An Official American Thoracic Society/European Respiratory Society Policy Statement: Enhancing Implementation, Use, and Delivery of Pulmonary Rehabilitation

Rochester, Carolyn L.; Vogiatzis, Ioannis; Holland, Anne E; Lareau, Suzanne C.; Marciniuk, Darcy; Puhan, Milo A.; Spruit, Martijn A.; Masefield, Sarah; Casaburi, Richard; Clini, Enrico; Crouch, R. H.; Garcia‐Aymerich, Judith; Garvey, Chris; Goldstein, Roger; Hill, Kylie; Morgan, Michael; Nici, Linda; Pitta, Fábio; Ries, Andrew L.; Singh, Sally; Troosters, Thierry; Wijkstra, Peter J.; Yawn, Barbara P.; ZuWallack, Richard

doi:10.1164/rccm.201510-1966st

Cited by 615 publications

(524 citation statements)

References 125 publications

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“…14 In most surgical procedures, including volume reduction and lung transplant, PR has potential benefits before and after surgery. 15 Although PR is an indispensable component that increases the success rate of lung transplant, there is no guideline for PR to be applied to transplant candidates.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Pehlivan

Balcı²,

Kılıç³

et al. 2018

Exp Clin Transplant

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Objectives: The frequency and success rates of lung transplant in patients with end-stage lung disease are increasing. In our study, we investigated the effects of preoperative pulmonary rehabilitation on pulmonary function, exercise capacity, and quality of life in patients who are candidates for lung transplant. Materials and Methods: This prospective study included 39 consecutive patients who were candidates for lung transplant. All patients underwent preoperative pulmonary rehabilitation for at least 3 weeks. Results: Our patient group included 25 male and 14 female patients with a mean age of 36 years (range, 15 -68 y). Although no significant improvement was shown in the forced expiratory volume in 1 second after pulmonary rehabilitation, significant improvements were observed in the Modified Medical Research Council dyspnea scores (P = .001) and 6-minute walk distance (P = .001). We also observed statistically significant improvements in the ShortForm 36 Quality of Life Questionnaire's physical function (P = .01) and emotional role (P = .02) subparameters. We also found a significant improvement in the Beck Depression Inventory score (P = .004). There was no correlation between Beck Depression Inventory scores before and after rehabilitation and 6-minute walk distance, Short-Form 36, and Modified Medical Research Council dyspnea scores. Conclusions: Our results suggest that preoperative pulmonary rehabilitation improves exercise capacity, reduces the sensation of dyspnea and muscle strength loss, and has a positive effect on the psychologic state of patients who are candidates for lung transplant. Key words: Dyspnea, Muscle loss, Psychologic assessment IntroductionLung transplant is the last treatment option for endstage lung disease patients for whom conservative treatments have failed. 1 A pulmonary rehabilitation (PR) program has an important role in this group of patients who have chronic lung diseases and complex medical histories. 2 Studies have shown positive effects of PR programs in patients who are on wait lists for transplant and have shown that postoperative outcomes are improved in patients who can obtain higher preoperative exercise capacity. 3 In chronic pulmonary diseases such as chronic obstructive pulmonary disease, bronchiectasis, and interstitial lung disease, the efficacy and reliability of exercise have been well-documented. [4][5][6] However, data are still scarce on the safety and efficacy of exercise in patients with end-stage lung disease who are transplant candidates. Evidence-based exercise training programs for pre-and postoperative stages of transplant have not yet been developed. Considering the exercise principles and recom mendations in the guidelines for the care of adults with chronic pulmonary disease, exercise training programs should be established to offer optimal health benefits for transplant candidates on wait lists. 7 Patients prepared for lung transplant are a select patient population with advanced chronic lung disease. These patients typically have ven...

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Section: Discussionmentioning

confidence: 99%

Untitled

Pehlivan

Balcı²,

Kılıç³

et al. 2018

Exp Clin Transplant

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“…Despite these benefits, pulmonary rehabilitation has been grossly underutilized [4], probably for multiple reasons, including underrecognition of its importance by healthcare professionals and patients, unwillingness of the patient to attend sessions, unavailability of programs in certain geographic areas, and insufficient third-party reimbursement [5]. After hospitalization for an exacerbation, when the need for pulmonary rehabilitation is arguably greatest, attendance at centers is especially problematic [6].…”

Section: Introductionmentioning

confidence: 99%

There’s no place like home: Integrating pulmonary rehabilitation into the home setting

Macrea

ZuWallack

Nici

2017

Monaldi Arch Chest Dis

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Traditional, outpatient pulmonary rehabilitation provided to stable chronic obstructive pulmonary disease (COPD) patients leads to significant improvements in dyspnea, exercise capacity and health related quality of life. Also, when started during or shortly after a hospitalization for a COPD exacerbation, pulmonary rehabilitation improves these patient-centered outcomes and arguably reduces subsequent health care utilization and mortality. Despite these benefits, the uptake of traditional pulmonary rehabilitation remains disappointingly poor. Homebased pulmonary rehabilitation, a safe and effective alternative to traditional, center-based programs, can broaden access. While proven improvements in dyspnea, exercise capacity and health status justify implementation of home-based pulmonary rehabilitation, it would be helpful to know whether it can also decrease health care utilization and be cost-effective.

