Exercise-Based Rehabilitation Delivery Models in Comorbid Chronic Pulmonary Disease and Chronic Heart Failure

Abstract

Among the most prevalent multimorbidities that accompany the aging process, chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) stand out, representing the main causes of hospital admissions in the world. The prevalence of COPD coexistence in patients with CHF is higher than in control subjects, given the common risk factors associated with a complex process of chronic diseases developing in the aging process. COPD-CHF coexistence confers a marked negative impact on mechanical-ventilatory, cardiocirculatory, autonomic, gas exchange, muscular, ventilatory, and cerebral blood flow, further impairing the reduced exercise capacity and health status of either condition alone. In this context, integrated approach to the cardiopulmonary based on pharmacological optimization and non-pharmacological treatment (i.e., exercise-based cardiopulmonary and metabolic rehabilitation) can be emphatically encouraged by health professionals as they are safe and well-tolerated, reducing hospital readmissions, morbidity, and mortality. This review aims to explore aerobic exercise, the cornerstone of cardiopulmonary and metabolic rehabilitation, resistance and inspiratory muscle training and exercise-based rehabilitation delivery models in patients with COPD-CHF multimorbidities across the continuum of the disease. In addition, the review address the importance of adjuncts to enhance exercise capacity in these patients, which may be used to optimize the gains obtained in these programs.

Effects of Qigong Therapy on the Anaerobic Threshold in Patients with Stable Coronary Artery Disease: A Randomized Controlled Trial

“…In addition, this mechanism may be associated with the enhanced oxygen uptake capacity of skeletal muscles, increased arterial and venous oxygen difference, decreased blood supply of peripheral muscle metabolism, and reduced cardiac load and myocardial oxygen consumption. Furthermore, it may also be affected by the enhanced muscle oxygen utilization capacity and metabolic capacity, which can improve cardiovascular efficiency, significantly enhance patients' exercise endurance and maximum oxygen consumption, and reduce fatigue [20][21][22]. e QG therapy can improve the muscle adaptability of patients.…”

Definition, diagnosis, and treatment of respiratory sarcopenia

“…Respiratory muscle training, including inspiratory muscle training (IMT), is the most promising intervention for respiratory sarcopenia. IMT is recommended to be performed daily (five to seven times a week) for 30 min (or two sets of 15 min each) at a load ranging from 30 to 80% of the MIP [63]. A method of 30 breaths (3–5 min per session) at the highest tolerable intensity twice a day has also been shown to be effective [64].…”

Comprehensive care for people living with heart failure and chronic obstructive pulmonary disease—Integration of palliative care with disease-specific care: From guidelines to practice

“…Pulmonary rehabilitation, particularly involving aerobic exercises, increases physical capacity, reduces the feeling of dyspnea and fatigue, and significantly improves the QoL in people living with COPD ( 2 , 14 , 26 , 70 , 71 ). In patients with coexistence of CHF and COPD, exercise rehabilitation is especially needed, because in this group the decrease in cardiopulmonary capacity has a particularly negative impact on physical capacity, the severity of the dominant symptoms (particularly breathlessness), and the QoL ( 72 , 73 ). The limitation of physical capacity cachexia and sarcopenia resulting in skeletal muscle dysfunction exaggerates breathlessness and fatigue in people with CHF and COPD ( 1 , 2 , 66 ).…”