Pulmonary Rehabilitation and Physical Activity in Patients with Chronic Obstructive Pulmonary Disease

Abstract

Physical inactivity is common in patients with chronic obstructive pulmonary disease (COPD) compared with age-matched healthy individuals or patients with other chronic diseases. Physical inactivity independently predicts poor outcomes across several aspects of this disease, but it is (at least in principle) treatable in patients with COPD. Pulmonary rehabilitation has arguably the greatest positive effect of any current therapy on exercise capacity in COPD; as such, gains in this area should facilitate increases in physical activity. Furthermore, because pulmonary rehabilitation also emphasizes behavior change through collaborative self-management, it may aid in the translation of increased exercise capacity to greater participation in activities involving physical activity. Both increased exercise capacity and adaptive behavior change are necessary to achieve significant and lasting increases in physical activity in patients with COPD. Unfortunately, it is readily assumed that this translation occurs naturally. This concise clinical review will focus on the effects of a comprehensive pulmonary rehabilitation program on physical activity in patients with COPD. Changing physical activity behavior in patients with COPD needs an interdisciplinary approach, bringing together respiratory medicine, rehabilitation sciences, social sciences, and behavioral sciences.

Recent Advances in Pulmonary Rehabilitation for Patients with COPD

“…Metabolic cart systems which measure expired O 2 and CO 2 ; however, cannot be used over extended periods of time. [45][46][47] Physical activity can also be monitored directly using physical activity monitors.…”

“…Pedometers are devices which estimate the number of steps taken through mechanical or digital measurements in only the vertical plane. [45][46][47] This is a limited measure of physical activity. Accelerometers detect acceleration in one, two or three directions (uni-, bi-or triaxial accelerometers).…”

“…heartrate or skin temperature) in an attempt to optimize physical activity assessments. 45,47 With the advancement of technology, many activity monitors are available recently to measure physical activity (Figure 8). [48][49][50] Physical activity in patients with COPD is dependent on many factors, including physiological, behavioral, social, environmental, and cultural factors.…”

“…47 This clinical review will cover the definition of physical activity (which is a different component than exercise capacity); its prevalence in COPD, its objective measurement, risk factors for physical inactivity, and potential ways to improve or maintain the components of physical strength. PR has arguably the strongest positive effect of any current therapy on exercise capacity in stable patients with COPD.…”

Adding Pedometers to Pulmonary Rehabilitation Did Not Result in Greater Physical Activity. An Important Answer, but What Was the Question?

“…Nolan and colleagues should be acknowledged for helping our community restart the discussion about the complementary, not identical, concepts of exercise (e.g., walking) and an active lifestyle (e.g., time on moderately intense physical activity) (10). The difference, which is beyond semantics, should be a driving force for the future design of new interventions and strategies for education and pulmonary rehabilitation (16). Outcomes from pulmonary rehabilitation and other interventions need to go beyond exercise capacity, switching to changes in physical activity behavior in COPD.…”