Poor Work Efficiency is Associated with Poor Exercise Capacity and Health-Related Quality of Life in Patients with Chronic Obstructive Pulmonary Disease

Abstract

Shih-Hsing Yang,1 Mei-Chen Yang,2,3 Yao-Kuang Wu,2,3 Chih-Wei Wu,2,3 Po-Chun Hsieh,4 Chan-Yen Kuo,5 I-Shiang Tzeng,5 Chou-Chin Lan2,3 1Department of Respiratory Therapy, Fu Jen Catholic University, New Taipei City, Taiwan; 2Division of Pulmonary Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; 3School of Medicine, Tzu-Chi University, Hualien, Taiwan; 4Department of Chinese Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation; School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan; 5Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, TaiwanCorrespondence: Chou-Chin LanDivision of Pulmonary Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289, Jianguo Road, Xindian City, New Taipei City, 23142, TaiwanTel [phone] Ext. 2259Fax [phone]Email [email protected]: Chronic obstructive pulmonary disease (COPD) is a progressive disease with deteriorating cardiopulmonary function that decreases the health-related quality of life (HRQL) and exercise capacity. Patients with COPD often have cardiovascular and muscular problems that hinder oxygen uptake by peripheral tissues, resulting in poor oxygen consumption efficiency. It is important to develop new physiological parameters to evaluate oxygen consumption efficiency during activities and to evaluate its association with exercise capacity and HRQL. Work efficiency (WE) measures oxygen consumption efficiency during exercise. We hypothesize that patients with poor WE should have exercise intolerance and poor HRQL. Therefore, we aimed to evaluate the association between WE and exercise capacity, HRQL and other cardiopulmonary parameters.Patients and Methods: Seventy-eight patients with COPD were evaluated with spirometry, cardiopulmonary exercise testing, and assessment of dyspnea score and HRQL (using the St. George’s Respiratory Questionnaire [SGRQ]). Cardiopulmonary exercise testing was performed using a cycle ergometer with an incremental protocol and exhaled breath analysis to assess oxygen consumption. WE was defined as the relationship between oxygen consumption and workload.Results: There were 31 patients with normal WE (group I) and 47 patients (group II) with poor WE. Patients with poor WE had lower exercise capacity (maximal oxygen consumption, group I vs II as 1050± 53 vs 845 ± 34 mL/min, p=0.0011), poorer HRQL (SGRQ score 41.1± 3.0 vs 55± 2.2, p=0.0002), higher exertional dyspnea score (5.1± 0.2 vs 6.1± 0.2, p= 0.0034) and early anaerobic metabolism during exercise (anaerobic threshold, 672± 27 vs 583 ± 18 mL/min, p=0.0052).Conclusion: WE is associated with exercise capacity and HRQL. Here, patients with poor WE also had exercise intolerance, poorer HRQL, and more exertional dyspnea.Keywords: chronic obstructive pulmonary disease, exercise physiology, work efficiency

Keywords

• chronic obstructive pulmonary disease
• exercise physiology
• work efficiency