Impact of Rehabilitation on the Health of Patients with COPD
According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD), pulmonary rehabilitation is one of the most effective therapeutic interventions for reducing dyspnea, improving physical performance, and enhancing quality of life. Below, we summarize current insights on the effectiveness and possibilities of rehabilitation for these patients.
What do the available studies say?
All patients with chronic obstructive pulmonary disease (COPD) benefit from rehabilitation regardless of its severity; the most evidence is available for patients in the moderately severe to severe stages. According to studies, it is associated with statistically significant (p < 0.001) and clinically relevant improvements in physical performance (in the 6-minute walking test [6MWT] by 44 meters; 95% confidence interval [CI] 35–55), reduction in dyspnea (+0.79 points in the Chronic Respiratory Disease Questionnaire [CRQ]; 95% CI 38–86), and improvement in quality of life (−6.9 points in the Saint George's Respiratory Questionnaire [SGRQ]; 95% CI −9.3 to −4.5).
For patients with acute exacerbation of COPD, pulmonary rehabilitation initiated immediately after hospital discharge reduces the number of rehospitalizations (odds ratio [OR] 0.22; 95% CI 0.08–0.58; p = 0.002) and mortality (OR 0.10; 95% CI 0.10–0.84; p = 0.02), additionally improving physical performance (in 6MWT by 62 meters; 95% CI 38–86) and quality of life (−7.8 points in SGRQ; 95% CI −12.1 to −3.5; p < 0.001). Such benefits are not achieved by any single medication used in the treatment of COPD.
How do individual rehabilitation techniques fare?
Endurance and interval training
The latest randomized study showed that patients in the advanced stages of COPD can benefit from interval training. Compared to continuous endurance training, it is associated with a lower degree of dynamic hyperinflation, thus allowing for longer training with less exertional dyspnea (6.2 vs. 7.2 points on the 10-point Borg scale).
Strength training
A meta-analysis of data from 750 patients with COPD showed that strength training combined with endurance training improves quality of life (−7.44 points in SGRQ; p = 0.005) and muscle strength (by 12 kg in the lower limbs; p < 0.001) compared to endurance training alone.
Respiratory muscle training
According to a meta-analysis, this type of training can independently improve respiratory muscle strength (PImax +13 cmH2O; p < 0.001), physical performance (in 6MWT by 32 meters; p < 0.001), and exertional dyspnea (p < 0.001). However, its additive benefit in comprehensive pulmonary rehabilitation is small.
Neuromuscular electrical stimulation
Muscle contractions induced by electrodes attached to the skin are primarily used in patients in advanced stages of the disease or immobile individuals. Improvement in the 6MWT was observed by 37 meters (p < 0.001).
Vibration training
Training with a vibration platform, which reflexively induces muscle contractions, improves balance by 36% (p < 0.001) according to a randomized study. Compared to endurance training alone, it also increases physical performance (in 6MWT by 27 meters; p < 0.05).
Other modalities
Other components of pulmonary rehabilitation can include training in breathing techniques to prolong exhalation or special coughing techniques.
Conclusion
Pulmonary rehabilitation is an effective and cost-efficient therapeutic intervention that reduces dyspnea, improves physical performance and overall quality of life in patients with COPD. Among other benefits, it prevents muscle mass loss and significantly reduces anxiety and depression in these patients. It is indicated from stage II or B according to GOLD; however, its clear implementation into the guidelines is still missing.
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Source: Gloeckl R., Schneeberger T., Jarosch I. et al. Pulmonary rehabilitation and exercise training in chronic obstructive pulmonary disease. Dtsch Arztebl Int 2018; 115 (8): 117–123, doi: 10.3238/arztebl.2018.0117.
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