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S30 Nutrition and Exercise Rehabilitation in Obesity Hypoventilation Syndrome (NERO): A Pilot Randomised Controlled Trial
  1. S Mandal1,
  2. ES Suh1,
  3. R Harding1,
  4. A Vaughan-France1,
  5. M Ramsay1,
  6. B Connolly1,
  7. D Bear1,
  8. H McLaughlin2,
  9. S Greenwood2,
  10. M Polkey3,
  11. M Elliott4,
  12. A Douiri5,
  13. J Moxham2,
  14. N Hart1
  1. 1Lane-Fox Respiratory Unit, Guy’s and St Thomas’ NHS Trust, London, UK
  2. 2King’s College Hospital, London, UK
  3. 3Royal Brompton and Harefield NHS Trust, London, UK
  4. 4St James’ Hospital, Leeds, Leeds, UK
  5. 5Department of Primary Care and Public Health Sciences & NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, UK

Abstract

Introduction We have previously shown that treatment of obesity hypoventilation syndrome (OHS) with non-invasive ventilation (NIV) results in weight reduction and an increase in physical activity (Murphy et al., 2012). We therefore hypothesised that a multi-modal rehabilitation programme, in addition to NIV, would lead to enhanced weight loss.

Method We conducted a randomised controlled trial of NIV alone vs. NIV and a personalised rehabilitation programme in patients with OHS. Subjects in the intervention group received a bespoke diet and exercise regime, from a dietician and physiotherapist. All patients, in both groups, were reviewed monthly for 3 months. Anthropometrics, exercise capacity and health related quality of life (HQRL) were measured at baseline and at 3 months. The primary outcome measure at 3 months was weight loss. Secondary outcomes included: body mass index (BMI), neck circumference (NC), waist circumference (WC), hip circumference (HC) blood pressure (BP), rectus femoris cross-sectional area (RFCSA) and quadriceps maximal voluntary contraction (QMVC), 6 min walk distance (6MWD) and HRQL measures.

Results 37 subjects were randomised with data from 30 patients analysed at 3 months (15 in each group). There were no differences between the groups in all parameters measured at baseline. The intervention group showed greater weight loss than the control group (-11.9 ± 6.7 vs. -2.4 ± 6.2 kg; p < 0.0001). There were also differences in NC, WC and HC (all p < 0.001, Table 1) with an improvement in BP observed in the intervention group (Table 1). In addition, there was an increase in weight corrected RFCSA and muscle strength (p < 0.0001, Table 1) with an increase in 6MWD in the intervention group (122 ± 161 vs. 46 ± 60 m; p = 0.005; Table 1). Finally, HRQL improved in the intervention group as evidenced by a greater reduction in Epworth sleepiness score, an increase in severe respiratory insufficiency questionnaire sum score and a greater decrease in the hospital and anxiety depression score (Table 1, all p < 0.0001).

Abstract S30 Table 1

Changes in anthropometrics, blood pressure, peripheral muscle area, peripheral muscle strength and exercise capacity

Conclusion In patients with OHS, the addition of a hospital-home hybrid personalised diet and exercise programme to standard NIV was shown to enhance weight loss as well as, skeletal muscle area and strength, exercise capacity and HRQL.

Reference 1 Murphy PB, Davidson C, Hind MD, et al. Volume targeted versus pressure support non-invasive ventilation in patients with super obesity and chronic respiratory failure: a randomised controlled trial. Thorax. 2012;67:727–34

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