Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease: Highly Effective but Often Overlooked
Brett A. Dolezal (University of California)
Christopher B. Cooper (University of California)
- Downloaded
- Viewed
Abstract
Patients with chronic obstructive pulmonary disease receive a range of treatments including but not limited to inhaled bronchodilators, inhaled and systemic corticosteroids, supplemental oxygen, and pulmonary rehabilitation. Pulmonary rehabilitation is a multidisciplinary intervention that seeks to combine patient education, exercise, and lifestyle changes into a comprehensive program. Programs 6 to 8 weeks in length have been shown to improve health, reduce dyspnea, increase exercise capacity, improve psychological well-being, and reduce healthcare utilization and hospitalization. Although the use of pulmonary rehabilitation is widely supported by the literature, controversy still exists regarding what should be included in the programs. The goal of this review was to summarize the evidence for pulmonary rehabilitation and identify the areas that hold promise in improving its utilization and effectiveness.
- keywords
- Pulmonary Disease, Chronic Obstructive, Pulmonary Rehabilitation, Exercise Limitation, Exercise Prescription
Reference
1. World Health Organization. Disease burden and mortality estimates [Internet]. Geneva: World Health Organization; 2020[cited 2020 Jun 14]. Available from: https://www.who.int/healthinfo/global_burden_disease/estimates/en/.
2. Witek TJ Jr, Mahler DA. Minimal important difference of the transition dyspnoea index in a multinational clinical trial. Eur Respir J 2003;21:267-72.
3. Waschki B, Kirsten AM, Holz O, Mueller KC, Schaper M, Sack AL, et al. Disease progression and changes in physical activity in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2015;192:295-306.
4. Global Initiative for chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of COPD [Internet]. Fontana, WI: GOLD; 2020 [cited 2020Jun 14]. Available from: https://goldcopd.org/wp-content/uploads/2019/12/GOLD-2020-FINAL-ver1.2-03Dec19_WMV.pdf.
5. Pitta F, Troosters T, Spruit MA, Probst VS, Decramer M, Gosselink R. Characteristics of physical activities in daily life in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2005;171:972-7.
6. Pepin V, Saey D, Laviolette L, Maltais F. Exercise capacity in chronic obstructive pulmonary disease: mechanisms of limitation. COPD 2007;4:195-204.
7. van Buul AR, Kasteleyn MJ, Chavannes NH, Taube C. Association between morning symptoms and physical activity in COPD: a systematic review. Eur Respir Rev 2017;26:160033.
8. American Thoracic Society; American College of Chest Physicians. ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med 2003;167:211-77.
9. Oga T, Nishimura K, Tsukino M, Sato S, Hajiro T. Analysis of the factors related to mortality in chronic obstructive pulmonary disease: role of exercise capacity and health status. Am J Respir Crit Care Med 2003;167:544-9.
10. Martinez FJ, Foster G, Curtis JL, Criner G, Weinmann G, Fishman A, et al. Predictors of mortality in patients with emphysema and severe airflow obstruction. Am J Respir Crit Care Med 2006;173:1326-34.
11. Rochester CL, Vogiatzis I, Holland AE, Lareau SC, Marciniuk DD, Puhan MA, et al. An Official American Thoracic Society/European Respiratory Society policy statement: enhancing implementation, use, and delivery of pulmonary rehabilitation. Am J Respir Crit Care Med 2015;192:1373-86.
12. Jenkins AR, Gowler H, Curtis F, Holden NS, Bridle C, Jones AW. Efficacy of supervised maintenance exercise following pulmonary rehabilitation on health care use: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis 2018;13:257-73.
13. McCarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2015;(2):CD003793.
14. Puhan MA, Gimeno-Santos E, Cates CJ, Troosters T. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2016;12:CD005305.
15. Moore E, Palmer T, Newson R, Majeed A, Quint JK, Soljak MA. Pulmonary rehabilitation as a mechanism to reduce hospitalizations for acute exacerbations of COPD: a systematic review and meta-analysis. Chest 2016;150:837-59.
16. Pierobon A, Sini Bottelli E, Ranzini L, Bruschi C, Maestri R, Bertolotti G, et al. COPD patients’ self-reported adherence, psychosocial factors and mild cognitive impairment in pulmonary rehabilitation. Int J Chron Obstruct Pulmon Dis 2017;12:2059-67.
