Severity-Stratified Pulmonary Rehabilitation Modulates Diaphragm Function and Oxidative Stress in Hospitalized AECOPD Patients: A Randomized Controlled Trial

Objective: Diaphragmatic dysfunction and oxidative stress are central pathophysiological alterations in patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Evidence is lacking regarding early pulmonary rehabilitation protocols stratified by objective disease severity and their physiological effects. This study aimed to evaluate the impact of an individualized, severity-graded exercise rehabilitation program on diaphragmatic function and oxidative stress biomarkers in these patients. Methods: In this single-center randomized controlled trial, 132 AECOPD patients were first stratified into three severity grades (I, II, III) based on predefined clinical and physiological criteria, then randomly assigned to either a study group (n=66, receiving severity-graded rehabilitation) or a control group (n=66, receiving conventional rehabilitation).Diaphragmatic function was assessed by bedside ultrasonography measuring excursion (DE), end-inspiratory thickness (DTei), and end-expiratory thickness (DTee). Serum levels of malondialdehyde (MDA), superoxide dismutase (SOD), and total antioxidant capacity (TAOC) were determined. All measurements were taken before and after the intervention. The trial was registered with the Chinese Clinical Trial Registry (ChiCTR2500106687). Results: <0.05). Conclusion: Severity-graded exercise rehabilitation effectively improves diaphragmatic function and enhances endogenous antioxidant capacity in hospitalized AECOPD patients. The improvement in diaphragmatic excursion was significantly correlated with favorable changes in oxidative stress biomarkers, suggesting a potential physiological association. These findings support the efficacy of severity-graded rehabilitation but warrant further mechanistic studies.