An Official American Thoracic Society/European Respiratory Society Statement: Key Concepts and Advances in Pulmonary Rehabilitation

Spruit, Martijn A.; Singh, Sally; Garvey, Chris; ZuWallack, Richard; Nici, Linda; Holland, Anne E; Lareau, Suzanne C.; Pitta, Fábio; Sewell, Louise; Raskin, Jonathan; Bourbeau, Jean; Crouch, R. H.; Franssen, Frits M.E.; Casaburi, Richard; Vercoulen, J.H.M.M.; Vogiatzis, Ioannis; Gosselink, Rik; Clini, Enrico; Effing, Tanja; Palen, Job van der; Troosters, Thierry; Janssen, Daisy J.A.; Collins, Eileen G.; Garcia‐Aymerich, Judith; Brooks, Dina; Fahy, Bonnie; Puhan, Milo A.; Hoogendoorn, Martine; Garrod, Rachel; Schols, A.M.W.J.; Carlin, Brian; Benzo, Roberto; Morgan, Mike; Ries, Andrew L.; Goldstein, Roger; Dowson, Claire A.; Brožek, Jan; Donner, Claudio F.; Wouters, Emiel F.M.

doi:10.1164/rccm.201309-1634st

Cited by 3,017 publications

(3,206 citation statements)

References 725 publications

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“…In 2013 the definition of pulmonary rehabilitation was revised [14,15] and the new ATS/ERS definition of pulmonary rehabilitation is: Pulmonary rehabilitation is a comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies which include, but are not limited to, exercise training, education and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors. (12:1170,13:e16)…”

Section: Introductionmentioning

confidence: 99%

“…So The ATS/ERS statement on pulmonary rehabilitation emphasizes the importance of promoting an adaptive behaviour change, especially collaborative self-management attempting to gain a higher level of physical activity in daily life (PADL) [14,15]. Collaborative self-management strategies promote self-efficacy – confidence in successfully managing one’s health – which are central in acquiring new adaptive behaviour [15].…”

Section: Introductionmentioning

confidence: 99%

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Barriers and motivational factors towards physical activity in daily life living with COPD – an interview based pilot study

Østergaard

Sritharan

Kristiansen

et al. 2018

European Clinical Respiratory Journal

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Background: In Denmark, few people with Chronic Obstructive Pulmonary Disease (COPD) engage in physical activity although it is evident that pulmonary rehabilitation has positive effects on physical activity, dyspnoea, anxiety, fatigue and quality of life. Objective: The purpose of this pilot study was to explore why people with COPD do not engage in physical activity and to explore motivational factors and barriers towards physical activity. Furthermore, to explore the role general practitioners have in this matter. Design: We conducted fieldwork among five people with COPD and three general practitioners using qualitative semi-structured interviews. We made a thematic analysis and our analytical perspective was based on The Health Belief Model and Self Determination Theory. Results: Findings revealed that people with COPD was not active because they did not receive the necessary information from the general practitioners about the benefits of physical activity neither about the negative consequences of an inactive lifestyle. Motivational factors were knowledge about COPD and benefits of physical activity. Experiencing the benefits on their own bodies, feeling that it was not dangerous to feel breathless and being successful coping with breathlessness were motivational. Functional tests like walking tests were very important and motivational for the participants because they outlined the progress achieved during activity and provided evidence of progress that was easy to comprehend compared with spirometry tests. General practitioners did not inform about the benefits of physical activity because they felt that medication was more important than physical activity and that people with COPD would not be motivated to be active. Conclusions: The main reason for people with COPD not being physically active in our study was lack of sufficient information from their general practitioners. This study described some barriers, enablers and motivational factors for a physically active lifestyle and the general practitioners’ role in this. Thus, it is important that people with COPD receive early information about physical activity - and it should start with the general practitioners, who are the gate keepers in the health care system. We recommend that lung function test results are never used as a single indicator of disease progression and that more focus should be paid to functional tests like The Shuttle Walking Test or The Six Minute Walking Test.Further studies to identify barriers to, and facilitators for referral people with COPD to physical activity in daily life from the perspective of Danish general practitioners are required.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Barriers and motivational factors towards physical activity in daily life living with COPD – an interview based pilot study

Østergaard

Sritharan

Kristiansen

et al. 2018

European Clinical Respiratory Journal

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“…Measurements were performed at CIRO before entering PR, as part of a 3 day baseline assessment and after completion of the PR during a 2 day outcome assessment3 with quadriceps muscle strength (QMS) as primary outcome. Secondary outcomes included body composition measured by dual energy X‐ray absorptiometry (DEXA), cycle endurance time (CET), inspiratory muscle strength (IMS), and daily steps by a tri‐axial GT3X Actigraph accelerometer (Health One Technology, Fort Walton Beach, FL) worn on an elastic belt firmly attached around the waist for 7 consecutive days before and after the intervention period, habitual dietary intake using a validated cross‐check dietary history method and fasting plasma levels of vitamin D (25‐hydroxycholecalciferol), branched‐chain amino acids (BCAAs), and fatty acid profile in phospholipids.…”

