Behavioral Adaptation Outperforms Clinical and Immune Biomarkers in Predicting Response to Pulmonary Rehabilitation in Older Patients with Advanced COPD

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Patients with advanced COPD respond differently to pulmonary rehabilitation (PR), and respiratory impairment does not explain these differences. Behavioral adaptation may contribute to this variability. Seventy-seven patients with advanced COPD (GOLD III–IV) completed a 3-week PR programme. Response was defined by change in 6-minute walking distance (6MWD). Clinical, functional, psychological, lifestyle and immune variables were assessed, including Brief-COPE strategies, TTV viremia and T-cell subsets. Mediation analysis examined the relationship between age, coping and rehabilitation response. Findings were explored in the IMPROVE trial (n=36), comparing standard PR with PR plus psychological support. Greater improvement in 6MWD was associated with higher Active Coping and Planning, while Self-Distraction also differed across response groups. Planning was the only coping strategy that significantly mediated the association between age and rehabilitation response (number of subjects 5.05 ± 1.93vs 7.10±1.35 in non responders vs good responders, respectively; p<0.001), accounting for approximately 26% of the total age effect. Conventional physiological measures, lifestyle characteristics and immune biomarkers, including TTV viremia and T-cell subsets, did not significantly distinguish responders from non-responders. Planning and Active Coping were associated with response in both sexes. In IMPROVE, psychological support was associated with maintenance of rehabilitation benefits at six months, with improvements in psychological well-being, quality of life and coping strategies. Coping strategies may add information to assessment of PR response. Planning may account for age-related differences in rehabilitation outcomes and could be considered when tailoring psychological support. Keywords: Chronic obstructive pulmonary disease; pulmonary rehabilitation; behavioral adaptation; coping strategies; resilience; Brief COPE; rehabilitation response; psychological support; aging.

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