Skip to main navigation menu Skip to main content Skip to site footer

Review article: Biomedical intelligence

Vol. 140 No. 3536 (2010)

Making pulmonary rehabilitation a success in COPD

  • J Bourbeau
DOI
https://doi.org/10.4414/smw.2010.13067
Cite this as:
Swiss Med Wkly. 2010;140:w13067
Published
30.08.2010

Summary

A truly successful pulmonary rehabilitation entails implementing physical activity maintenance. This article reviews the current knowledge on pulmonary rehabilitation and the expected benefits, the setting, the relationship between self-management and pulmonary rehabilitation, in order to develop and implement clinically-effective physical activity maintenance interventions.

The effectiveness of pulmonary rehabilitation is well-established. However, access to pulmonary rehabilitation is limited. Home-based pulmonary rehabilitation has been shown to be an effective, equivalent alternative to outpatient pulmonary rehabilitation in COPD patients. The opportunity to offer different pulmonary rehabilitation settings tailored to individual needs should improve accessibility to this intervention.

Sustained long-term physical activity remains the most important challenge for COPD patients. We need a dependable system of coordinated health care interventions and communication, and components that include self-management support. Self-management should be an integrated part of pulmonary rehabilitation and remain long after the pulmonary rehabilitation is completed. By early identification of patients who may have difficulty maintaining exercise and implementing appropriate self-management interventions during and after the rehabilitation program, it may be possible to promote better long-term involvement in physical activity.

Pulmonary rehabilitation should not stand alone; the best program is that which can be maintained to translate into a continuous increase in the activities of daily living. Future research should evaluate the effect of self-management interventions combined with pulmonary rehabilitation to improve long-term activity and exercise maintenance.

