P-176PULMONARY REHABILITATION IMPROVES FUNCTIONAL PARAMETERS BEFORE AND AFTER THORACIC SURGERY

Abstract

Objectives: A complex pulmonary rehabilitation programme provides improvement in functional parameters with higher exercise capacity and functional reserves before thoracic surgery. Rehabilitation in the postoperative healing period can be safer and risk of pulmonological complications might be reduced. Method(s): Lung functions, chest kinematics, 6-min walking distance, exercise capacity and quality of life tests were measured in 208 chronic obstructive pulmonary disease (COPD) patients who underwent thoracic surgery. The pulmonary rehabilitation programme takes 3 weeks and includes 30 min of morning respiratory training, chest wall mobilization and learning controlled breathing techniques with an additional 15-30 min cycle training 2-3 times a day, smoking cessation and inhalation therapy. The most common indication of the operations was lung cancer (72%). The average age was 63+/-9 years. One third of the patients had pre-and postoperative rehabilitation (PPO), 1/3 had preoperative (PRE), and 1/3 had postoperative rehabilitation only (POS). Results were compared by paired t-test, non-parametric sign test and Wilcoxon test. Significance was accepted at the P < 0.05. Distributions were tested for normality by the Kolmogorov-Smirnov test. Result(s): There was a significant improvement in FEV1 (PRE: 64+/-16 vs 67+/-16%pred*; PPO: 60+/-13 vs 66+/-13%pred*preoperatively, 48+/-13 vs 52+/-13%pred*postoperatively; POS: 56+/-16 vs 61+/-14%pred*, p < 0.05) and in 6-min walking distance (PRE: 403+/-87 vs 452+/-86 m; PPO: 388+/-86 vs 439+/-83 m*before, 337+/-111 vs 397+/-105 m*after the operation; POS: 362+/-89 vs 434+/-94 m*, P < 0.0001). Chest wall expansion improved significantly (PRE: 4.4+/-2.3 vs 5.9+/-2.2 cm; PPO: 4.2+/-2.3 vs 5.7+/-2.8cm before*, 2.8+/-1.6 vs 4.5+/-2.3 cm*after the operation; POS: 2.8+/-1.4 vs 4.8+/-2.0 cm*;*P<0.0001). Significant improvement of the FVC, grip strength, mMRC and CAT questionnaires were also detected. Conclusion(s): Perioperative pulmonary rehabilitation improved exercise capacity and functional reserves significantly and reduced the symptoms (dyspnoea, fatigue and depression). Functional operability was promoted by improvement of cardiovascular function, metabolism, muscle function and lung mechanics.