Effects of Breathing Retraining in Patients With Chronic Obstructive Pulmonary Disease

Pulmonary rehabilitation programmes aim at improving exercise capacity, activities of daily living, quality of life and perhaps survival in patients with chronic obstructive pulmonary disease (COPD). Recently, well-designed studies investigated and confirmed the efficacy of comprehensive pulmonary rehabilitation programmes, including exercise training, breathing exercises, optimal medical treatment, psychosocial support and health education. In the present overview, the contribution of exercise training in clinical practice to the demonstrated effects of pulmonary rehabilitation is discussed by means of six basic questions. These include: 1) the significance of exercise training; 2) the optimal intensity for exercise training; 3) prescribing training modalities; 4) the effects of exercise training combined with medication, nutrition or oxygen; 5) how training effects should be maintained; and 6) where the rehabilitation programme should be performed: in-patient, out-patient or homecare? First, exercise training has been proven to be an essential component of pulmonary rehabilitation. Training intensity is of key importance. High-intensity training (>70% maximal workload) is feasible even in patients with more advanced COPD. In addition, the effects on peripheral muscle function and ventilatory adaptations are superior to low-intensity training. There is, however, no consensus on the optimal training modalities. Both walking and cycling improved exercise performance. Since peripheral muscle function has been recognized as an important contributor to exercise performance, specific peripheral muscle training recently gained interest. Improved submaximal exercise performance and increased quality of life were found after muscle training. The optimal training regimen (strength or endurance) and the muscle groups to be trained, remain to be determined. Training of respiratory muscles is recommended in patients with ventilatory limitation during exercise. The additional effects of anabolic-androgenic drugs, oxygen and nutrition are not well-established in COPD patients and need further research. In order to maintain training effects, close attention of the rehabilitation team is required. The continuous training frequency necessary to maintain training effects remains to be defined. At this point in time, out-patient-based programmes show the best results and guarantee the best supervision and a multidisciplinary approach. Future research should focus on the role of homecare programmes to maintain improvements.

Section: What Is the Optimal Intensity For Exercise Training?mentioning

confidence: 98%

Exercise training in COPD patients: the basic questions

Gosselink¹,

Troosters²,

Decramer³

1997

“…The physiotherapy programme consisted of conventional physiotherapy (relaxation exercises [11], and breathing retraining [12]), upper limb training [13], target-flow inspiratory muscle training (IMT) [14], and exercise training on a home-trainer according to ALLISON et al [15]. The patients started exercise training for 4 min at 60% of their maximal workload (Wmax) of the cycle ergometer test.…”

Section: Rehabilitation Programmementioning

confidence: 99%

Quality of life in patients with chronic obstructive pulmonary disease improves after rehabilitation at home

Wijkstra¹,

Altena²,

Kraan³

et al. 1994

274

161

Q Qu ua al li it ty y o of f l li if fe e i in n p pa at ti ie en nt ts s w wi it th h c ch hr ro on ni ic c o ob bs st tr ru uc ct ti iv ve e p pu ul lm mo on na ar ry y d di is se ea as se e i im mp pr ro ov ve es s a af ft te er r r re eh ha ab bi il li it ta at ti io on n a at t h ho om me e P.J. Wijkstra*, R. Van Altena*, J. Kraan* We studied 43 patients with severe airflow obstruction: forced expiratory volume in one second (FEV 1 ) 1.3±0.4 l (mean±SD), FEV 1 /inspiratory vital capacity (IVC) 37±7.9%. After stratification, 28 patients were randomly allocated in a home rehabilitation programme for 12 weeks. Fifteen patients in a control group received no rehabilitation. The rehabilitation group received physiotherapy by the local physiotherapist, and supervision by a nurse and a general practitioner. Quality of life was assessed by the four dimensions of the Chronic Respiratory Questionnaire (CRQ).We found a highly significant improvement in the rehabilitation group compared to the control group for the dimensions dyspnoea, emotion, and mastery. Lung function showed no changes in the rehabilitation group. The exercise tolerance improved significantly in the rehabilitation group compared to the control group. The improvement in quality of life was not correlated with the improvement in exercise tolerance.Rehabilitation of COPD patients at home may improve quality of life; this improvement is not correlated with an improvement in lung function and exercise tolerance.

