Does pulmonary rehabilitation address treatable traits? A systematic review

Holland, Anne E; Wageck, Bruna; Hoffman, Mariana; Lee, Annemarie L.; Jones, Arwel W.

doi:10.1183/16000617.0042-2022

Cited by 10 publications

(11 citation statements)

References 26 publications

(66 reference statements)

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“…Treatable traits is a precision-medicine model of care that involves identifying traits using a multi-dimensional assessment in an individual and creating a personalised management strategy that targets these traits 10 .This approach to patient care has been shown to be effective in people with OAD 10,30 , and treatable traits has been proposed to optimise pulmonary rehabilitation outcomes. Our study suggests that people who 'can't do, don't do' may benefit from pulmonary rehabilitation most, where additional traits can be targeted to improve physical capacity and physical inactivity 31 .…”

Section: Discussionmentioning

confidence: 87%

Physical capacity and inactivity in obstructive airway diseases: a “can do, do do” analysis

Urroz Guerrero,

Lewthwaite,

Gibson

et al. 2024

ERJ Open Res

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Physical capacity is an important determinant of physical activity in people with obstructive airway disease (OAD). This study aimed to extend the “can do, do do” concept in people with OAD, to identify if people categorised into quadrants based on physical capacity and activity differ by clinical and movement behaviour characteristics. A total of 281 participants (bronchiectasis n=60, severe asthma n=93, COPD n=70 and control n=58) completed assessments to characterise physical capacity as “can do”versus“can't do” (6-minute walk distance<or ≥70%predicted) and physical activity as “do do”versus“don't do” (accelerometer derived moderate-to-vigorous intensity physical activity (MVPA)<or ≥150 min/week). The control group had a greater proportion of people in the “can do, do do” quadrant compared with the OAD groups (76%versus10–33%). People with OAD in the “can't do, don't do” quadrant had worse clinical characteristics (airflow limitation, comorbidities, quality of life and functional dyspnoea) and spent less time doing light-intensity physical activity (LPA) and more time being sedentary compared with the “can do, do do” quadrant. This study highlights that many people with OAD may be inactive because they do not have the physical capacity to participate in MVPA, which is further impacted by greater disease severity. It is important to consider the potential benefits of addressing LPA and sedentary behaviour due to sub-optimal levels of these movement behaviours across different quadrants. Future research is needed to investigate if tailoring intervention approaches based on quadrant allocation is effective in people with OAD.

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Section: Discussionmentioning

confidence: 87%

Physical capacity and inactivity in obstructive airway diseases: a “can do, do do” analysis

Urroz Guerrero,

Lewthwaite,

Gibson

et al. 2024

ERJ Open Res

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“…A recent systematic review, however, highlighted that, while deconditioning was addressed in almost all the randomised controlled studies on pulmonary rehabilitation, other treatable traits were addressed much less frequently ( e.g. obesity/cachexia in 18% of studies, anxiety/depression in 10% of studies and encouragement to engage independently in exercise only in 46% of reported studies) [ 17 ]. Nevertheless, these traits are very prevalent in individuals with COPD.…”

Section: Definition Of (Modern) Pulmonary Rehabilitationmentioning

confidence: 99%

Pulmonary rehabilitation and physical interventions

Troosters¹,

Janssens²,

Demeyer³

et al. 2023

Eur Respir Rev

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Pulmonary rehabilitation has established a status of evidence-based therapy for patients with symptomatic COPD in the stable phase and after acute exacerbations. Rehabilitation should have the possibility of including different disciplines and be offered in several formats and lines of healthcare. This review focusses on the cornerstone intervention, exercise training, and how training interventions can be adapted to the limitations of patients. These adaptations may lead to altered cardiovascular or muscular training effects and/or may improve movement efficiency. Optimising pharmacotherapy (not the focus of this review) and oxygen supplements, whole-body low- and high-intensity training or interval training, and resistance (or neuromuscular electrical stimulation) training are important training modalities for these patients in order to accommodate cardiovascular and ventilatory impairments. Inspiratory muscle training and whole-body vibration may also be worthwhile interventions in selected patients. Patients with stable but symptomatic COPD, those who have suffered exacerbations and patients waiting for or who have received lung volume reduction or lung transplantation are good candidates. The future surely holds promise to further personalise exercise training interventions and to tailor the format of rehabilitation to the individual patient's needs and preferences.

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“…The extent to which pulmonary rehabilitation programmes currently address treatable traits is unclear. A recent systematic review evaluated 116 RCTs of pulmonary rehabilitation with 6893 participants to establish the frequency with which individual traits were addressed 65 . The trait of deconditioning was addressed in 97% of studies through the provision of exercise training.…”

Section: Different Models Of Carementioning

confidence: 99%

“…A recent systematic review evaluated 116 RCTs of pulmonary rehabilitation with 6893 participants to establish the frequency with which individual traits were addressed. 65 The trait of deconditioning was addressed in 97% of studies through the provision of exercise training. There was evidence that some extrapulmonary and behavioural/lifestyle traits were addressed in pulmonary rehabilitation, but this occurred in a relatively small number of studies.…”

Section: Treatable Traits In Pulmonary Rehabilitationmentioning

confidence: 99%

Treatable traits models of care

McDonald,

Holland

2023

Respirology

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Treatable traits is a personalized approach to the management of respiratory disease. The approach involves a multidimensional assessment to understand the traits present in individual patients. Traits are phenotypic and endotypic characteristics that can be identified, are clinically relevant and can be successfully treated by therapy to improve clinical outcomes. Identification of traits is followed by individualized and targeted treatment to those traits. First proposed for the management of asthma and chronic obstructive pulmonary disease (COPD) the approach is recommended in many other areas of respiratory and now immunology medicine. Models of care for treatable traits have been proposed in different diseases and health care setting. In asthma and COPD traits are identified in three domains including pulmonary, extrapulmonary and behavioural/lifestyle/risk‐factors. In bronchiectasis and interstitial lung disease, a fourth domain of aetiological traits has been proposed. As the core of treatable traits is personalized and individualized medicine; there are several key aspects to treatable traits models of care that should be considered in the delivery of care. These include person centredness, consideration of patients' values, needs and preferences, health literacy and engagement. We review the models of care that have been proposed and provide guidance on the engagement of patients in this approach to care.

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Does pulmonary rehabilitation address treatable traits? A systematic review

Cited by 10 publications

References 26 publications

Physical capacity and inactivity in obstructive airway diseases: a “can do, do do” analysis

Physical capacity and inactivity in obstructive airway diseases: a “can do, do do” analysis

Pulmonary rehabilitation and physical interventions

Treatable traits models of care

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