Noninvasive ventilation as an adjunct to exercise training in patients with chronic respiratory disease

Abstract

Educational aimsTo describe the potential benefits of noninvasive positive-pressure ventilation (NIV) as an adjunct to exercise training in selected patients with chronic obstructive pulmonary disease (COPD) or chest wall restriction.To outline the mechanisms by which NIV may improve exercise performance in selected patients with COPD or chest wall restriction.To identify characteristics of patients with chronic respiratory disease who are more likely to respond to NIV-assisted training.To highlight major practical considerations for implementing NIV-assisted training in an individual with COPD or chest wall restriction.SummarySevere exertional dyspnoea is a major impediment to physical activity and adversely affects quality of life for many individuals with chronic respiratory disease. Although exercise can improve cardiorespiratory and peripheral muscle responses, training at sufficient intensity and duration may be difficult for the very breathless, deconditioned patient. Consequently, strategies to optimise training for such individuals are gaining interest. NIV is one such option and there is a growing body of evidence outlining its benefits in selected patients. However, the technique is not without its constraints and problems. An understanding of the mechanisms underlying improvements in exercise performance with NIV-assisted training is important in targeting appropriate candidates for intervention and identifying the best therapy to achieve the maximum benefit.