“…Relaxation exercises were carried out according to Jacobson's technique of progressive muscle relaxation [22]. Breathing retraining consisted of education on COPD, pursed-lip breathing, expiratory abdominal augmentation, and synchronization of thoracic and abdominal movement [23]. Upper limb training was carried out according to the principles of proprioceptive neuromuscular facilitation (PNF), consisting of two exercises for each arm with the same weight and co-ordinated with breathing during exhalation [24].…”

Section: Rehabilitation Programmementioning

confidence: 99%

Effects of home rehabilitation on physical performance in patients with chronic obstructive pulmonary disease (COPD)

Wijkstra

Mark²,

Kraan³

et al. 1996

We investigated whether 12 weeks of rehabilitation at home in patients with chronic obstructive pulmonary disease (COPD) had a beneficial effect on lactate production, metabolic gas exchange data, workload of the inspiratory muscles, and dyspnoea during a maximal bicycle ergometer test. A second aim was to assess whether a change in dyspnoea was related to a change of inspiratory muscle workload.Forty three COPD patients with severe airways obstruction were included in the study: mean forced expiratory volume in one second (FEV1) 1.3±0.4 L (44% predicted), mean FEV1/inspiratory vital capacity (IVC) 37±8%. Twenty eight patients started a rehabilitation programme, whilst 15 patients received no rehabilitation. Rehabilitation was carried out at home; patients were supervised by a general practitioner, a physiotherapist and a nurse. Exercise tolerance was measured by means of a 6 min walking distance test (6MWD) and maximal workload (Wmax) during an incremental symptom-limited cycle ergometer test. Inspiratory muscle workload at Wmax was assessed with the Tension Time Index (TTI), and dyspnoea at Wmax with the Borg scale.After 12 weeks, the rehabilitation group showed a significantly larger increase in 6MWD (from 438 to 447 m) and in Wmax (from 70 to 78 W) compared with the control group. A significant improvement in oxygen consumption (V 'O 2 ) (from 1.0 to 1.1 L), lactate level (from 3.7 to 3.1 mEq·L -1 ), dyspnoea (from 6.0 to 4.5) and TTI (from 0.10 to 0.08) at Wmax occurred in the rehabilitation group during the programme. The reduction in TTI was not significantly correlated with the fall in dyspnoea, as assessed by the Borg scale.We conclude that 12 weeks of rehabilitation at home in COPD patients increases symptom-limited V 'O 2 in combination with an increased Wmax. At this significantly higher Wmax, there was a reduction in dyspnoea, lactate level and inspiratory muscle workload. The reduction in dyspnoea was not related to a decreased inspiratory muscle workload. This study shows that rehabilitation at home can produce beneficial physiological improvements during exercise in patients with chronic obstructive pulmonary disease. Eur Respir J., 1996, 9, 104-110 Several studies have already shown that pulmonary rehabilitation increases the exercise tolerance of patients with chronic obstructive pulmonary disease (COPD) [1][2][3][4][5][6][7][8][9][10][11]. In contrast to most studies that were carried out in a clinical setting [1-9], we have developed a home-based rehabilitation programme. In a previous study, we have already shown that rehabilitation at home increases exercise tolerance and quality of life [12]. In this study we report upon the same group of patients, but we now address the effects of home rehabilitation on physiological parameters during a maximal exercise test and the effects on 6 min walking distance.Until now, little has been known about the physiological changes during exercise after rehabilitation. The study of CASABURI and co-workers [5] showed that exercise training reduces ...