Respiratory rehabilitation in COPD patients: Experience in a rural Primary Health Care Center Respiratory rehabilitation improves physical capacity and quality of life in COPD patients as it has been previously reported. In Chile there are few and unpublished experiences on respiratory rehabilitation programs (RRP) implemented in primary health care (PHC). Our aim was to evaluate RRP outcome in COPD patients carried out in a rural PHC center. Methods: A prospective descriptive study of RRP in a PHC center implemented in Talagante (a village located 40 km from Santiago). COPD patients were enrolled in the study from July 2012 to May 2014. Patients having the inclusion criteria were admitted to a 12 weeks-long RPP. This program included a 90 minute-long sessions of aerobic training (walking), strength training of upper and lower limbs (dumbbell, ankle support and elastic bands) and respiratory muscle training (threshold valve), twice a week. Quality of life, strength of trained muscles, six-minutes walking test (TM6), BODE index and dyspnea index, were measured before and after completing RRP. Results were expressed as mean ± SD. Results: Out of 79 patients initially assessed, 54 were admitted to the RRP and 39 patients completed the program and were included in the analysis. Their mean age was 67.

Lower extremity exercise training in the rehabilitation of patients with chronic obstructive pulmonary diseaseSeveral studies have shown that poor exercise tolerance in Chronic Obstructive Pulmonary Disease (COPD) patients is multifactorial in origin. However, a major exercise-limiting factor in COPD is peripheral muscle dysfunction, particularly the muscles of the lower extremities, characterized by atrophic muscles and reduced fatigue resistance due to morphological and metabolic alterations of peripheral muscles. This chapter therefore evaluated the scientifi c evidence regarding the benefi cial effect of lower extremities exercise in the pulmonary rehabilitation in COPD patients. The technical characteristics of this exercise training were also reviewed. Exercise training of lower limbs was recommended in respiratory rehabilitation of COPD patients. The lower extremities muscle exercise training provides signifi cant benefi ts to patients with COPD in terms of reduction of dyspnea and improvemet in exercise capacity and in quality of life (quality level of evidence = A, strong recommendation). Higher-intensity exercise training and with interval exercise of the lower extrmities produces greater physiological benefi ts. ResumenDiversos estudios han demostrado que la pobre tolerancia al ejercicio de los pacientes con Enfermedad Pulmonar Obstructiva Crónica (EPOC) es de origen multifactorial. Sin embargo, un importante factor limitante del ejercicio en los pacientes con EPOC es la disfunción muscular periférica, sobre todo de los músculos de las extremidades inferiores, que se caracteriza por atrofi a muscular y reducida resistencia a la fatiga dado por alteraciones morfológicas y metabólicas de los músculos periféricos. En este capitulo se evaluó la evidencia científi ca que existe en cuanto a los benefi cios del entrenamiento muscular de extremidades inferiores (EEII) en la rehabilitación respiratoria en pacientes con EPOC. También se revisan las características técnicas de dicho entrenamiento. Se recomienda la realización de entrenamiento muscular de EEII en rehabilitación respiratoria de pacientes con EPOC. El entrenamiento muscular de extremidades inferiores otorga signifi cativos benefi cios a los pacientes con EPOC en cuanto a disminuir la disnea, mejorar la capacidad de ejercicio y la calidad de vida (calidad de la evidencia A, recomendación fuerte). El entrenamiento de EEII de alta intensidad y con intervalos produce signifi cativos benefi cios fi siológicos.Palabras clave: Ejercicio de extremidades inferiores, rehabilitación respiratoria, disfunción muscular periférica, entrenamiento muscular, EPOC.