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J Cardiopulm Rehabil Prev. 2010 May-Jun;30(3):195-202. doi: 10.1097/HCR.0b013e3181c565e4.

Six-minute walk distance in patients with severe end-stage COPD: association with survival after inpatient pulmonary rehabilitation.

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Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA.



To evaluate the relationship between the 6-minute walk distance (6MWD) and survival in a cohort of patients with severe end-stage chronic obstructive pulmonary disease (COPD) who received inpatient pulmonary rehabilitation (IPR) from 1995 to 2007.


We retrospectively analyzed 815 patients with severe end-stage COPD who received IPR. 6MWDs before and after IPR (pre-6MWD, post-6MWD) were compared to assess whether 6MWD was significantly changed after IPR. The Kaplan-Meier survival curves were constructed to show the relationship between survival and 6MWD. The age- and or comorbidities-adjusted Cox proportional hazard model was applied to assess association between the survival and the pre-6MWD, post-6MWD, or difference in 6MWD from the pre-6MWD to post-6MWD (Delta6MWD).


Baseline demographics demonstrated a median age 74.0 years, mostly women (60.1%), and white (89.9%) patients with significant comorbid diseases who were most recently hospitalized in acute care facilities (95.1%). IPR significantly increased the 6MWD (mean distance change: 86.4 m; 95% confidence interval [CI], 81.5-91.3 m). Pre-6MWD was not significantly associated with survival. However, post-6MWD was significantly associated with age- and comorbidity-adjusted survival (post-6MWD hazard ratio = 1.336; 95% CI, 1.232-1.449 [post-6MWD x m relative to post-6MWD 2x m]), and Delta6MWD was also significantly associated with age-, comorbidities-, and pre-6MWD-adjusted survival (Delta6MWD hazard ratio = 1.337; 95% CI, 1.227-1.457 [Delta6MWD x m relative to Delta6MWD 2x m]).


In patients with severe end-stage COPD, IPR significantly improved 6MWD, and the post-6MWD and Delta6MWD were positively associated with the length of survival.

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