17. Lacasse Y, Cates CJ, McCarthy B, Welsh EJ. This Cochrane Review is closed: deciding what constitutes enough research and where next for pulmonary rehabilitation in COPD. Cochrane Database Syst Rev 2015;(11):ED000107.
18. Man WD, Soliman MG, Gearing J, Radford SG, Rafferty GF, Gray BJ, et al. Symptoms and quadriceps fatigability after walking and cycling in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2003;168:562-7.
19. Pepin V, Saey D, Whittom F, LeBlanc P, Maltais F. Walking versus cycling: sensitivity to bronchodilation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2005;172:1517-22.
20. Bernard S, LeBlanc P, Whittom F, Carrier G, Jobin J, Belleau R, et al. Peripheral muscle weakness in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998;158:629-34.
21. Gosker HR, Hesselink MK, Duimel H, Ward KA, Schols AM. Reduced mitochondrial density in the vastus lateralis muscle of patients with COPD. Eur Respir J 2007;30:73-9.
22. Puente-Maestu L, Perez-Parra J, Godoy R, Moreno N, Tejedor A, Gonzalez-Aragoneses F, et al. Abnormal mitochondrial function in locomotor and respiratory muscles of COPD patients. Eur Respir J 2009;33:1045-52.
23. Gosselink R, Troosters T, Decramer M. Peripheral muscle weakness contributes to exercise limitation in COPD. Am J Respir Crit Care Med 1996;153:976-80.
24. Hamilton AL, Killian KJ, Summers E, Jones NL. Muscle strength, symptom intensity, and exercise capacity in patients with cardiorespiratory disorders. Am J Respir Crit Care Med 1995;152(6 Pt 1):2021-31.
25. Agusti AG, Sauleda J, Miralles C, Gomez C, Togores B, Sala E, et al. Skeletal muscle apoptosis and weight loss in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2002;166:485-9.
26. Casaburi R, Patessio A, Ioli F, Zanaboni S, Donner CF, Wasserman K. Reductions in exercise lactic acidosis and ventilation as a result of exercise training in patients with obstructive lung disease. Am Rev Respir Dis 1991;143:9-18.
27. Wagner PD. Skeletal muscles in chronic obstructive pulmonary disease: deconditioning, or myopathy? Respirology 2006;11:681-6.
28. Maltais F, Decramer M, Casaburi R, Barreiro E, Burelle Y, Debigare R, et al. An official American Thoracic Society/European Respiratory Society statement: update on limb muscle dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2014;189:e15-62.
29. Cooper CB. The connection between chronic obstructive pulmonary disease symptoms and hyperinflation and its impact on exercise and function. Am J Med 2006;119(10 Suppl 1):21-31.
30. Vogiatzis I, Zakynthinos S. Factors limiting exercise tolerance in chronic lung diseases. Compr Physiol 2012;2:1779-817.
31. Garcia-Rio F, Rojo B, Casitas R, Lores V, Madero R, Romero D, et al. Prognostic value of the objective measurement of daily physical activity in patients with COPD. Chest 2012;142:338-46.
32. Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007;39:1423-34.
33. Myers J. Physical activity: the missing prescription. Eur J Cardiovasc Prev Rehabil 2005;12:85-6.
34. Sala E, Roca J, Marrades RM, Alonso J, Gonzalez De Suso JM, Moreno A, et al. Effects of endurance training on skeletal muscle bioenergetics in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999;159:1726-34.
35. Bernard S, Whittom F, Leblanc P, Jobin J, Belleau R, Berube C, et al. Aerobic and strength training in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999;159:896-901.
36. Maltais F, LeBlanc P, Simard C, Jobin J, Berube C, Bruneau J, et al. Skeletal muscle adaptation to endurance training in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1996;154(2 Pt 1):442-7.
37. Griffiths TL, Burr ML, Campbell IA, Lewis-Jenkins V, Mullins J, Shiels K, et al. Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial. Lancet 2000;355:362-8.
38. Ries AL, Kaplan RM, Limberg TM, Prewitt LM. Effects of pulmonary rehabilitation on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease. Ann Intern Med 1995;122:823-32.
