Pulmonary Rehabilitation Research Paper
Pulmonary Rehabilitation has Positive Effects on Depression and Anxiety in Patients with Chronic Obstructive Pulmonary Disease
Amy Butler
Boise State University
Abstract
Symptoms of anxiety and depression are prevalent in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) and are known to worsen patient-centered outcomes and quality of life. Evidence supports the use of pulmonary rehabilitation to effectively manage psychological morbidities in COPD. This review examines whether pulmonary rehabilitation has a positive effect on depression and anxiety in COPD patients.
In recent findings, evidence has shown that pulmonary rehabilitation, which includes exercise training, disease education, and psychosocial …show more content…
support, can effectively improve anxiety and depression in COPD. The quality of supporting data varies but indicates a consistent outcome in favor of pulmonary rehabilitation for anxiety and depression when compared with other methods. However, it is not certain which components of pulmonary rehabilitation lead to improved anxiety and depression, and further research is needed to ensure that psychological benefits gained during rehabilitation continue.
Pulmonary Rehabilitation has Positive Effects on Depression and Anxiety in Patients with Chronic Obstructive Pulmonary Disease
The capacity for better work performance can be achieved by proper conditioning of the body by regular exercise so that oxygen and body energy are used at ideal levels.
Numerous studies have been conducted on the benefits of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease; however, only a few address its significance in reducing the level of anxiety and depression in those patients. Paz-Dı´az et al. (2006) states that chronic obstructive pulmonary disease (COPD) is a common and very debilitating disease that is frequently associated with anxiety and depression. According to Coventry and Hind (2007), in the management of COPD, pulmonary rehabilitation is widely regarded as the cornerstone of treatment for all patients. In Harrison et al. (2012) longer hospital-based or community-based outpatient rehabilitation programs and shorter, more intensive inpatient rehabilitation programs have both proven to be useful and effective in enhancing physical capacity and health-related quality of life (HRQL) and reducing psychological distress in COPD patients. Along with education, rehabilitation can relieve fears and anxiety associated with chronic lung disease, thereby ensuring long-term dedication to exercising. This paper uses the previous cited articles as well as others to establish the direct positive effect that pulmonary rehabilitation has on anxiety and depression in COPD …show more content…
patients.
Claim
Pulmonary rehabilitation should be implemented in all patients with chronic obstructive pulmonary disease not only for its physical benefits but its psychosocial benefits when dealing with depression and anxiety. Studies have shown that rates of anxiety and depression are much higher in COPD patients than the general public. And, unsurprisingly, the decline in COPD patients’ overall health correlates directly with the increase of depression and anxiety which in turn correlates with an increase in hospital admissions. Some studies even showed that interaction with others suffering from COPD was helpful to patient in coping with the disease and gave them better general sense of well-being.
Reason
Fear of increasing symptoms leads to avoidance of activities, which in turn leads to further deterioration in physical health and functional ability. This deterioration then leads to increased symptoms of physical exertion and so on. Addy (2007) The article by Coventry and Hind (2007) states a meta-analysis of 65 studies with data on over 3600 patients with chronic respiratory disease showed that pulmonary rehabilitation programs that included both large muscle exercise and education were associated with moderate but clinically significant improvements in patients' psychological wellbeing. In another study that involved 24 patients with severe COPD, Paz-Dı´az et al., (2006) found that PR which includes exercise induces significant changes in depression, health-related quality of life, and dyspnea, and lesser (but important) changes in anxiety scores. And it suggested that the data indicates that decreased depression should be added to the list of beneficial effects of PR. And yet another study, (Addy, 2007) found in regard to symptoms of depression that after completing a pulmonary rehabilitation program patients felt more hopeful about their future and denied feeling low in mood and was taking interest in activities and enjoying participating as much as possible in daily tasks. Also, is regard to symptoms of anxiety, some patients continued to suffer from difficulties breathing but felt in control of these symptoms and was no longer avoiding activities because of the discomfort experienced.
Evidence
In Coventry and Hind (2007), six studies evaluated the effectiveness of exercise rehabilitation for the treatment of anxiety in COPD patients.
The difference in the treatment effect was statistically significant and favored comprehensive rehabilitation over standard care (three studies, n=269; SMD=−0.33, 95% CI: −0.57 to −0.09, P=.008). Comprehensive rehabilitation was still superior to standard care when only the two high quality studies were pooled (SMD=−0.26, 95% CI: −0.51 to −0.01, P=.04). Also in Paz-Dı´az et al. (2006), depression severity as assessed by the Beck Inventory test decreased significantly in the rehabilitation group (14 8 to 6 2, P 0.01), but it did not change in the control group. Similarly, the anxiety trait improved in the group who completed rehabilitation, but it failed to reach statistical significance (35 26 to 19 8, P 0.06). There were no changes in the control group. According to Bratas, Espnes, Rannestad, and Walstad (2010), the anxiety score did not change significantly after rehabilitation (–0.1, p ¼ 545), though there was a significant reduction of the depression score (–0.8, p¼ 002). In Harrison et al. (2012), a patient population 518 patients (57.5% male) with a mean (SD) age of 69.2 years (±8.8 years) were categorized into the 3 predefined HADS sub-groups ('none', 'probable' and 'presence'). The prevalence for symptoms of anxiety was 48.5%, 24.3% and 27.2% and for symptoms of depression was 60.9%, 21.7% and 17.4% respectively. There were
no significant differences between any baseline variables for the 3 sub-groups. The effect of PR on anxiety and depression the mean (SD) HADS score for patients who completed the program reduced from 7.99 (4.10) to 6.72 (3.72) for anxiety and 6.80 (3.56) to 5.74 (3.45) for depression (both p
Amy Butler
Boise State University
Abstract
Symptoms of anxiety and depression are prevalent in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) and are known to worsen patient-centered outcomes and quality of life. Evidence supports the use of pulmonary rehabilitation to effectively manage psychological morbidities in COPD. This review examines whether pulmonary rehabilitation has a positive effect on depression and anxiety in COPD patients.