References

  1. Lacasse Y, Wong E, Guyatt GH, et al. Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease. Lancet. 1996;348(9035):1115–9.
  2. Nici L, Donner C, Wouters E, et al. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med. 2006;173(12):1390–413.
  3. Heppner PS, Morgan C, Kaplan RM, et al. Regular walking and long-term maintenance of outcomes after pulmonary rehabilitation. J Cardiopulm Rehabil. 2006;26(1):44–53.
  4. Berry MJ, Rejeski WJ, Adair NE, et al. A randomized, controlled trial comparing long-term and short-term exercise in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2003; 23(1):60–8.
  5. Emery CF, Shermer RL, Hauck ER, et al. Cognitive and psychological outcomes of exercise in a 1-year follow-up study of patients with chronic obstructive pulmonary disease. Health Psychol. 2003;22(6):598–604.
  6. Lacasse Y, Goldstein R, Lasserson TJ, et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2006;(4):CD003793.
  7. Ries AL, Bauldoff GS, Carlin BW, et al. Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines. Chest. 2007;131(5 Suppl):4S–42S.
  8. Casaburi R, Patessio A, Ioli F, et al. 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(1):9–18.
  9. Maltais F, LeBlanc P, Simard C, 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 (Aug)):442–7.
  10. Maltais F, Simard AA, Simard C, et al. 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(1):288–93.
  11. Maltais F, LeBlanc P, Simard C, 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.
  12. Maltais F, LeBlanc P, Jobin J, et al. Intensity of training and physiologic adaptation in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1997;155(2):555–61.
  13. Ries AL, Kaplan RM, Limberg TM, et al. Effects of pulmonary rehabilitation on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease. Ann Intern Med. 1995;122(11):823–32.
  14. Bernard S, Whittom F, LeBlanc P, et al. Aerobic and strength training in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999159(3):896–901.
  15. Puente-Maestu L, Sanz M, Sanz P, et al. Comparison of effects of supervised versus self-monitored training programmes in patients with chronic obstructive pulmonary disease. Eur Respir J. 2000;15(3):517–25.
  16. Vogiatzis I, Williamson AF, Miles J, et al. Physiological response to moderate exercise workloads in a pulmonary rehabilitation program in patients with varying degrees of airflow obstruction. Chest. 1999;116(5):1200–7.
  17. Whittom F, Jobin J, Simard PM, et al. Histochemical and morphological characteristics of the vastus lateralis muscle in patients with chronic obstructive pulmonary disease. Med Sci Sports Exerc. 1998;30(10):1467–74.
  18. O’Donnell DE, McGuire M, Samis L, et al. General exercise training improves ventilatory and peripheral muscle strength and endurance in chronic airflow limitation. Am J Respir Crit Care Med. 1998;157(5 Pt 1):1489–97.
  19. Gigliotti F, Coli C, Bianchi R, et al. Exercise training improves exertional dyspnea in patients with COPD: evidence of the role of mechanical factors. Chest. 2003;123(6):1794–802.
  20. Bickford L, Hodgkin J, McInturff S. National pulmonary rehabilitation survey. Update. J Cardiopulm Rehabil. 1995;15(6):406–11.
  21. Brooks D, Sottana R, Bell B, et al. Characterization of pulmonary rehabilitation programs in Canada in 2005. Can Respir J. 2007;14(2):87–92.
  22. Yohannes AM, Connolly MJ. Pulmonary rehabilitation programmes in the UK: a national representative survey. Clin Rehabil. 2004;18(4):444–9.
  23. Goldstein R, Gort E, Stubbing D, et al. Randomised controlled trial of respiratory rehabilitation. Lancet. 1994;344(8934):1394–7.
  24. Strijbos JH, Postma DS, van AR, et al. A comparison between an outpatient hospital-based pulmonary rehabilitation program and a home-care pulmonary rehabilitation program in patients with COPD. A follow-up of 18 months. Chest. 1996;109(2):366–72.
  25. Debigarré R, Maltais F, Whittom F, et al. Feasibility and efficacy of home exercise training before lung volume reduction. J Cardiopulm Rehabil. 1999;19(4):235–41.
  26. Maltais F, Bourbeau J, Shapiro S, et al. Effects of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med. 2008;149(12):869–78.
  27. Strijbos JH, Postma DS, van AR, et al. Feasibility and effects of a home-care rehabilitation program in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 1996;16(6):386–93.
  28. Wijkstra PJ, Ten Vergert EM, van AR, et al. Long term benefits of rehabilitation at home on quality of life and exercise tolerance in patients with chronic obstructive pulmonary disease. Thorax. 1995;50(8):824–8.
  29. Vieira DSR, Maltais F, Bourbeau J. Home-based pulmonary rehabilitation in chronic obstructive pulmonary disease patients. Curr Opin in Pulm Med. 2010;16:134–43.
  30. Brooks D, Krip B, Mangovski-Alzamora S, et al. The effect of postrehabilitation programmes among individuals with chronic obstructive pulmonary disease. Eur Respir J. 2002;20(1):20–9.
  31. Ries AL, Kaplan RM, Myers R, et al. Maintenance after pulmonary rehabilitation in chronic lung disease: a randomized trial. Am J Respir Crit Care Med. 2003;167(6):880–8.
  32. Kaplan RM, Ries AL, Prewitt LM, et al. Self-efficacy expectations predict survival for patients with chronic obstructive pulmonary disease. Health Psychol. 1994;13(4):366–8.
  33. Brassington GS, Atienza AA, Perczek RE, et al. Intervention-related cognitive versus social mediators of exercise adherence in the elderly. Am J Prev Med. 2002;23(2 Suppl):80–6.
  34. Rhodes RE, Martin AD, Taunton JE, et al. Factors associated with exercise adherence among older adults. An individual perspective. Sports Med. 1999;28(6):397–411.
  35. Adams SG, Smith PK, Allan PF, et al. Systematic review of the chronic care model in chronic obstructive pulmonary disease prevention and management. Arch Intern Med. 2007;167(6):551–61.
  36. Effing T, Monninkhof E, van der Valk, et al. Self-management education for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2007;(4):CD002990.
  37. McAuley E, Lox C, Duncan TE. Long-term maintenance of exercise, self-efficacy, and physiological change in older adults. J Gerontol. 1993; 48(4):218–24.
  38. Jette AM, Rooks D, Lachman M, et al. Home-based resistance training: predictors of participation and adherence. Gerontologist. 1998;38(4):412–21.
  39. Nault D, Dagenais J, Perreault V, et al. Qualitative evaluation of a disease specific self-management program “Living well with COPD”. 2000: 317S.
  40. Soicher JE, Gauvin L, Bernard S, et al. Predictors of exercise adherence in COPD: A basis for designing rehabilitation strategies. 2009: A5377.
  41. Bourbeau J, Nault D, Dang-Tan T. Self-management and behaviour modification in COPD. Patient Educ Couns. 2004;52(3):271–7.
  42. Bourbeau J, van der Palen J. Promoting effective self-management programmes to improve COPD. Eur Respir J. 2009;33(3):461–3.
  43. Guell MR, de LP, Galdiz JB, et al. Home vs hospital-based pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: a Spanish multicenter trial. Arch Bronconeumol. 2008;44(10):512–8.
  44. Bourbeau J, Nault D. Self-management strategies in chronic obstructive pulmonary disease. Clin Chest Med. 2007;28(3):617–28.