Brief Report E12 Journal of Cardiopulmonary Rehabilitation and Prevention 2018;38:E12-E15 www.jcrpjournal.com E vidence has shown that regular exercise can atten- uate the chronic inflammatory process by inducing systemic increase of cytokines with anti-inflammatory properties, 1 as observed in adults and older adults, which increases interleukin 6 (IL-6) levels during muscle con- traction. This is followed by the release of cytokines inter- leukin 1 receptor antagonist, interleukin 10, soluble tissue Effects of a Long-term Pulmonary Rehabilitation Program on Functional Capacity and Inflammatory Profile of Older Patients With COPD Fabíola C. O. S. Vieira, MSc; Daniele S. Pereira, PhD; Thacianna B. Costa, PhD; Rilda C. A. Souza, MSc; Célia M. M. B. Castro, PhD; Arméle Dornelas de Andrade, PhD; Patrícia Érika de Melo Marinho, PhD Author Affiliations: Post-Graduate Program of Health Science (Mss Vieira and Souza and Dr Marinho), Immunopathology Laboratory Keizo Asami (Drs Costa and Castro), and Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department (Drs Dornelas de Andrade and Marinho), Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil; and Nursing Course and Physical Therapy Course, Universidade Federal de Alfenas, Minas Gerais, Brazil (Dr Pereira). All the authors have read and approved submission of the manuscript. The authors declare no conflicts of interest. Correspondence: Patrícia Érika de Melo Marinho, PhD, Cardiopulmonary Physical Therapy Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Av Jornalista Aníbal Fernandes, s/n Cidade Universitária, Recife, PE, Brazil, CEP: 50740-560 (patricia.marinho@ufpe.br or patmarinho@yahoo.com.br). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/HCR.0000000000000303 Purpose: To evaluate the effects of a long-term pulmonary rehabilitation program (PRP) on functional capacity, maximal inspiratory pressure (MIP), quality of life, and plasma levels of tumor necrosis factor alpha (TNF- α), soluble tumor necrosis factor receptors 1 and 2 (sTNFR1 and sTNFR2, respectively), and cytokine interleukin 1beta (IL-1 β) in elderly patients with chronic obstructive pulmonary disease (COPD). Methods: In a quasi-experimental study, PRP effectiveness was investigated in elderly patients with stage I-IV COPD undergo- ing a 6-mo training program. Participants took part in an 80-min PRP 3 times/wk. Before and after the intervention, the distance walked during a 6-min walk test (6MWD), MIP, St George’s Re- spiratory Questionnaire (SGRQ), and plasma levels of TNF- α, sTNFR1, sTNFR2, and IL-1 β were evaluated. Results: In 7 patients who completed the PRP and had markers evaluated, we observed improvement in 6MWD (range, 26-331 m) and MIP for most patients. There was an improvement in impact and total domains for all patients and in symptoms and activity for most patients on the SGRQ at the completion of the PRP. TNF- α, sTNFR1, sTNFR2, and IL-1 β increased in some patients at the end of the PRP. The 6-mo PRP improved functional capac- ity, MIP, and quality of life for most patients. Conclusions: Inflammatory markers showed various changes at the end of the study; however, only sTNFR2 levels improved after the PRP. Key Words: chronic obstructive pulmonary disease • cytokines • inflammation • quality of life • respiratory muscle training necrosis factor R1 (sTNFR1), and soluble tissue necrosis factor R2 (sTNFR2), resulting in an exercise-induced an- ti-inflammatory effect. 1 Inflammatory mediators such as tumor necrosis factor alpha (TNF- α) and their soluble receptors sTNFR1 and sT- NFR2, interleukin 1beta (IL-1 β) and IL-6, and acute-phase proteins such as fibrinogen and C-reactive protein are re- lated to the pathogenesis of chronic obstructive pulmonary disease (COPD). 2 The chronic inflammation process is relat- ed to reduced muscle mass and strength due to the catabolic action of cytokines, especially TNF- α. 3 Considering that physical activity can have an immuno- regulatory relationship in the chronic inflammatory process when regularly and moderately performed, 4 participation in an individualized pulmonary rehabilitation program (PRP) can provide symptom reduction and consequent improve- ment in quality of life (QOL) in patients with COPD. To our knowledge, no studies have been conducted that inves- tigated the effects of a PRP on the inflammatory profile of these patients. Thus, the present study aimed to evaluate functional capacity and the behavior of TNF- α, sTNFR1, sTNFR2, and IL-1 β levels in patients with COPD in re- sponse to a long-term PRP. PATIENTS AND METHODS This study represents a quasi-experimental design using a series of cases to investigate the effects of a 6-mo PRP on functional capacity and the behavior of TNF- α, sTNFR1, sTNFR2, and IL-1 β levels. Subjects performed 3 sessions/ wk of an 80-min duration on alternate days for 6 mo fol- lowing an individual program tailored to the needs of the patient and limitations based on symptoms. This investi- gation tested the hypothesis that a long-term PRP would reduce the inflammatory profile in older adult patients with severe COPD. PATIENTS Inclusion criteria included a clinical history, physical ex- amination, and confirmation of airway obstruction using forced expiratory volume in 1 sec (FEV 1 )/forced vital ca- pacity (FVC) <70%, according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD). 5 This study was approved by the institutional ethics committee, and the study was conducted in accordance with the Declaration of Helsinki. All subjects were informed of the benefits and risks of the investigation and provided written informed consent before involvement in the study. The initial evaluation of all patients included clinical and anthropometric characteristics, medications, smoking his- tory, and a QOL questionnaire. The PRP was started within 48 hr after the initial assessment. Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.