rehabilitation Program for Patients with COPD-Induced Malnutrition and Muscle Wasting: A Case Series

Abstract

Chronic obstructive pulmonary disease (COPD) induced malnutrition is a common and serious problem resulting in a higher risk of complications, exacerbations, and hospitalization. We developed an inpatient geriatric rehabilitation program for patients with severe COPD and malnutrition and demonstrated its feasibility. The aim of the current study was to explore its preliminary effects. A prospective case series was conducted, including a total of eight patients with severe COPD and low fat-free muscle mass index (FFMi). Our 6–10 weeks program consisted of anaerobic resistance training, based on the nonlinear periodized exercise (NLPE) principles, nutritional support, psychoeducation on physical energy management, combined with a restriction of physical activities. Overall activity level, as measured in metabolic equivalents (METs), remained consistently below 3 METs for all patients. Primary outcomes were changes body composition (FFMi, body mass index (BMI), and body weight), muscle function, and exercise performance from the start and end of the study. We used paired samples t-test or Wilcoxon signed-rank test to compare pre and postscores. Body composition and muscle function showed both significant and clinically relevant improvements after discharge of the program. Exercise performance showed a clinically relevant improvement. Additionally, ADL independence and health-related quality of life were improved. The patients in the current study had a clinical improved body composition, increased personal FFMi and exercise performance despite the absence of cardio-training and restrictions in functional walking distance. A cluster randomized controlled study will be necessary to show the definitive effect of the intervention.