Section: Methodsmentioning

confidence: 99%

“…Treatment of muscle dysfunction to alleviate progressive disability has been subject of intensive research in COPD. Exercise training is considered as cornerstone of pulmonary rehabilitation (PR) for improving lower limb muscle function 3. The latest Cochrane meta‐analysis by Ferreira et al 4 concludes that nutritional supplementation promotes weight gain and fat‐free mass as proxy of muscle mass among patients with COPD, especially if undernourished and when combined with exercise training.…”

Section: Introductionmentioning

confidence: 99%

A randomized clinical trial investigating the efficacy of targeted nutrition as adjunct to exercise training in COPD

Bool

Rutten

Helvoort

et al. 2017

J cachexia sarcopenia muscle

111

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BackgroundEvidence regarding the efficacy of nutritional supplementation to enhance exercise training responses in COPD patients with low muscle mass is limited.The objective was to study if nutritional supplementation targeting muscle derangements enhances outcome of exercise training in COPD patients with low muscle mass.MethodsEighty‐one COPD patients with low muscle mass, admitted to out‐patient pulmonary rehabilitation, randomly received oral nutritional supplementation, enriched with leucine, vitamin D, and omega‐3 fatty acids (NUTRITION) or PLACEBO as adjunct to 4 months supervised high intensity exercise training.ResultsThe study population (51% males, aged 43–80) showed moderate airflow limitation, low diffusion capacity, normal protein intake, low plasma vitamin D, and docosahexaenoic acid. Intention‐to‐treat analysis revealed significant differences after 4 months favouring NUTRITION for body mass (mean difference ± SEM) (+15 ± 06 kg, P = 001), plasma vitamin D (+24%, P = 0004), eicosapentaenoic acid (+91%,P < 0001), docosahexaenoic acid (+31%, P < 0001), and steps/day (+24%, P = 0048). After 4 months, both groups improved skeletal muscle mass (+04 ± 01 kg, P < 0001), quadriceps muscle strength (+123 ± 23 Nm,P < 0001), and cycle endurance time (+1914 ± 343 s, P < 0001). Inspiratory muscle strength only improved in NUTRITION (+05 ± 01 kPa, P = 0001) and steps/day declined in PLACEBO (−18%,P = 0005).ConclusionsHigh intensity exercise training is effective in improving lower limb muscle strength and exercise performance in COPD patients with low muscle mass and moderate airflow obstruction. Specific nutritional supplementation had additional effects on nutritional status, inspiratory muscle strength, and physical activity compared with placebo.

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“…The American Thoracic Society (ATS)/European Respiratory Society (ERS) definition of pulmonary rehabilitation: ‘ Pulmonary rehabilitation is a comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies that include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors [17]. ’…”

Section: Rehabilitation and Palliative Carementioning

confidence: 99%

Danish respiratory society position paper: palliative care in patients with chronic progressive non-malignant lung diseases

Marsaa

Gundestrup

Lange

et al. 2018

European Clinical Respiratory Journal

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Background: Chronic non-malignant lung diseases such as chronic obstructive pulmonary disease (COPD) and interstitial lung diseases (ILD) result in reduced quality of life (QoL), a high symptom burden and reduced survival. Patients with chronic non-malignant lung disease often have limited access to palliative care. The symptom burden and the QoL of these patients resembles patients with cancer and the general palliative approach is similar. However, the disease trajectory is often slow and unpredictable, and the palliative effort must be built on accessibility, continuity and professional competences. The Danish Health Authority as well as the WHO recommends that there is access to palliative care for all patients with life-threatening diseases regardless of diagnosis. In 2011, the Danish Health Authority requested that the national medical societies would to formulate guidelines for palliation. Methods: In 2015, a group of members of the Danish Respiratory Society (DRS) was appointed for this purpose. It was composed of experienced ILD and COPD researchers as well as clinicians from different parts of Denmark. A literature review was made, a draft was prepared, and all recommendations were agreed upon unanimously. Results: The Danish version of the position paper was finally submitted for review and accepted by all members of DRS. Conclusion: In this position paper we provide recommendations on the terminology of chronic and terminal lung failure, rehabilitation and palliative care, advanced care planning, informal caregivers and bereavement, symptom management, the imminently dying patient, and organization of palliative care for patients with chronic non-malignant lung diseases.

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An Official American Thoracic Society/European Respiratory Society Statement: Key Concepts and Advances in Pulmonary Rehabilitation

Abstract: The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease.

Cited by 3,017 publications

References 725 publications

Barriers and motivational factors towards physical activity in daily life living with COPD – an interview based pilot study

Barriers and motivational factors towards physical activity in daily life living with COPD – an interview based pilot study

A randomized clinical trial investigating the efficacy of targeted nutrition as adjunct to exercise training in COPD

Danish respiratory society position paper: palliative care in patients with chronic progressive non-malignant lung diseases

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