Does pulmonary rehabilitation decrease frailty in COPD?

Frailty is more prevalent in patients with COPD than in the general population and increasing frailty is associated with an increased risk of adverse outcomes including mortality, hospitalisation and poorer quality of life. The degree to which the progression of frailty is reversible in COPD patients has not been clearly established. Pulmonary rehabilitation (PR) is an important component in the management of COPD and leads to clinically significant improvements in dyspnoea and exercise capacity. This study aimed to establish if there is an improvement in frailty in patients with COPD after a course of PR. Patients with a primary diagnosis of COPD who underwent a 7 week pulmonary rehabilitation course between November 2021 and December 2023 were included (n=154). The Rockwood Clinical Frailty Scale (CFS) scores were recorded by a physiotherapist before and after completion of the PR intervention. Results showed that the mean difference in CFS score for all patients after the intervention was −0.58. A Wilcoxon Signed-Rank Test indicated that the difference in scores was statistically significant, Z=-6.74, p<0.001. Patients classified as frail before the intervention (CFS score≥5)(n=17) had a greater improvement in CFS score after PR than non-frail/pre-frail patients (CFS score≤4)(n=137) (−1.28 vs −0.49, p<0.001). These results suggest that pulmonary rehabilitation improves frailty status in the short term in patients with COPD and that those with more advanced frailty may stand to gain the most benefit. Further research is needed to establish whether the effect is maintained long term and to determine the clinical significance.