Quality of life in patients with chronic pulmonary obstructive disease andthe impact of physical training

Background: Health related quality of life (QoL) is severely impaired in CO PD patients as a consequence of dyspnea and limited exercise tolerance, whi ch Psychosocial factors such as depression and anxiety also contribute to t his impairment. Aim: To evaluate: a) the impact of COPD on quality of life, and b) the effect of 10 weeks of exercise training on exercise performance and on QoL. Patients and methods: The Spanish version of the Chronic Respi ratory Questionnaire (CRQ) was applied to 55 COPD patients (FEV1 37 +/- 13% pred) for the assessment of QoL and in 30 of them submitted to exercise tr aining for 10 weeks. Exercise performance was evaluated by measuring: six-m inute walking distance, maximal workload (Wmax) maximal O-2 consumption (VO (2)max) as well as endurance time, blood lactic acid dyspnea and leg fatigu e during a submaximal exercise. Trained patients were evaluated before and after training. Results: COPD patients showed a reduction (mean +/- SD) in the four domains of the CRQ: dyspnea (3.1 +/- 0.9); fatigue (4.3 +/- 1.3); mastery (4.65 +/- 1.3), emotional function (4.1 +/- 0.97), and in Wmax and VO(2)max (52 +/- 16 Watt and 970 +/- 301 ml/min). No significant relationsh ip between the impairment in exercise tolerance and in QoL was observed. Ex ercise training significantly improved the four domains of QoL (p < 0.0001) , Wmax (p < 0.05). VO2 max (p < 0.02) and endurance time (p < 0.001). Isoti me exercise measurements of dyspnea, leg fatigue and lactic acid decreased after training (p < 0.001). Isotime exercise measurements of dyspnea, leg f atigue and lactic acid decreased after training (p < 0.001, each). No signi ficant relation between changes in QoL and changes in exercise performance were observed. Conclusions: Our results demonstrate that QoL is seriously i mpaired in patients with COPD and confirm: (a) the lack of relationship of QoL tto the usually measured physiological parameters, and (b) the benefici al effect of exercise training on QoL through the reduction of symptoms. Th ese findings stresses the need of measuring quality of life in our patients if we want to evaluate the impact of therapeutic procedures on well-being from the patients' perspective.