39. Whittom F, Jobin J, Simard PM, Leblanc P, Simard C, Bernard S, et al. Histochemical and morphological characteristics of the vastus lateralis muscle in patients with chronic obstructive pulmonary disease. Med Sci Sports Exerc 1998;30:1467-74.
40. Sahin H, Naz I, Varol Y, Aksel N, Tuksavul F, Ozsoz A. Is a pulmonary rehabilitation program effective in COPD patients with chronic hypercapnic failure? Expert Rev Respir Med 2016;10:593-8.
41. Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013;188:e13-64.
42. Cooper CB, Barjaktarevic I. A new algorithm for the management of COPD. Lancet Respir Med 2015;3:266-8.
43. Bischoff EW, Hamd DH, Sedeno M, Benedetti A, Schermer TR, Bernard S, et al. Effects of written action plan adherence on COPD exacerbation recovery. Thorax 2011;66:26-31.
44. Rice KL, Dewan N, Bloomfield HE, Grill J, Schult TM, Nelson DB, et al. Disease management program for chronic obstructive pulmonary disease: a randomized controlled trial. Am J Respir Crit Care Med 2010;182:890-6.
45. Effing T, Monninkhof EM, van der Valk PD, van der Palen J, van Herwaarden CL, Partidge MR, et al. Self-management education for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2007;(4):CD002990.
46. Trappenburg JC, Monninkhof EM, Bourbeau J, Troosters T, Schrijvers AJ, Verheij TJ, et al. Effect of an action plan with ongoing support by a case manager on exacerbation-related outcome in patients with COPD: a multicentre randomised controlled trial. Thorax 2011;66:977-84.
47. Effing T, Kerstjens H, van der Valk P, Zielhuis G, van der Palen J. (Cost)-effectiveness of self-treatment of exacerbations on the severity of exacerbations in patients with COPD: the COPE II study. Thorax 2009;64:956-62.
48. Wagg K. Unravelling self-management for COPD: what next? Chron Respir Dis 2012;9:5-7.
49. Zwerink M, Brusse-Keizer M, van der Valk PD, Zielhuis GA, Monninkhof EM, van der Palen J, et al. Self management for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2014;2014:CD002990.
50. Murphy LA, Harrington P, Taylor SJ, Teljeur C, Smith SM, Pinnock H, et al. Clinical-effectiveness of self-management interventions in chronic obstructive pulmonary disease: An overview of reviews. Chron Respir Dis 2017;14:276-88.
51. Burge AT, Cox NS, Abramson MJ, Holland AE. Interventions for promoting physical activity in people with chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev 2020;4:CD012626.
52. Adams SG, Smith PK, Allan PF, Anzueto A, Pugh JA, Cornell JE. Systematic review of the chronic care model in chronic obstructive pulmonary disease prevention and management. Arch Intern Med 2007;167:551-61.
53. Kruis AL, Smidt N, Assendelft WJ, Gussekloo J, Boland MR, Rutten-van Molken M, et al. Integrated disease management interventions for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2013;(10):CD009437.
54. Puente-Maestu L, Sanz ML, Sanz P, Cubillo JM, Mayol J, Casaburi R. Comparison of effects of supervised versus selfmonitored training programmes in patients with chronic obstructive pulmonary disease. Eur Respir J 2000;15:517-25.
55. Ringbaek TJ, Broendum E, Hemmingsen L, Lybeck K, Nielsen D, Andersen C, et al. Rehabilitation of patients with chronic obstructive pulmonary disease: exercise twice a week is not sufficient! Respir Med 2000;94:150-4.
56. Iepsen UW, Jorgensen KJ, Ringbaek T, Hansen H, Skrubbeltrang C, Lange P. A combination of resistance and endurance training increases leg muscle strength in COPD: an evidencebased recommendation based on systematic review with meta-analyses. Chron Respir Dis 2015;12:132-45.
57. Cooper CB. Exercise in chronic pulmonary disease: aerobic exercise prescription. Med Sci Sports Exerc 2001;33(7Suppl):S671-9.
58. Meshe OF, Claydon LS, Bungay H, Andrew S. The relationship between physical activity and health status in patients with chronic obstructive pulmonary disease following pulmonary rehabilitation. Disabil Rehabil 2017;39:746-56.
59. Casaburi R, Porszasz J, Burns MR, Carithers ER, Chang RS, Cooper CB. Physiologic benefits of exercise training in rehabilitation of patients with severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1997;155:1541-51.
