Relationship between dyspnea/oxygen saturation and leg discomfort/6-minute walking distance in patients with COPD participating in pulmonary rehabilitation

array:23 ["pii" => "S2531043719301436" "issn" => "25310437" "doi" => "10.1016/j.pulmoe.2019.07.012" "estado" => "S300" "fechaPublicacion" => "2019-11-01" "aid" => "1397" "copyright" => "Sociedade Portuguesa de Pneumologia" "copyrightAnyo" => "2019" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Pulmonol. 2019;25:357-60" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 619 "formatos" => array:3 [ "EPUB" => 72 "HTML" => 371 "PDF" => 176 ] ] "itemAnterior" => array:19 [ "pii" => "S2531043719301667" "issn" => "25310437" "doi" => "10.1016/j.pulmoe.2019.08.002" "estado" => "S300" "fechaPublicacion" => "2019-11-01" "aid" => "1399" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Pulmonol. 2019;25:356-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 504 "formatos" => array:3 [ "EPUB" => 68 "HTML" => 261 "PDF" => 175 ] ] "en" => array:9 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Strategies to relieve dyspnoea in patients with advanced chronic respiratory diseases. A narrative review. Authors’ reply" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "356" "paginaFinal" => "357" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nicolino Ambrosino, Claudio Fracchia" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Nicolino" "apellidos" => "Ambrosino" ] 1 => array:2 [ "nombre" => "Claudio" "apellidos" => "Fracchia" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043719301667?idApp=UINPBA00004E" "url" => "/25310437/0000002500000006/v1_201911020923/S2531043719301667/v1_201911020923/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "Letter to the Editor" "titulo" => "Relationship between dyspnea/oxygen saturation and leg discomfort/6-minute walking distance in patients with COPD participating in pulmonary rehabilitation" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "357" "paginaFinal" => "360" ] ] "autores" => array:6 [ 0 => array:4 [ "autoresLista" => "Lília Maia Santos" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Lília Maia" "apellidos" => "Santos" "email" => array:1 [ 0 => "lilasantos87@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Pneumology Department, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Serviço de Pneumologia A, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal." ] ] ] 1 => array:3 [ "autoresLista" => "Paula Inês Pedro" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Paula Inês" "apellidos" => "Pedro" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Pneumology Department, Hospital Garcia de Orta, Almada, Portugal" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "autoresLista" => "Ana Dias" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Ana" "apellidos" => "Dias" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Pneumology Department, Hospital Pulido Valente, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "autoresLista" => "Cristina Braço Forte" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Cristina Braço" "apellidos" => "Forte" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Pneumology Department, Hospital São Bernardo, Centro Hospitalar de Setúbal, Setúbal, Portugal" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "autoresLista" => "Paula Raposo" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Paula" "apellidos" => "Raposo" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Pneumology Department, Hospital Pulido Valente, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "autoresLista" => "Maria Fátima Rodrigues" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Maria Fátima" "apellidos" => "Rodrigues" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0030" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0035" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Pneumology Department, Hospital Pulido Valente, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal" "etiqueta" => "a" "identificador" => "aff0030" ] 1 => array:3 [ "entidad" => "Universidade de Lisboa, Faculdade de Medicina, Instituto de Saúde Ambiental (ISAMB), Lisboa, Portugal" "etiqueta" => "b" "identificador" => "aff0035" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2121 "Ancho" => 2940 "Tamanyo" => 350977 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Boxplot of dyspnea (A), minimum oxygen saturation (B), distance walked (C) and leg discomfort (D) in the 6-minute walk test performed at the beginning and at the end of pulmonary rehabilitation program." ] ] ] "textoCompleto" => "Chronic and progressive dyspnea, the most characteristic symptom of chronic obstructive pulmonary disease (COPD), is often associated with physical activity reduction, not only because of the symptom itself but also because of the anticipation of discomfort caused by physical exertion.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a> Fatigue is also one of the main symptoms, described as the second most prevalent.<a class="elsevierStyleCrossRefs" href="#bib0005">1,3</a> Therefore, relief of these symptoms is one of the primary goals in the management of patients with COPD.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>It is known that FEV1 is not useful in predicting dyspnea and some studies have evaluated the relationship between dyspnea and dynamic hyperinflation.<a class="elsevierStyleCrossRefs" href="#bib0005">1,4</a> Similarly, despite exercise-induced oxygen desaturation being observed in patients with COPD, mostly in those with more severe disease and with predominant emphysema phenotype, the underlying mechanism remains poorly understood.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> Also, limb muscle dysfunction may play an important role in exercise limitation.