title: Have we underestimated the efficacy of pulmonary rehabilitation in improving mood?
abstract: BACKGROUND
  Patients with COPD have a high prevalence of anxiety and depression. The efficacy of pulmonary rehabilitation (PR) in treating more severe anxiety and depression is unknown. The study aimed to explore the effectiveness of PR in reducing symptoms of anxiety and depression across a spectrum of severities.
  
  
  METHODS
  The study used principles of comparative effectiveness research. Data was analysed from 518 patients with COPD [57.5% male, mean (SD) age 69.2 years (± 8.8 years)]. Patients were categorised into 3 groups based on their hospital anxiety and depression scale (HADS) scores pre PR ('none' 0-7, 'probable' 8-10 and 'presence' 11-21). A responder was defined as achieving a change of ≥ 48 m on the incremental shuttle walk test (ISWT). Patients were categorised as 'completers' if they attended their discharge assessment for PR.
  
  
  RESULTS
  Anxiety and depression did not reduce following PR in patients with no symptoms (p > 0.05). Patients with a 'probable' or 'presence' of symptoms had significant reductions (both p < 0.001). There was a difference between sub-groups in change for anxiety and depression with patients scoring highest on the HADS having the greatest reductions (p < 0.001). There was no correlation between anxiety or depression and completion of PR (p > 0.05). Responders and non-responders did not differ in their anxiety or depression levels (p > 0.05).
  
  
  CONCLUSIONS
  PR is effective in reducing symptoms of anxiety and depression. Previous studies may have underestimated the effectiveness of the PR programme in improving mood.
authors.affiliation: Institute of Lung Health, Glenfield Hospital, University Hospitals Leicester NHS Trust, Leicester LE3 9QP, UK. samantha.harrison@uhl-tr.nhs.uk
authors.forename: S L
authors.initials: SL
authors.lastname: Harrison
authors.forename: N J
authors.initials: NJ
authors.lastname: Greening
authors.forename: J E A
authors.initials: JE
authors.lastname: Williams
authors.forename: M D L
authors.initials: MD
authors.lastname: Morgan
authors.forename: M C
authors.initials: MC
authors.lastname: Steiner
authors.forename: S J
authors.initials: SJ
authors.lastname: Singh
mesh_terms: D000368:Aged; D001007:Anxiety / Q000209:etiology / Q000534:rehabilitation*; D057186:Comparative Effectiveness Research; D003863:Depression / Q000209:etiology / Q000534:rehabilitation*; D005080:Exercise Test / Q000379:methods; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology / Q000534:rehabilitation*; D016896:Treatment Outcome