60. Maltais F, Simard AA, Simard C, Jobin J, Desgagnes P, LeBlanc P. Oxidative capacity of the skeletal muscle and lactic acid kinetics during exercise in normal subjects and in patients with COPD. Am J Respir Crit Care Med 1996;153:288-93.
61. McKeough ZJ, Velloso M, Lima VP, Alison JA. Upper limb exercise training for COPD. Cochrane Database Syst Rev 2016;11:CD011434.
62. Kongsgaard M, Backer V, Jorgensen K, Kjaer M, Beyer N. Heavy resistance training increases muscle size, strength and physical function in elderly male COPD-patients: a pilot study. Respir Med 2004;98:1000-7.
63. Simpson K, Killian K, McCartney N, Stubbing DG, Jones NL. Randomised controlled trial of weightlifting exercise in patients with chronic airflow limitation. Thorax 1992;47:70-5.
64. Iepsen UW, Jorgensen KJ, Ringbaek T, Hansen H, Skrubbeltrang C, Lange P. A systematic review of resistance training versus endurance training in COPD. J Cardiopulm Rehabil Prev 2015;35:163-72.
65. Liao WH, Chen JW, Chen X, Lin L, Yan HY, Zhou YQ, et al. Impact of resistance training in subjects with COPD: a systematic review and meta-analysis. Respir Care 2015;60:1130-45.
66. Covey MK, Collins EG, Reynertson SI, Dilling DF. Resistance training as a preconditioning strategy for enhancing aerobic exercise training outcomes in COPD. Respir Med 2014;108:1141-52.
67. McDonald VM, Gibson PG, Scott HA, Baines PJ, Hensley MJ, Pretto JJ, et al. Should we treat obesity in COPD? The effects of diet and resistance exercise training. Respirology 2016;21:875-82.
68. Hurley BF, Roth SM. Strength training in the elderly: effects on risk factors for age-related diseases. Sports Med 2000;30:249-68.
69. Louvaris Z, Spetsioti S, Kortianou EA, Vasilopoulou M, Nasis I, Kaltsakas G, et al. Interval training induces clinically meaningful effects in daily activity levels in COPD. Eur Respir J 2016;48:567-70.
70. Elkins MR, Dwyer TJ. Interval and continuous training are similarly effective in chronic obstructive pulmonary disease. Br J Sports Med 2011;45:155-6.
71. Porszasz J, Rambod M, van der Vaart H, Rossiter HB, Ma S, Kiledjian R, et al. Sinusoidal high-intensity exercise does not elicit ventilatory limitation in chronic obstructive pulmonary disease. Exp Physiol 2013;98:1102-14.
72. Casaburi R, Bhasin S, Cosentino L, Porszasz J, Somfay A, Lewis MI, et al. Effects of testosterone and resistance training in men with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2004;170:870-8.
73. Sin DD, Man SF. Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality. Proc Am Thorac Soc 2005;2:8-11.
74. Vivodtzev I, Minet C, Wuyam B, Borel JC, Vottero G, Monneret D, et al. Significant improvement in arterial stiffness after endurance training in patients with COPD. Chest 2010;137:585-92.
75. Aldabayan YS, Ridsdale HA, Alrajeh AM, Aldhahir AM, Lemson A, Alqahtani JS, et al. Pulmonary rehabilitation, physical activity and aortic stiffness in COPD. Respir Res 2019;20:166.
76. Bronstad E, Tjonna AE, Rognmo O, Dalen H, Heggli AM, Wisloff U, et al. Aerobic exercise training improves right- and left ventricular systolic function in patients with COPD. COPD 2013;10:300-6.
77. Hakamy A, Bolton CE, McKeever TM. The effect of pulmonary rehabilitation on mortality, balance, and risk of fall in stable patients with chronic obstructive pulmonary disease. Chron Respir Dis 2017;14:54-62.
78. Zhang W, Zhang Y, Li CW, Jones P, Wang C, Fan Y. Effect of Statins on COPD: A Meta-Analysis of Randomized Controlled Trials. Chest 2017;152:1159-68.
79. O’Donnell DE, Fluge T, Gerken F, Hamilton A, Webb K, Aguilaniu B, et al. Effects of tiotropium on lung hyperinflation, dyspnoea and exercise tolerance in COPD. Eur Respir J 2004;23:832-40.