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>As far as we know, no previous study has evaluated the relationship between dyspnea and oxygen saturation (SpO2), nor between leg discomfort and distance walked.The aims of this study were to investigate the association between dyspnea and SpO2, and between leg discomfort and distance walked in the 6-minute walk test (6MWT), as well as the impact of Pulmonary Rehabilitation (PR) program on these variables.This was a longitudinal retrospective study of patients with COPD who completed an outpatient PR program during 2016 at Pulmonology Department of Centro Hospitalar Universitário Lisboa Norte, Portugal. Subjects attended a multicomponent PR program with patient-tailored therapies, 8–16 weeks long. Those with ambulatory oxygen supplementation maintained it during the 6MWT and exercise training.At the beginning and at the end of PR program, all patients underwent 6MWT. The variables analyzed were the degree of dyspnea and leg discomfort at the end of each 6MWT according to Modified Borg Scale, minimum SpO2 observed by pulse oximeter and distance walked during the test.Using software SPSS®, Wilcoxon or Student´s T-test were carried out, as appropriate, for comparison of variables at the beginning and at the end of the program. Associations were assessed using Spearman´s coefficient, considering significant p-values below 0.05.Forty-six subjects with COPD completed the PR program, whose baseline characteristics are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Thirty-seven percent of them were on long-term oxygen therapy and 28.3% were on nocturnal noninvasive ventilation.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>At the beginning and at the end of the PR program the mean degree of dyspnea was 3±1.8 and 2.5±1.7, and mean minimum SpO2 value was 84.9±5.4% and 87.6±4.3%, respectively. Only SpO2 improved significantly (p=0.007) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and 1B). We observed no correlation between the degree of dyspnea and minimum SpO2, neither in the initial 6MWT (p=0.31) nor in the final one (p=0.09).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The mean distance walked was 340.7±105 and 373.3±95m in the initial and final 6MWT, respectively, with significant improvement (p=0.003) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). The degree of leg discomfort reported in the initial and final 6MWT had a median value of 2±3 with no significant improvement after PR (p=0.128) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). We observed a mild (rho=0.308) but significant (p=0.04) correlation between leg discomfort and distance walked in the initial 6MWT, but not in the final one (p=0.077).This study shows the benefit of PR programs in patients with COPD, namely in oxygen saturation and exercise capacity. Similarly, previous studies evidenced improvement in arterial oxygenation with breathing techniques such as pursed lips breathing during exercise training, with physiological and clinical significance indicating its possible effect in decreasing airway collapse and respiratory rate.<a class="elsevierStyleCrossRef" href="#bib0030">6</a>The multifactorial nature of dyspnea is well known and we observed no correlation between the degree of dyspnea and oxygen saturation. The maintenance of dynamic hyperinflation, airflow limitation and respiratory muscle weakness, leading to an increased mechanical load and a neuromechanical dissociation, might explain in part this absence of correlation and the lack of significant improvement in dyspnea.<a class="elsevierStyleCrossRefs" href="#bib0005">1,4</a> Peripheral muscle dysfunction, frequent in patients with COPD, also enhances exertional dyspnea and exercise intolerance.<a class="elsevierStyleCrossRefs" href="#bib0010">2,3</a> Those patients often have an augmented lactic acid production for a given exercise work rate, increasing their ventilatory demand.<a class="elsevierStyleCrossRefs" href="#bib0010">2,3</a>After PR program, our subjects reported a similar degree of leg discomfort for a significantly greater distance walked (32.6m). This is in line with extensive evidence showing improvement in exercise tolerance with a significant increment in distance walked by patients with COPD during 6MWT after PR program.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>Our findings reflect the multifactorial essence of dyspnea and fatigue as the most prevalent characteristics of patients with COPD, and the need for future research to clarify the underlying effects of PR on them.FundingThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Conflicts of interestNone." "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-02-04" "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2121 "Ancho" => 2940 "Tamanyo" => 350977 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Boxplot of dyspnea (A), minimum oxygen saturation (B), distance walked (C) and leg discomfort (D) in the 6-minute walk test performed at the beginning and at the end of pulmonary rehabilitation program." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Legend: SD=standard deviation; BMI=body mass index; GOLD=Global Initiative Obstructive Lung Disease; FEV1=forced expiratory volume in one second; BD=bronchodilator; FVC=forced vital capacity; DLCO=diffusing capacity: mMRC=modified Medical Research Council Dyspnea Scale." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Results \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 (80.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (mean in years ± SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68±10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMI (mean in kg/m2 ± SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.7±4.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Current/former smoker n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 (95.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Comorbidities</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arterial hypertensionn (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 (63) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sleep obstructive apnea n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (20) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bronchiectasis n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (20) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anxiety/depression n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (20) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Atrial fibrillation n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (13) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Structural heart disease n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (13) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pulmonary hypertension n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (10.