In recent findings, evidence has shown that pulmonary rehabilitation, which includes exercise training, disease education, and psychosocial …show more content…
support, can effectively improve anxiety and depression in COPD. The quality of supporting data varies but indicates a consistent outcome in favor of pulmonary rehabilitation for anxiety and depression when compared with other methods. However, it is not certain which components of pulmonary rehabilitation lead to improved anxiety and depression, and further research is needed to ensure that psychological benefits gained during rehabilitation continue.
Pulmonary Rehabilitation has Positive Effects on Depression and Anxiety in Patients with Chronic Obstructive Pulmonary Disease
The capacity for better work performance can be achieved by proper conditioning of the body by regular exercise so that oxygen and body energy are used at ideal levels.
Numerous studies have been conducted on the benefits of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease; however, only a few address its significance in reducing the level of anxiety and depression in those patients. Paz-Dı´az et al. (2006) states that chronic obstructive pulmonary disease (COPD) is a common and very debilitating disease that is frequently associated with anxiety and depression. According to Coventry and Hind (2007), in the management of COPD, pulmonary rehabilitation is widely regarded as the cornerstone of treatment for all patients. In Harrison et al. (2012) longer hospital-based or community-based outpatient rehabilitation programs and shorter, more intensive inpatient rehabilitation programs have both proven to be useful and effective in enhancing physical capacity and health-related quality of life (HRQL) and reducing psychological distress in COPD patients. Along with education, rehabilitation can relieve fears and anxiety associated with chronic lung disease, thereby ensuring long-term dedication to exercising. This paper uses the previous cited articles as well as others to establish the direct positive effect that pulmonary rehabilitation has on anxiety and depression in COPD …show more content…
patients.
Claim
Pulmonary rehabilitation should be implemented in all patients with chronic obstructive pulmonary disease not only for its physical benefits but its psychosocial benefits when dealing with depression and anxiety. Studies have shown that rates of anxiety and depression are much higher in COPD patients than the general public. And, unsurprisingly, the decline in COPD patients’ overall health correlates directly with the increase of depression and anxiety which in turn correlates with an increase in hospital admissions. Some studies even showed that interaction with others suffering from COPD was helpful to patient in coping with the disease and gave them better general sense of well-being.
Reason
Fear of increasing symptoms leads to avoidance of activities, which in turn leads to further deterioration in physical health and functional ability. This deterioration then leads to increased symptoms of physical exertion and so on. Addy (2007) The article by Coventry and Hind (2007) states a meta-analysis of 65 studies with data on over 3600 patients with chronic respiratory disease showed that pulmonary rehabilitation programs that included both large muscle exercise and education were associated with moderate but clinically significant improvements in patients' psychological wellbeing. In another study that involved 24 patients with severe COPD, Paz-Dı´az et al., (2006) found that PR which includes exercise induces significant changes in depression, health-related quality of life, and dyspnea, and lesser (but important) changes in anxiety scores. And it suggested that the data indicates that decreased depression should be added to the list of beneficial effects of PR. And yet another study, (Addy, 2007) found in regard to symptoms of depression that after completing a pulmonary rehabilitation program patients felt more hopeful about their future and denied feeling low in mood and was taking interest in activities and enjoying participating as much as possible in daily tasks. Also, is regard to symptoms of anxiety, some patients continued to suffer from difficulties breathing but felt in control of these symptoms and was no longer avoiding activities because of the discomfort experienced.
Evidence
In Coventry and Hind (2007), six studies evaluated the effectiveness of exercise rehabilitation for the treatment of anxiety in COPD patients.
The difference in the treatment effect was statistically significant and favored comprehensive rehabilitation over standard care (three studies, n=269; SMD=−0.33, 95% CI: −0.57 to −0.09, P=.008). Comprehensive rehabilitation was still superior to standard care when only the two high quality studies were pooled (SMD=−0.26, 95% CI: −0.51 to −0.01, P=.04). Also in Paz-Dı´az et al. (2006), depression severity as assessed by the Beck Inventory test decreased significantly in the rehabilitation group (14 8 to 6 2, P 0.01), but it did not change in the control group. Similarly, the anxiety trait improved in the group who completed rehabilitation, but it failed to reach statistical significance (35 26 to 19 8, P 0.06). There were no changes in the control group. According to Bratas, Espnes, Rannestad, and Walstad (2010), the anxiety score did not change significantly after rehabilitation (–0.1, p ¼ 545), though there was a significant reduction of the depression score (–0.8, p¼ 002). In Harrison et al. (2012), a patient population 518 patients (57.5% male) with a mean (SD) age of 69.2 years (±8.8 years) were categorized into the 3 predefined HADS sub-groups ('none', 'probable' and 'presence'). The prevalence for symptoms of anxiety was 48.5%, 24.3% and 27.2% and for symptoms of depression was 60.9%, 21.7% and 17.4% respectively. There were
no significant differences between any baseline variables for the 3 sub-groups. The effect of PR on anxiety and depression the mean (SD) HADS score for patients who completed the program reduced from 7.99 (4.10) to 6.72 (3.72) for anxiety and 6.80 (3.56) to 5.74 (3.45) for depression (both p