80. Casaburi R, Kukafka D, Cooper CB, Witek TJ Jr, Kesten S. Improvement in exercise tolerance with the combination of tiotropium and pulmonary rehabilitation in patients with COPD. Chest 2005;127:809-17.
81. Kesten S, Casaburi R, Kukafka D, Cooper CB. Improvement in self-reported exercise participation with the combination of tiotropium and rehabilitative exercise training in COPD patients. Int J Chron Obstruct Pulmon Dis 2008;3:127-36.
82. Heaton RK, Grant I, McSweeny AJ, Adams KM, Petty TL. Psychologic effects of continuous and nocturnal oxygen therapy in hypoxemic chronic obstructive pulmonary disease. Arch Intern Med 1983;143:1941-7.
83. Alison JA, McKeough ZJ, Leung RW, Holland AE, Hill K, Morris NR, et al. Oxygen compared to air during exercise training in COPD with exercise-induced desaturation. Eur Respir J 2019;53:1802429.
84. Neves LF, Reis MH, Plentz RD, Matte DL, Coronel CC, Sbruzzi G. Expiratory and expiratory plus inspiratory muscle training improves respiratory muscle strength in subjects with COPD:systematic review. Respir Care 2014;59:1381-8.
85. Xu W, Li R, Guan L, Wang K, Hu Y, Xu L, et al. Combination of inspiratory and expiratory muscle training in same respiratory cycle versus different cycles in COPD patients: a randomized trial. Respir Res 2018;19:225.
86. O’Brien K, Geddes EL, Reid WD, Brooks D, Crowe J. Inspiratory muscle training compared with other rehabilitation interventions in chronic obstructive pulmonary disease: a systematic review update. J Cardiopulm Rehabil Prev 2008;28:128-41.
87. Wouters EF, Posthuma R, Koopman M, Liu WY, Sillen MJ, Hajian B, et al. An update on pulmonary rehabilitation techniques for patients with chronic obstructive pulmonary disease. Expert Rev Respir Med 2020;14:149-61.
88. Coyle ME, Shergis JL, Huang ET, Guo X, Di YM, Zhang A, et al. Acupuncture therapies for chronic obstructive pulmonary disease: a systematic review of randomized, controlled trials. Altern Ther Health Med 2014;20:10-23.
89. Vonbank K, Strasser B, Mondrzyk J, Marzluf BA, Richter B, Losch S, et al. Strength training increases maximum working capacity in patients with COPD: randomized clinical trial comparing three training modalities. Respir Med 2012;106:557-63.
90. Polkey MI, Qiu ZH, Zhou L, Zhu MD, Wu YX, Chen YY, et al. Tai Chi and pulmonary rehabilitation compared for treatment-naive patients with COPD: a randomized controlled trial. Chest 2018;153:1116-24.
91. Vogiatzis I, Rochester CL, Spruit MA, Troosters T, Clini EM;American Thoracic Society/European Respiratory Society Task Force on Policy in Pulmonary Rehabilitation. Increasing implementation and delivery of pulmonary rehabilitation:key messages from the new ATS/ERS policy statement. Eur Respir J 2016;47:1336-41.
92. Han MK, Martinez CH, Au DH, Bourbeau J, Boyd CM, Branson R, et al. Meeting the challenge of COPD care delivery in the USA: a multiprovider perspective. Lancet Respir Med 2016;4:473-526.
93. Godtfredsen N, Sorensen TB, Lavesen M, Pors B, Dalsgaard LS, Dollerup J, et al. Effects of community-based pulmonary rehabilitation in 33 municipalities in Denmark: results from the KOALA project. Int J Chron Obstruct Pulmon Dis 2019;14:93-100.
94. Amin S, Abrazado M, Quinn M, Storer TW, Tseng CH, Cooper CB. A controlled study of community-based exercise training in patients with moderate COPD. BMC Pulm Med 2014;14:125.
95. Holland AE, Mahal A, Hill CJ, Lee AL, Burge AT, Cox NS, et al. Home-based rehabilitation for COPD using minimal resources:a randomised, controlled equivalence trial. Thorax 2017;72:57-65.
- Downloaded
- Viewed
- 0KCI Citations
- 0WOS Citations