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Charlson Comorbidity Index</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(mean±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.9±1.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GOLD airflow limitation severity</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GOLD 1 n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (8.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GOLD 2 n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (34.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GOLD 3 n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (41.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GOLD 4 n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (15.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GOLD ABCD</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GOLD B n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (47.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GOLD D n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 (52.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FEV1 post BD (mean in % ± SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48.7±19.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FVC post BD (mean in % ± SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83.4±21.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DLCO (mean in % ± SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48.6±20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Respiratory failure</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No respiratory failure n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (8.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypoxemic n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 (73.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypercapnic n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (17.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dyspnea</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">mMRC 2 n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 (65.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">mMRC 3 or 4 n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (34.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2157889.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Baseline characteristics of the subjects." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic obstructive pulmonary disease: clinical integrative physiology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.E. O’Donnell" 1 => "P. Laveneziana" 2 => "K. Webb" 3 => "J.A. Neder" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ccm.2013.09.008" "Revista" => array:7 [ "tituloSerie" => "Clin Chest Med" "fecha" => "2014" "volumen" => "35" "numero" => "1" "paginaInicial" => "51" "paginaFinal" => "69" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24507837" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An official American thoracic society/European respiratory society statement: key concepts and advances in pulmonary rehabilitation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. Spruit" 1 => "S.J. Singh" 2 => "C. Garvey" 3 => "R. Zu Wallack" 4 => "L. Nici" 5 => "C. Rochester" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2013" "volumen" => "188" "numero" => "8" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An official American thoracic society/european respiratory society statement: update on limb muscle dysfunction in chronic obstructive pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Maltais" 1 => "M. Decramer" 2 => "R. Casaburi" 3 => "E. Barreiro" 4 => "Y. Burelle" 5 => "R. Debigaŕe" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2014" "volumen" => "189" "numero" => "9" "paginaInicial" => "15" "paginaFinal" => "62" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dynamic hyperinflation and dyspnea during the 6-minute walk test in stable chronic obstructive pulmonary disease patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Satake" 1 => "T. Shioya" 2 => "S. Uemura" 3 => "H. Takahashi" 4 => "K. Sugawara" 5 => "C. Kasai" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J COPD" "fecha" => "2015" "volumen" => "10" "paginaInicial" => "153" "paginaFinal" => "158" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exercise-induced Oxygen Desaturation in Chronic Obstructive Pulmonary Disease Patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "I. García-Talavera" 1 => "P. Jiménez González" 2 => "R. Dorta Sánchez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2015.01.004" "Revista" => array:7 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2015" "volumen" => "51" "numero" => "10" "paginaInicial" => "481" "paginaFinal" => "482" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25824417" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evidence underlying breathing retraining in people with stable chronic obstructive pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Dechman" 1 => "C.R. Wilson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Phys Ther" "fecha" => "2004" "volumen" => "84" "numero" => "12" "paginaInicial" => "1189" "paginaFinal" => "1197" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15563259" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of rehabilitative exercise training on peripheral muscle remodelling in patients with COPD: targeting beyond the lungs" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I. Nasis" 1 => "E.A. Kortianou" 2 => "E. Clini" 3 => "N.G. Koulouris" 4 => "I. Vogiatzis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2174/1389450111314020011" "Revista" => array:7 [ "tituloSerie" => "Curr Drug Targets" "fecha" => "2013" "volumen" => "14" "numero" => "2" "paginaInicial" => "262" "paginaFinal" => "273" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23256723" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/25310437/0000002500000006/v1_201911020923/S2531043719301436/v1_201911020923/en/main.assets" "Apartado" => array:4 [ "identificador" => "72880" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/25310437/0000002500000006/v1_201911020923/S2531043719301436/v1_201911020923/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043719301436?idApp=UINPBA00004E"]

