title: Generic, symptom based, exercise rehabilitation; integrating patients with COPD and heart failure.
abstract: BACKGROUND
  Patients with Chronic Heart Failure (CHF) develop similar symptoms of exertional breathlessness and fatigue as patients with COPD. Although pulmonary (exercise based) rehabilitation (PR) is an integral part of the management of COPD, the potential for exercise rehabilitation (ER) to assist patients with CHF may not be as readily appreciated. We investigated whether combined ER for patients with CHF and COPD was feasible and effective using the model of PR.
  
  
  METHODS
  57 patients with CHF were randomized 2:1 to 7 weeks ER (CHF-ER) or 7 weeks of usual care (CHF-UC). As a comparator 55 patients with COPD were simultaneously recruited to the same ER program (COPD-ER). The primary outcome measure was the Incremental Shuttle Walk Test (ISWT) and the secondary outcome measures were the Endurance Shuttle Walk Test (ESWT), isometric quadriceps strength and health status.
  
  
  RESULTS
  27 CHF and 44 COPD patients completed ER and 17 patients with CHF completed UC. The CHF-ER group made significant improvements, compared to CHF-UC, in the mean (95%CI) ISWT distance; 62(35-89)m vs -6(-11 to 33)m p < 0.001. The CHF-ER group also made statistically significant improvements in health status. The improvements in exercise performance and health status were similar between patients with CHF and COPD, treated with ER.
  
  
  CONCLUSIONS
  Patients with CHF who undergo ER improve similarly in their exercise performance and health status to COPD. Combined training programs for COPD and CHF are effective and feasible, such that service provision could be targeted around common disability rather than the primary organ disease.
authors.affiliation: Dept. of Respiratory Medicine, Allergy and Thoracic Surgery, University Hospitals of Leicester NHS trust, Glenfield Hospital, Leicester, United Kingdom. rach27evans@hotmail.com
authors.forename: R A
authors.initials: RA
authors.lastname: Evans
authors.forename: S J
authors.initials: SJ
authors.lastname: Singh
authors.forename: R
authors.initials: R
authors.lastname: Collier
authors.forename: I
authors.initials: I
authors.lastname: Loke
authors.forename: M C
authors.initials: MC
authors.lastname: Steiner
authors.forename: M D L
authors.initials: MD
authors.lastname: Morgan
mesh_terms: D000368:Aged; D004417:Dyspnea / Q000378:metabolism / Q000503:physiopathology / Q000534:rehabilitation*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006333:Heart Failure / Q000378:metabolism / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D010101:Oxygen Consumption / Q000502:physiology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000378:metabolism / Q000503:physiopathology / Q000534:rehabilitation*; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology