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Pulmonary rehabilitation

Author
Bartolome R Celli, MD
Section Editor
James K Stoller, MD, MS
Deputy Editor
Helen Hollingsworth, MD

INTRODUCTION

Pulmonary rehabilitation improves symptoms, quality of life, pulmonary function, and health care utilization in patients with chronic respiratory disease. Most of the evidence supporting the benefit of pulmonary rehabilitation has been derived from studies of patients with chronic obstructive pulmonary disease (COPD). However, results obtained in patients with respiratory diseases different from COPD have provided evidence that the benefits from pulmonary rehabilitation are also observed in symptomatic patients with other respiratory diseases.  

The indications, goals, and components of pulmonary rehabilitation and the potential benefits for patients with chronic lung disease will be reviewed here [1]. Other therapeutic modalities, such as smoking cessation, oxygen therapy, bronchodilators, antibiotics, nutritional support, respiratory muscle training and resting, and cardiac rehabilitation, are discussed separately. (See "Management of stable chronic obstructive pulmonary disease" and "Overview of smoking cessation management in adults" and "Long-term supplemental oxygen therapy" and "Nutritional support in advanced lung disease" and "Respiratory muscle training and resting in COPD" and "Cardiac rehabilitation: Indications, efficacy, and safety in patients with coronary heart disease".)

DEFINITION

Pulmonary rehabilitation is a broad therapeutic concept. It is defined by the American Thoracic Society and the European Respiratory Society as 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" [2,3].

PATIENT SELECTION

The indications for pulmonary rehabilitation have not been precisely defined. The Global Initiative for Chronic Obstructive Disease suggests that pulmonary rehabilitation be included in the management of patients with chronic obstructive pulmonary disease (COPD) categories B, C, and D (table 1) [4]. For respiratory diseases different from COPD, there have been no formal statements regarding patient selection, but it is common to consider pulmonary rehabilitation in symptomatic patients whose quality of life is impaired by their disease.

Frailty affects approximately one-fourth of patients with COPD and is a predictor of noncompletion of pulmonary rehabilitation. However, a study of 816 patients with stable COPD of whom 212 (26 percent) met criteria for frailty found that those who completed pulmonary rehabilitation experienced reduced dyspnea, improved exercise performance and physical activity level, and 61 percent no longer met criteria for frailty [5]. Thus, frailty is not necessarily a contraindication. Similarly, chronic hypercapnia due to advanced COPD is not a contraindication, as benefit has been demonstrated in these patients [6].

                                 
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Literature review current through: Nov 2017. | This topic last updated: Jul 13, 2017.
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References
Top
  1. Troosters T, Casaburi R, Gosselink R, Decramer M. Pulmonary rehabilitation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2005; 172:19.
  2. Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013; 188:e13.
  3. Rochester CL, Vogiatzis I, Holland AE, et al. An Official American Thoracic Society/European Respiratory Society Policy Statement: Enhancing Implementation, Use, and Delivery of Pulmonary Rehabilitation. Am J Respir Crit Care Med 2015; 192:1373.
  4. Global Initiative for Chronic Obstructive Lung Disease (GOLD): Global Strategy for the Diagnosis, Management, and Prevention of COPD 2017. www.goldcopd.org (Accessed on January 19, 2017).
  5. Maddocks M, Kon SS, Canavan JL, et al. Physical frailty and pulmonary rehabilitation in COPD: a prospective cohort study. Thorax 2016; 71:988.
  6. Sahin H, Naz I, Varol Y, et al. Is a pulmonary rehabilitation program effective in COPD patients with chronic hypercapnic failure? Expert Rev Respir Med 2016; 10:593.
  7. Garvey C, Bayles MP, Hamm LF, et al. Pulmonary Rehabilitation Exercise Prescription in Chronic Obstructive Pulmonary Disease: Review of Selected Guidelines: AN OFFICIAL STATEMENT FROM THE AMERICAN ASSOCIATION OF CARDIOVASCULAR AND PULMONARY REHABILITATION. J Cardiopulm Rehabil Prev 2016; 36:75.
  8. Clini EM, Crisafulli E. Exercise capacity as a pulmonary rehabilitation outcome. Respiration 2009; 77:121.
  9. Dolmage TE, Evans RA, Hill K, et al. The effect of pulmonary rehabilitation on critical walk speed in patients with COPD: a comparison with self-paced walks. Chest 2012; 141:413.
  10. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002; 166:111.
  11. Puhan MA, Gimeno-Santos E, Cates CJ, Troosters T. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2016; 12:CD005305.
  12. Celli B, Tetzlaff K, Criner G, et al. The 6-Minute-Walk Distance Test as a Chronic Obstructive Pulmonary Disease Stratification Tool. Insights from the COPD Biomarker Qualification Consortium. Am J Respir Crit Care Med 2016; 194:1483.
  13. Singh SJ, Morgan MD, Scott S, et al. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax 1992; 47:1019.
  14. Hsia D, Casaburi R, Pradhan A, et al. Physiological responses to linear treadmill and cycle ergometer exercise in COPD. Eur Respir J 2009; 34:605.
  15. Man WD, Polkey MI, Donaldson N, et al. Community pulmonary rehabilitation after hospitalisation for acute exacerbations of chronic obstructive pulmonary disease: randomised controlled study. BMJ 2004; 329:1209.
  16. Lacasse Y, Wong E, Guyatt GH, et al. Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease. Lancet 1996; 348:1115.
  17. Sinclair DJ, Ingram CG. Controlled trial of supervised exercise training in chronic bronchitis. Br Med J 1980; 280:519.
  18. Cockcroft AE, Saunders MJ, Berry G. Randomised controlled trial of rehabilitation in chronic respiratory disability. Thorax 1981; 36:200.
  19. O'Donnell DE, Webb KA, McGuire MA. Older patients with COPD: benefits of exercise training. Geriatrics 1993; 48:59.
  20. Toshima MT, Kaplan RM, Ries AL. Experimental evaluation of rehabilitation in chronic obstructive pulmonary disease: short-term effects on exercise endurance and health status. Health Psychol 1990; 9:237.
  21. O'Hara WJ, Lasachuk BP, Matheson P, et al. Weight training and backpacking in chronic obstructive pulmonary disease. Respir Care 1984; 29:1202.
  22. Wijkstra PJ, Van Altena R, Kraan J, et al. Quality of life in patients with chronic obstructive pulmonary disease improves after rehabilitation at home. Eur Respir J 1994; 7:269.
  23. Goldstein RS, Gort EH, Stubbing D, et al. Randomised controlled trial of respiratory rehabilitation. Lancet 1994; 344:1394.
  24. Güell R, Casan P, Belda J, et al. Long-term effects of outpatient rehabilitation of COPD: A randomized trial. Chest 2000; 117:976.
  25. O'Shea SD, Taylor NF, Paratz JD. Progressive resistance exercise improves muscle strength and may improve elements of performance of daily activities for people with COPD: a systematic review. Chest 2009; 136:1269.
  26. Güell MR, de Lucas P, Gáldiz JB, et al. [Home vs hospital-based pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: a Spanish multicenter trial]. Arch Bronconeumol 2008; 44:512.
  27. Maltais F, Bourbeau J, Shapiro S, et al. Effects of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med 2008; 149:869.
  28. Troosters T, Probst VS, Crul T, et al. Resistance training prevents deterioration in quadriceps muscle function during acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2010; 181:1072.
  29. Morris PE, Berry MJ, Files DC, et al. Standardized Rehabilitation and Hospital Length of Stay Among Patients With Acute Respiratory Failure: A Randomized Clinical Trial. JAMA 2016; 315:2694.
  30. Holland AE, Mahal A, Hill CJ, et al. Home-based rehabilitation for COPD using minimal resources: a randomised, controlled equivalence trial. Thorax 2017; 72:57.
  31. Sewell L, Singh SJ, Williams JE, et al. How long should outpatient pulmonary rehabilitation be? A randomised controlled trial of 4 weeks versus 7 weeks. Thorax 2006; 61:767.
  32. du Moulin M, Taube K, Wegscheider K, et al. Home-based exercise training as maintenance after outpatient pulmonary rehabilitation. Respiration 2009; 77:139.
  33. Beauchamp MK, Evans R, Janaudis-Ferreira T, et al. Systematic review of supervised exercise programs after pulmonary rehabilitation in individuals with COPD. Chest 2013; 144:1124.
  34. Pitta F, Troosters T, Probst VS, et al. Are patients with COPD more active after pulmonary rehabilitation? Chest 2008; 134:273.
  35. Dallas MI, McCusker C, Haggerty MC, et al. Using pedometers to monitor walking activity in outcome assessment for pulmonary rehabilitation. Chron Respir Dis 2009; 6:217.
  36. Rejbi IB, Trabelsi Y, Chouchene A, et al. Changes in six-minute walking distance during pulmonary rehabilitation in patients with COPD and in healthy subjects. Int J Chron Obstruct Pulmon Dis 2010; 5:209.
  37. Güell MR, Cejudo P, Ortega F, et al. Benefits of Long-Term Pulmonary Rehabilitation Maintenance Program in Patients with Severe Chronic Obstructive Pulmonary Disease. Three-Year Follow-up. Am J Respir Crit Care Med 2017; 195:622.
  38. Sabit R, Griffiths TL, Watkins AJ, et al. Predictors of poor attendance at an outpatient pulmonary rehabilitation programme. Respir Med 2008; 102:819.
  39. Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based guidelines. ACCP/AACVPR Pulmonary Rehabilitation Guidelines Panel. American College of Chest Physicians. American Association of Cardiovascular and Pulmonary Rehabilitation. Chest 1997; 112:1363.
  40. O'Shea SD, Taylor NF, Paratz J. Peripheral muscle strength training in COPD: a systematic review. Chest 2004; 126:903.
  41. Zu Wallack RL, Patel K, Reardon JZ, et al. Predictors of improvement in the 12-minute walking distance following a six-week outpatient pulmonary rehabilitation program. Chest 1991; 99:805.
  42. Belman MJ, Kendregan BA. Exercise training fails to increase skeletal muscle enzymes in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 1981; 123:256.
  43. Maltais F, LeBlanc P, Simard C, et al. Skeletal muscle adaptation to endurance training in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1996; 154:442.
  44. Casaburi R, Patessio A, Ioli F, et al. Reductions in exercise lactic acidosis and ventilation as a result of exercise training in patients with obstructive lung disease. Am Rev Respir Dis 1991; 143:9.
  45. Porszasz J, Emtner M, Goto S, et al. Exercise training decreases ventilatory requirements and exercise-induced hyperinflation at submaximal intensities in patients with COPD. Chest 2005; 128:2025.
  46. Casaburi R, Porszasz J, Burns MR, et al. Physiologic benefits of exercise training in rehabilitation of patients with severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1997; 155:1541.
  47. Celli BR. The clinical use of upper extremity exercise. Clin Chest Med 1994; 15:339.
  48. Ries AL, Ellis B, Hawkins RW. Upper extremity exercise training in chronic obstructive pulmonary disease. Chest 1988; 93:688.
  49. Janaudis-Ferreira T, Hill K, Goldstein RS, et al. Resistance arm training in patients with COPD: A Randomized Controlled Trial. Chest 2011; 139:151.
  50. Martinez FJ, Vogel PD, Dupont DN, et al. Supported arm exercise vs unsupported arm exercise in the rehabilitation of patients with severe chronic airflow obstruction. Chest 1993; 103:1397.
  51. Costi S, Crisafulli E, Degli Antoni F, et al. Effects of unsupported upper extremity exercise training in patients with COPD: a randomized clinical trial. Chest 2009; 136:387.
  52. Pan L, Guo YZ, Yan JH, et al. Does upper extremity exercise improve dyspnea in patients with COPD? A meta-analysis. Respir Med 2012; 106:1517.
  53. Puhan MA, Büsching G, Schünemann HJ, et al. Interval versus continuous high-intensity exercise in chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med 2006; 145:816.
  54. Coppoolse R, Schols AM, Baarends EM, et al. Interval versus continuous training in patients with severe COPD: a randomized clinical trial. Eur Respir J 1999; 14:258.
  55. Beauchamp MK, Nonoyama M, Goldstein RS, et al. Interval versus continuous training in individuals with chronic obstructive pulmonary disease--a systematic review. Thorax 2010; 65:157.
  56. Zainuldin R, Mackey MG, Alison JA. Optimal intensity and type of leg exercise training for people with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2011; :CD008008.
  57. Nasis IG, Vogiatzis I, Stratakos G, et al. Effects of interval-load versus constant-load training on the BODE index in COPD patients. Respir Med 2009; 103:1392.
  58. Tandon MK. Adjunct treatment with yoga in chronic severe airways obstruction. Thorax 1978; 33:514.
  59. Holland AE, Hill CJ, Jones AY, McDonald CF. Breathing exercises for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2012; 10:CD008250.
  60. Yamaguti WP, Claudino RC, Neto AP, et al. Diaphragmatic breathing training program improves abdominal motion during natural breathing in patients with chronic obstructive pulmonary disease: a randomized controlled trial. Arch Phys Med Rehabil 2012; 93:571.
  61. Gosselink RA, Wagenaar RC, Rijswijk H, et al. Diaphragmatic breathing reduces efficiency of breathing in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1995; 151:1136.
  62. Geddes EL, O'Brien K, Reid WD, et al. Inspiratory muscle training in adults with chronic obstructive pulmonary disease: an update of a systematic review. Respir Med 2008; 102:1715.
  63. Smith K, Cook D, Guyatt GH, et al. Respiratory muscle training in chronic airflow limitation: a meta-analysis. Am Rev Respir Dis 1992; 145:533.
  64. Belman MJ, Botnick WC, Nathan SD, Chon KH. Ventilatory load characteristics during ventilatory muscle training. Am J Respir Crit Care Med 1994; 149:925.
  65. Maddocks M, Nolan CM, Man WD, et al. Neuromuscular electrical stimulation to improve exercise capacity in patients with severe COPD: a randomised double-blind, placebo-controlled trial. Lancet Respir Med 2016; 4:27.
  66. Ngai SP, Jones AY, Tam WW. Tai Chi for chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev 2016; :CD009953.
  67. Make B. Collaborative self-management strategies for patients with respiratory disease. Respir Care 1994; 39:566.
  68. Brown AT, Hitchcock J, Schumann C, et al. Determinants of successful completion of pulmonary rehabilitation in COPD. Int J Chron Obstruct Pulmon Dis 2016; 11:391.
  69. Atkins CJ, Kaplan RM, Timms RM, et al. Behavioral exercise programs in the management of chronic obstructive pulmonary disease. J Consult Clin Psychol 1984; 52:591.
  70. Ries AL, Kaplan RM, Limberg TM, Prewitt LM. Effects of pulmonary rehabilitation on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease. Ann Intern Med 1995; 122:823.
  71. Wedzicha JA, Bestall JC, Garrod R, et al. Randomized controlled trial of pulmonary rehabilitation in severe chronic obstructive pulmonary disease patients, stratified with the MRC dyspnoea scale. Eur Respir J 1998; 12:363.
  72. Heffner JE, Fahy B, Hilling L, Barbieri C. Outcomes of advance directive education of pulmonary rehabilitation patients. Am J Respir Crit Care Med 1997; 155:1055.
  73. Kuzma AM, Meli Y, Meldrum C, et al. Multidisciplinary care of the patient with chronic obstructive pulmonary disease. Proc Am Thorac Soc 2008; 5:567.
  74. Burge AT, Lee A, Nicholes M, et al. Advance care planning education in pulmonary rehabilitation: A qualitative study exploring participant perspectives. Palliat Med 2013; 27:508.
  75. van Manen JG, Bindels PJ, Dekker FW, et al. Risk of depression in patients with chronic obstructive pulmonary disease and its determinants. Thorax 2002; 57:412.
  76. Yohannes AM, Dryden S, Hanania NA. The Responsiveness of the Anxiety Inventory for Respiratory Disease Scale Following Pulmonary Rehabilitation. Chest 2016; 150:188.
  77. Lustig FM, Haas A, Castillo R. Clinical and rehabilitation regime in patients with chronic obstructive pulmonary diseases. Arch Phys Med Rehabil 1972; 53:315.
  78. Solomon BK, Wilson KG, Henderson PR, et al. Loss of Dignity in Severe Chronic Obstructive Pulmonary Disease. J Pain Symptom Manage 2016; 51:529.
  79. Paz-Díaz H, Montes de Oca M, López JM, Celli BR. Pulmonary rehabilitation improves depression, anxiety, dyspnea and health status in patients with COPD. Am J Phys Med Rehabil 2007; 86:30.
  80. Ries AL, Bauldoff GS, Carlin BW, et al. Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines. Chest 2007; 131:4S.
  81. Bianchi R, Gigliotti F, Romagnoli I, et al. Impact of a rehabilitation program on dyspnea intensity and quality in patients with chronic obstructive pulmonary disease. Respiration 2011; 81:186.
  82. McCarthy B, Casey D, Devane D, et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2015; :CD003793.
  83. Hanekom S, Gosselink R, Dean E, et al. The development of a clinical management algorithm for early physical activity and mobilization of critically ill patients: synthesis of evidence and expert opinion and its translation into practice. Clin Rehabil 2011; 25:771.
  84. Seymour JM, Moore L, Jolley CJ, et al. Outpatient pulmonary rehabilitation following acute exacerbations of COPD. Thorax 2010; 65:423.
  85. Ries AL, Make BJ, Lee SM, et al. The effects of pulmonary rehabilitation in the national emphysema treatment trial. Chest 2005; 128:3799.
  86. Cote CG, Celli BR. Pulmonary rehabilitation and the BODE index in COPD. Eur Respir J 2005; 26:630.
  87. Stav D, Raz M, Shpirer I. Three years of pulmonary rehabilitation: inhibit the decline in airflow obstruction, improves exercise endurance time, and body-mass index, in chronic obstructive pulmonary disease. BMC Pulm Med 2009; 9:26.
  88. Puhan MA, Scharplatz M, Troosters T, Steurer J. Respiratory rehabilitation after acute exacerbation of COPD may reduce risk for readmission and mortality -- a systematic review. Respir Res 2005; 6:54.
  89. Vale F, Reardon JZ, ZuWallack RL. The long-term benefits of outpatient pulmonary rehabilitation on exercise endurance and quality of life. Chest 1993; 103:42.
  90. Wijkstra PJ, TenVergert EM, van der Mark TW, et al. Relation of lung function, maximal inspiratory pressure, dyspnoea, and quality of life with exercise capacity in patients with chronic obstructive pulmonary disease. Thorax 1994; 49:468.
  91. Finnerty JP, Keeping I, Bullough I, Jones J. The effectiveness of outpatient pulmonary rehabilitation in chronic lung disease: a randomized controlled trial. Chest 2001; 119:1705.
  92. Petty TL, Nett LM, Finigan MM, et al. A comprehensive care program for chronic airway obstruction. Methods and preliminary evaluation of symptomatic and functional improvement. Ann Intern Med 1969; 70:1109.
  93. Hodgkin JE. Benefits and the Future of Pulmonary Rehabilitation. In: Pulmonary Rehabilitation: Guidelines To Success, 4th ed, Hodgkin JE, Celli BR, Connors GL (Eds), Mosby Elsevier, St. Louis, MI 2009.
  94. Hudson LD, Tyler ML, Petty TL. Hospitalization needs during an outpatient rehabilitation program for severe chronic airway obstruction. Chest 1976; 70:606.
  95. Jensen PS. Risk, protective factors, and supportive interventions in chronic airway obstruction. Arch Gen Psychiatry 1983; 40:1203.
  96. Griffiths TL, Burr ML, Campbell IA, et al. Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial. Lancet 2000; 355:362.
  97. Crisafulli E, Costi S, Luppi F, et al. Role of comorbidities in a cohort of patients with COPD undergoing pulmonary rehabilitation. Thorax 2008; 63:487.
  98. Crisafulli E, Gorgone P, Vagaggini B, et al. Efficacy of standard rehabilitation in COPD outpatients with comorbidities. Eur Respir J 2010; 36:1042.
  99. Foglio K, Bianchi L, Bruletti G, et al. Seven-year time course of lung function, symptoms, health-related quality of life, and exercise tolerance in COPD patients undergoing pulmonary rehabilitation programs. Respir Med 2007; 101:1961.
  100. Romagnoli M, Dell'Orso D, Lorenzi C, et al. Repeated pulmonary rehabilitation in severe and disabled COPD patients. Respiration 2006; 73:769.
  101. Ringbaek T, Brøndum E, Martinez G, et al. Rehabilitation in COPD: the long-term effect of a supervised 7-week program succeeded by a self-monitored walking program. Chron Respir Dis 2008; 5:75.
  102. Hill K, Bansal V, Brooks D, Goldstein RS. Repeat pulmonary rehabilitation programs confer similar increases in functional exercise capacity to initial programs. J Cardiopulm Rehabil Prev 2008; 28:410.
  103. Morisset J, Dubé BP, Garvey C, et al. The Unmet Educational Needs of Patients with Interstitial Lung Disease. Setting the Stage for Tailored Pulmonary Rehabilitation. Ann Am Thorac Soc 2016; 13:1026.
  104. Mendes FA, Gonçalves RC, Nunes MP, et al. Effects of aerobic training on psychosocial morbidity and symptoms in patients with asthma: a randomized clinical trial. Chest 2010; 138:331.
  105. Eichenberger PA, Diener SN, Kofmehl R, Spengler CM. Effects of exercise training on airway hyperreactivity in asthma: a systematic review and meta-analysis. Sports Med 2013; 43:1157.
  106. Morris NR, Kermeen FD, Holland AE. Exercise-based rehabilitation programmes for pulmonary hypertension. Cochrane Database Syst Rev 2017; 1:CD011285.
  107. Wang H, Liu X, Rice SJ, Belani CP. Pulmonary Rehabilitation in Lung Cancer. PM R 2016; 8:990.
  108. Jones LW, Eves ND, Peterson BL, et al. Safety and feasibility of aerobic training on cardiopulmonary function and quality of life in postsurgical nonsmall cell lung cancer patients: a pilot study. Cancer 2008; 113:3430.
  109. Wickerson L, Rozenberg D, Janaudis-Ferreira T, et al. Physical rehabilitation for lung transplant candidates and recipients: An evidence-informed clinical approach. World J Transplant 2016; 6:517.
  110. Li M, Mathur S, Chowdhury NA, et al. Pulmonary rehabilitation in lung transplant candidates. J Heart Lung Transplant 2013; 32:626.