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“…10 O treinamento de força muscular nos programas de reabilitação pulmonar (PRP) pode resultar em melhora da qualidade de vida, quando comparado ao exercício aeróbio. [11][12][13][14] Poucos estudos científicos têm destacado as vantagens da prescrição desse tipo de atividade realizada em ambulatório e ambiente domiciliar, com equipamentos acessíveis, uma vez que os pacientes e os serviços públicos em geral não têm acesso aos aparelhos elaborados para este fim, apesar das recomendações das diretrizes da saúde pública. 15 O novo modelo de atenção básica com foco na recuperação, prevenção e promoção da saúde, contempla atividade física, recomendando a realização durante 30min por dia, no mínimo, intensidade moderada, intencionando o desenvolvimento ou a manutenção da capacidade funcional do paciente, melhorando sua qualidade de vida (QV).…”

Section: Introductionunclassified

Treinamento de força muscular na reabilitação pulmonar em pacientes com DPOC: Uma revisão descritiva

et al. 2017

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Artigo de revisão ResumoIntrodução: A doença pulmonar obstrutiva crônica (DPOC) é uma patologia caracterizada pela obstrução progressiva do fluxo aéreo, parcialmente ou não totalmente reversível, causando prejuízos funcionais. Associado a tais limitações há também a disfunção muscular periférica. Existem evidências de que alterações musculoesqueléticas relacionadas à inatividade física repercutem negativamente no prognóstico dos pacientes com DPOC. Dessa forma, o fortalecimento muscular nestes indivíduos proporciona, além do aumento da força muscular, melhora da capacidade funcional e da qualidade de vida. Objetivos: Identificar os aparelhos utilizados para treinamento de força muscular e a eficácia dos programas de reabilitação pulmonar (PRP) em pacientes com DPOC. Métodos: Revisão narrativa com busca sistemática nas bases de dados Scielo, Pubmed, Medline e Tripdatabase, dos artigos publicados no período de 2005 a 2016. Resultados: Foram selecionados 24 estudos e descritos os tipos de equipamentos utilizados para o treino de força e os resultados dos programas de reabilitação. Conclusões: Os equipamentos de musculação são os mais utilizados para este fim, porém opções mais viáveis e mais versáteis produzem os mesmos resultados, além disso, em todos os estudos, os PRP produziram resultados significativos.Descritores: Doença pulmonar obstrutiva crônica (DPOC); Reabilitação pulmonar; Fortalecimento muscular; Disfunção muscular periférica; Aparelhos para treinamento muscular; Alta intensidade. AbstractMuscle strength training in pulmonary rehabilitation of COPD patients: A sistematic review Introduction: Chronic obstructive pulmonary disease (COPD) is characterized by progressive airflow obstruction, partially or not fully reversible, causing functional impairment. It is also associated with systemic limitations such as peripheral muscle disease; there is evidence that musculoskeletal disorders related to the physical inactivity presents a negative effect on the prognosis of COPD patients. Thus, peripheral muscles training in COPD patients can provide an increase in muscle strength, improving functional capacity and quality of life. Objectives: To identify the devices used for muscle strength training and the effectiveness of the pulmonary rehabilitation program (PRP) in patients with COPD. Method: The study is a systematic review in the databases such as Scielo, Pubmed, Medline and Tripdatabase, with publications from 2005 to 2016. We have selected 24 studies that described the types of equipment used for strength training, and the results of the pulmonary rehabilitation program. Results: Our analysis showed that the most frequent used equipment are the fitness equipment, however, more viable and more versatile options produce the same results, and in all studies, PRP produced significant results.

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An Official American Thoracic Society/European Respiratory Society Policy Statement: Enhancing Implementation, Use, and Delivery of Pulmonary Rehabilitation

Abstract: The ATS and ERS commit to undertake actions that will improve access to and delivery of PR services for suitable patients. They call on their members and other health professional societies, payers, patients, and patient advocacy groups to join in this commitment.

Cited by 615 publications

References 125 publications

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There’s no place like home: Integrating pulmonary rehabilitation into the home setting

Treinamento de força muscular na reabilitação pulmonar em pacientes com DPOC: Uma revisão descritiva

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