How to adapt the pulmonary rehabilitation programme to patients with chronic respiratory disease other than COPD

Abstract

Dyspnoea, fatigue, reduced exercise tolerance, peripheral muscle dysfunction and mood disorders are common features of many chronic respiratory disorders. Pulmonary rehabilitation successfully treats these manifestations in chronic obstructive pulmonary disease (COPD) and emerging evidence suggests that these benefits could be extended to other chronic respiratory conditions, although adaptations to the standard programme format may be required. Whilst the benefits of exercise training are well established in asthma, pulmonary rehabilitation can also provide evidence-based interventions including breathing techniques and self-management training. In interstitial lung disease, a small number of trials show improved exercise capacity, symptoms and quality of life following pulmonary rehabilitation, which is a positive development for patients who may have few treatment options. In pulmonary arterial hypertension, exercise training is safe and effective if patients are stable on medical therapy and close supervision is provided. Pulmonary rehabilitation for bronchiectasis, including exercise training and airway clearance techniques, improves exercise capacity and quality of life. In nonsmall cell lung cancer, a comprehensive interdisciplinary approach is required to ensure the success of pulmonary rehabilitation following surgery. Pulmonary rehabilitation programmes provide important and underutilised opportunities to improve the integrated care of people with chronic respiratory disorders other than COPD. @ERSpublications The benefits of pulmonary rehabilitation can be extended to people with a broad range of chronic respiratory conditions

The Effects of Respiratory Muscle Weakness and Pulmonary Involvement on Functional Status, Fatigue and Health Related Quality of Life in Patients With Systemic Sclerosis

“…[27][28][29] Marcisz et al 30 showed that FVC, forced expiratory volume in one second, VC, MVV, maximum midexpiratory flow rate 25-75%, and peak expiratory flow rate values were significantly decreased in SSc patients compared to controls. Pulmonary function test results of our patients are similar to this study.…”

Physical activity and training in sarcoidosis: review and experience-based recommendations

“…Although physical training interventions described for ILD show great similarities with interventions used in other chronic lung diseases, e.g. COPD [2,75], lessons learned from other disorders, like neurological and rheumatologic disorders, should be taken into account as well [6]. Studies carried out so far involving subjects with sarcoidosis have shown that physical activity can reduce their symptoms.…”

“…The intensity of the training should be personalized, tailored to the individual -which might also include adjustments for daily fluctuations in energy levels -to avoid aggravating the impairments, which would result in high dropout rates [2]. Besides, as with other chronic cardiopulmonary diseases, exercise limitation in sarcoidosis is most likely to be multifactorial, meaning that exercise capacity is not limited by any single component of the disease process, but rather by their collective quantitative interaction(s).…”

“…The unique clinical picture and underlying pathophysiology of sarcoidosis may require sarcoidosis-specific exercise prescription. Furthermore, organ-specific manifestations, such as joint pain and stiffness, may require modification of the standard PR program [2], including reduction of weight-bearing exercise [52].…”

“…Physical training or pulmonary rehabilitation (PR) is an important element of the comprehensive care of people with pulmonary diseases and other chronic diseases, including musculoskeletal disorders, neurological diseases, and psychiatric conditions [1][2][3][4][5][6]. Of note, exercise also has a role as treatment in diseases such as those of the locomotive apparatus or respiratory system that do not primarily manifest as organspecific disorders, but also are accompanied by many other clinical manifestations such as fatigue and other disabling nonspecific symptoms [3,6].…”