Review series: Rehabilitation in non COPD: Mechanisms of exercise limitation and pulmonary rehabilitation for patients with pulmonary fibrosis/restrictive lung disease

Abstract

The standard of care in the treatment of chronic lung disease includes pulmonary rehabilitation (PR). While evidence of the effectiveness of PR in chronic obstructive lung disease (COPD) is robust, that for pulmonary fibrosis and other non-fibrotic restrictive lung diseases is less extensive. However, PR has been shown to improve functional exercise capacity and health-related quality of life in non-COPD patients, primarily those with interstitial lung diseases. This review examines mechanisms of exercise limitation in non-COPD patients and discusses how they might affect both the application of and outcome measures of PR. We also review the assessment of exercise performance, dyspnea, and quality of life as well as special protocols, safety considerations, and special techniques in PR as applied to patients with pulmonary fibrosis or restrictive lung disease. At present, there are no evidence-based guidelines for PR in non-COPD patients whereas PR is firmly recommended in COPD management. More research is needed to strengthen the evidence for the use of PR in non-COPD patients. Meanwhile, the available data, summarized in this review, support the inclusion of PR in the management of all patients with chronic lung disease including pulmonary fibrosis and restrictive lung disease.

Aerobic and resistance exercise in systemic sclerosis: State of the art

“…Patients with SSc should have their blood pressure and heart rate monitored during exercise, and particluar attention should be paid to the cool-down period, since rapid falls in cardiac output can lead to syncope in patients with PAH (Markovitz & Cooper, 2010). Exercise must be stopped if chest pain, lightheadedness or palpitations occur (Markovitz & Cooper, 2010).…”

“…Patients with SSc and severe pulmonary hypertension may be enrolled in an exercise programme if the nature and the intensity of exercise is considered (Nici et al, 2006). These patients are optimally monitored by telemetry, especially if they are known to have experienced cardiac dysrhythmias (Markovitz & Cooper, 2010). In these patients, activities that increase intrathoracic pressure (such as high-intensity exercises) should be avoided, as they may lead to circulatory collapse and syncope (Markovitz & Cooper, 2010).…”

Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association

“…[81][82][83] Pulmonary rehabilitation has been shown to improve exercise endurance and the quality of life in patients with restrictive lung physiology of various pathogeneses and even decrease hospital admissions. [84][85][86] To date, specific trials looking at the benefit of pulmonary rehabilitation in adults with CHD with restrictive lung physiology are limited. Studies of supervised pulmonary rehabilitation in the setting of pulmonary hypertension associated with CHD have been encouraging, demonstrating safety and improvement in both exercise tolerance and quality of life.…”

Pulmonary rehabilitation: An overview

“…[2930] As long as patients have enough reserve to perform some exercise, it is likely that they can obtain a training benefit. Pulmonary rehabilitation has been used in diseases such as asthma, cystic fibrosis, interstitial lung disease (ILD), obesity-related respiratory disorders, pulmonary hypertension, neuromuscular and chest wall disorders.…”