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Letter to the Editor

Relationship between dyspnea/oxygen saturation and leg discomfort/6-minute walking distance in patients with COPD participating in pulmonary rehabilitation

Lília Maia Santos

Corresponding author

lilasantos87@hotmail.com

Corresponding author at: Serviço de Pneumologia A, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal.

Pneumology Department, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

Paula Inês Pedro

Pneumology Department, Hospital Garcia de Orta, Almada, Portugal

Ana Dias

Pneumology Department, Hospital Pulido Valente, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal

Cristina Braço Forte

Pneumology Department, Hospital São Bernardo, Centro Hospitalar de Setúbal, Setúbal, Portugal

Paula Raposo

Pneumology Department, Hospital Pulido Valente, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal

Maria Fátima Rodriguesa,b

a Pneumology Department, Hospital Pulido Valente, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal

b Universidade de Lisboa, Faculdade de Medicina, Instituto de Saúde Ambiental (ISAMB), Lisboa, Portugal

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    "titulo" => "Relationship between dyspnea&#47;oxygen saturation and leg discomfort&#47;6-minute walking distance in patients with COPD participating in pulmonary rehabilitation"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Boxplot of dyspnea &#40;A&#41;&#44; minimum oxygen saturation &#40;B&#41;&#44; distance walked &#40;C&#41; and leg discomfort &#40;D&#41; in the 6-minute walk test performed at the beginning and at the end of pulmonary rehabilitation program&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic and progressive dyspnea&#44; the most characteristic symptom of chronic obstructive pulmonary disease &#40;COPD&#41;&#44; is often associated with physical activity reduction&#44; not only because of the symptom itself but also because of the anticipation of discomfort caused by physical exertion&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Fatigue is also one of the main symptoms&#44; described as the second most prevalent&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a> Therefore&#44; relief of these symptoms is one of the primary goals in the management of patients with COPD&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">It is known that FEV<span class="elsevierStyleInf">1</span> is not useful in predicting dyspnea and some studies have evaluated the relationship between dyspnea and dynamic hyperinflation&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4</span></a> Similarly&#44; despite exercise-induced oxygen desaturation being observed in patients with COPD&#44; mostly in those with more severe disease and with predominant emphysema phenotype&#44; the underlying mechanism remains poorly understood&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Also&#44; limb muscle dysfunction may play an important role in exercise limitation&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">As far as we know&#44; no previous study has evaluated the relationship between dyspnea and oxygen saturation &#40;SpO<span class="elsevierStyleInf">2</span>&#41;&#44; nor between leg discomfort and distance walked&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The aims of this study were to investigate the association between dyspnea and SpO<span class="elsevierStyleInf">2</span>&#44; and between leg discomfort and distance walked in the 6-minute walk test &#40;6MWT&#41;&#44; as well as the impact of Pulmonary Rehabilitation &#40;PR&#41; program on these variables&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">This was a longitudinal retrospective study of patients with COPD who completed an outpatient PR program during 2016 at Pulmonology Department of Centro Hospitalar Universit&#225;rio Lisboa Norte&#44; Portugal&#46; Subjects attended a multicomponent PR program with patient-tailored therapies&#44; 8&#8211;16 weeks long&#46; Those with ambulatory oxygen supplementation maintained it during the 6MWT and exercise training&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">At the beginning and at the end of PR program&#44; all patients underwent 6MWT&#46; The variables analyzed were the degree of dyspnea and leg discomfort at the end of each 6MWT according to Modified Borg Scale&#44; minimum SpO<span class="elsevierStyleInf">2</span> observed by pulse oximeter and distance walked during the test&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Using software SPSS&#174;&#44; Wilcoxon or Student&#180;s T-test were carried out&#44; as appropriate&#44; for comparison of variables at the beginning and at the end of the program&#46; Associations were assessed using Spearman&#180;s coefficient&#44; considering significant p-values below 0&#46;05&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Forty-six subjects with COPD completed the PR program&#44; whose baseline characteristics are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Thirty-seven percent of them were on long-term oxygen therapy and 28&#46;3&#37; were on nocturnal noninvasive ventilation&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">At the beginning and at the end of the PR program the mean degree of dyspnea was 3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;8 and 2&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;7&#44; and mean minimum SpO<span class="elsevierStyleInf">2</span> value was 84&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;4&#37; and 87&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;3&#37;&#44; respectively&#46; Only SpO<span class="elsevierStyleInf">2</span> improved significantly &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;007&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A and 1B&#41;&#46; We observed no correlation between the degree of dyspnea and minimum SpO<span class="elsevierStyleInf">2&#44;</span> neither in the initial 6MWT &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;31&#41; nor in the final one &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;09&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The mean distance walked was 340&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>105 and 373&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>95<span class="elsevierStyleHsp" style=""></span>m in the initial and final 6MWT&#44; respectively&#44; with significant improvement &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46; The degree of leg discomfort reported in the initial and final 6MWT had a median value of 2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3 with no significant improvement after PR &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;128&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41;&#46; We observed a mild &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;308&#41; but significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41; correlation between leg discomfort and distance walked in the initial 6MWT&#44; but not in the final one &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;077&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">This study shows the benefit of PR programs in patients with COPD&#44; namely in oxygen saturation and exercise capacity&#46; Similarly&#44; previous studies evidenced improvement in arterial oxygenation with breathing techniques such as pursed lips breathing during exercise training&#44; with physiological and clinical significance indicating its possible effect in decreasing airway collapse and respiratory rate&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The multifactorial nature of dyspnea is well known and we observed no correlation between the degree of dyspnea and oxygen saturation&#46; The