title: Balance Training in Pulmonary Rehabilitation: EFFECTS ON PSYCHOSOCIAL OUTCOMES.
abstract: OBJECTIVE
  Balance impairment in chronic obstructive pulmonary disease (COPD) is associated with a worsening of quality of life (QOL) as related with fatigue perception, depression, and anxiety. The aim of this study was to examine the effect of balance training included in pulmonary rehabilitation (PR) on QOL, fatigue perception, depression, and anxiety in patients with COPD.
  
  
  METHODS
  Patients were assigned randomly to an intervention or PR-only group. The intervention group underwent balance training 3 times a week for 6 months concurrently with PR. The PR-only group received 6 months of the standard PR program. Quality of life was assessed at the beginning and at the end of the program using the St. George's Respiratory Questionnaire, fatigue using the Multidimensional Fatigue Inventory, and anxiety and depression using the Hospital Anxiety and Depression Scale. Exercise tolerance was determined from the 6-minute walk test.
  
  
  RESULTS
  After the 6 months of the intervention or PR-only, both the intervention (n = 32) and PR-only (n = 30) groups improved their QOL (activity, impact, and total) with a significant intergroup difference (P < .05) after PR. General fatigue, physical fatigue, and reduced activity decreased in both groups with an intergroup difference (P < .05). Anxiety decreased significantly in both groups with a greater change in the intervention group (P < .01). Only the intervention group had an improved depression score at the end of 6 months.
  
  
  CONCLUSIONS
  Balance training added to PR improved health-related QOL, fatigue, and mental health in patients with COPD.
authors.affiliation: Department of Physiology and Function Testing, Faculty of Medicine, University of Sousse, Sousse, Tunisia.
authors.forename: Wajdi
authors.initials: W
authors.lastname: Mkacher
authors.forename: Marwa
authors.initials: M
authors.lastname: Mekki
authors.forename: Faten
authors.initials: F
authors.lastname: Chaieb
authors.forename: Zouhair
authors.initials: Z
authors.lastname: Tabka
authors.forename: Yassine
authors.initials: Y
authors.lastname: Trabelsi
mesh_terms: D000368:Aged; D001007:Anxiety; D003863:Depression; D017079:Exercise Tolerance / Q000502:physiology; D005221:Fatigue; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D004856:Postural Balance / Q000502:physiology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology* / Q000534:rehabilitation*; D011788:Quality of Life / Q000523:psychology*; D016138:Walking