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Original article
Physical frailty and pulmonary rehabilitation in COPD: a prospective cohort study
  1. Matthew Maddocks1,
  2. Samantha S C Kon2,3,
  3. Jane L Canavan2,4,
  4. Sarah E Jones2,4,
  5. Claire M Nolan2,4,
  6. Alex Labey2,4,
  7. Michael I Polkey2,
  8. William D-C Man2,4
  1. 1King's College London, Cicely Saunders Institute, London, UK
  2. 2NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
  3. 3The Hillingdon Hospital NHS Foundation Trust, Middlesex, UK
  4. 4Harefield Pulmonary Rehabilitation Unit, Harefield Hospital, Middlesex, UK
  1. Correspondence to : Dr Matthew Maddocks, King's College London, Cicely Saunders Institute, London SE5 9PJ, UK; matthew.maddocks{at}


Background Frailty is an important clinical syndrome that is consistently associated with adverse outcomes in older people. The relevance of frailty to chronic respiratory disease and its management is unknown.

Objectives To determine the prevalence of frailty among patients with stable COPD and examine whether frailty affects completion and outcomes of pulmonary rehabilitation.

Methods 816 outpatients with COPD (mean (SD) age 70 (10) years, FEV1% predicted 48.9 (21.0)) were recruited between November 2011 and January 2015. Frailty was assessed using the Fried criteria (weight loss, exhaustion, low physical activity, slowness and weakness) before and after pulmonary rehabilitation. Predictors of programme non-completion were identified using multivariate logistic regression, and outcomes were compared using analysis of covariance, adjusting for age and sex.

Results 209/816 patients (25.6%, 95% CI 22.7 to 28.7) were frail. Prevalence of frailty increased with age, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, Medical Research Council (MRC) score and age-adjusted comorbidity burden (all p≤0.01). Patients who were frail had double the odds of programme non-completion (adjusted OR 2.20, 95% CI 1.39 to 3.46, p=0.001), often due to exacerbation and/or hospital admission. However, rehabilitation outcomes favoured frail completers, with consistently better responses in MRC score, exercise performance, physical activity level and health status (all p<0.001). After rehabilitation, 71/115 (61.3%) previously frail patients no longer met case criteria for frailty.

Conclusions Frailty affects one in four patients with COPD referred for pulmonary rehabilitation and is an independent predictor of programme non-completion. However, patients who are frail respond favourably to rehabilitation and their frailty can be reversed in the short term.

  • COPD epidemiology
  • Exercise
  • Pulmonary Rehabilitation

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Contributors MM and WD-CM contributed to the conception and design of the study. SSCK, JLC, SEJ and CMN recruited patients and conducted the study. MM, SSCK, AL, MIP and WD-CM contributed to data analysis and interpretation. All authors contributed to data interpretation and drafting the manuscript for important intellectual content.

  • Funding This work was supported by the NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK, who partly fund MIP's salary. MM is supported by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for South London and by Cicely Saunders International. CMN is supported by a NIHR Doctoral Fellowship. WD-CM was supported by a NIHR Clinician Scientist Award, Medical Research Council (UK) New Investigator Research Grant, NIHR Clinical Trials Fellowship and by the NIHR CLAHRC for Northwest London.

  • Competing interests MIP has received personal reimbursement for lecturing or consultancy regarding muscle function in COPD from Novartis and Philips Respironics. He discloses institutional reimbursement for consultancy from GSK, Novartis, Regneron, Lilly, Biomarin and BI and institutional agreements to conduct research with GSK, Novartis, AZ and Philips Respironics.

  • Ethics approval West London (11/H0707/2) and London Camberwell St Giles (11/LO/1780) Research Ethics Committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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