maintenance of dynamic hyperinflation&#44; airflow limitation and respiratory muscle weakness&#44; leading to an increased mechanical load and a neuromechanical dissociation&#44; might explain in part this absence of correlation and the lack of significant improvement in dyspnea&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;4</span></a> Peripheral muscle dysfunction&#44; frequent in patients with COPD&#44; also enhances exertional dyspnea and exercise intolerance&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Those patients often have an augmented lactic acid production for a given exercise work rate&#44; increasing their ventilatory demand&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">After PR program&#44; our subjects reported a similar degree of leg discomfort for a significantly greater distance walked &#40;32&#46;6<span class="elsevierStyleHsp" style=""></span>m&#41;&#46; This is in line with extensive evidence showing improvement in exercise tolerance with a significant increment in distance walked by patients with COPD during 6MWT after PR program&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Our findings reflect the multifactorial essence of dyspnea and fatigue as the most prevalent characteristics of patients with COPD&#44; and the need for future research to clarify the underlying effects of PR on them&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0075" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public&#44; commercial&#44; or not-for-profit sectors&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sleep obstructive apnea <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bronchiectasis <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anxiety&#47;depression <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Atrial fibrillation <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Structural heart disease <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pulmonary hypertension <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;10&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Charlson Comorbidity Index</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GOLD airflow limitation severity</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>GOLD 1 <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;8&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>GOLD 2 <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;34&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>GOLD 3 <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;41&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>GOLD 4 <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;15&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GOLD ABCD</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>GOLD B <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;47&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>GOLD D <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;52&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FEV<span class="elsevierStyleInf">1</span> post BD &#40;mean in &#37; &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FVC post BD &#40;mean in &#37; &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">D<span class="elsevierStyleInf">LCO</span> &#40;mean in &#37; &#177; SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Respiratory failure</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No respiratory failure <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;8&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hypoxemic <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;73&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hypercapnic <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;17&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dyspnea</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">mMRC 2 <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;65&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">mMRC 3 or 4 <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;34&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics of the subjects&#46;</p>"
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    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:7 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic obstructive pulmonary disease&#58; clinical integrative physiology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46;E&#46; O&#8217;Donnell"
                            1 => "P&#46; Laveneziana"
                            2 => "K&#46; Webb"
                            3 => "J&#46;A&#46; Neder"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ccm.2013.09.008"
                      "Revista" => array:7 [
                        "tituloSerie" => "Clin Chest Med"
                        "fecha" => "2014"
                        "volumen" => "35"
                        "numero" => "1"
                        "paginaInicial" => "51"
                        "paginaFinal" => "69"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24507837"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An official American thoracic society&#47;European respiratory society statement&#58; key concepts and advances in pulmonary rehabilitation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;A&#46; Spruit"
                            1 => "S&#46;J&#46; Singh"
                            2 => "C&#46; Garvey"
                            3 => "R&#46; Zu Wallack"
                            4 => "L&#46; Nici"
                            5 => "C&#46; Rochester"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2013"
                        "volumen" => "188"
                        "numero" => "8"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An official American thoracic society&#47;european respiratory society statement&#58; update on limb muscle dysfunction in chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Maltais"
                            1 => "M&#46; Decramer"
                            2 => "R&#46; Casaburi"
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                        "numero" => "9"
                        "paginaInicial" => "15"
                        "paginaFinal" => "62"
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                          "etal" => true
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                        "volumen" => "10"
                        "paginaInicial" => "153"
                        "paginaFinal" => "158"
                      ]
                    ]
                  ]
                ]
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                          "etal" => false
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                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2015"
                        "volumen" => "51"
                        "numero" => "10"
                        "paginaInicial" => "481"
                        "paginaFinal" => "482"
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                      "titulo" => "Evidence underlying breathing retraining in people with stable chronic obstructive pulmonary disease"
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                        "numero" => "12"
                        "paginaInicial" => "1189"
                        "paginaFinal" => "1197"
                        "link" => array:1 [
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                          "etal" => false
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                        "tituloSerie" => "Curr Drug Targets"
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                        "paginaFinal" => "273"
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Article information

ISSN: 25310437
Original language: English

DOI:10.1016/j.pulmoe.2019.07.012

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	24	4	28
2024 October	189	34	223
2024 September	146	32	178
2024 August	147	36	183
2024 July	157	37	194
2024 June	151	29	180
2024 May	124	43	167
2024 April	99	31	130
2024 March	91	27	118
2024 February	82	24	106
2024 January	76	27	103
2023 December	44	26	70
2023 November	70	49	119
2023 October	100	34	134
2023 September	95	27	122
2023 August	114	17	131
2023 July	127	29	156
2023 June	119	13	132
2023 May	185	33	218
2023 April	118	30	148
2023 March	161	25	186
2023 February	150	17	167
2023 January	105	23	128
2022 December	118	33	151
2022 November	129	39	168
2022 October	130	50	180
2022 September	104	27	131
2022 August	85	38	123
2022 July	99	62	161
2022 June	94	82	176
2022 May	110	49	159
2022 April	110	45	155
2022 March	117	52	169
2022 February	70	44	114
2022 January	123	45	168
2021 December	97	43	140
2021 November	69	45	114
2021 October	88	68	156
2021 September	84	52	136
2021 August	129	45	174
2021 July	98	19	117
2021 June	107	49	156
2021 May	241	46	287
2021 April	464	100	564
2021 March	244	48	292
2021 February	134	28	162
2021 January	115	22	137
2020 December	122	30	152
2020 November	110	29	139
2020 October	104	21	125
2020 September	131	48	179
2020 August	108	24	132
2020 July	84	26	110
2020 June	77	38	115
2020 May	100	23	123
2020 April	84	11	95
2020 March	58	30	88
2020 February	56	30	86
2020 January	77	54	131
2019 December	106	33	139
2019 November	116	46	162
2019 October	18	9	27
2019 September	21	17	38

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