Pulmonary rehabilitation improves symptoms, quality of life, pulmonary function, and health care utilization in patients with chronic respiratory disease. Most of the evidence supporting the benefit of pulmonary rehabilitation has been derived from studies of patients with chronic obstructive pulmonary disease (COPD). However, results obtained in patients with respiratory diseases different from COPD have provided evidence that the benefits from pulmonary rehabilitation are also observed in symptomatic patients with other respiratory diseases. The indications, goals, and components of pulmonary rehabilitation and the potential benefits for patients with chronic lung disease will be reviewed here [1]. Other therapeutic modalities, such as smoking cessation, oxygen therapy, bronchodilators, antibiotics, nutritional support, respiratory muscle training and resting, and cardiac rehabilitation, are discussed separately. (See "Management of stable chronic obstructive pulmonary disease" and "Overview of smoking cessation management in adults" and "Long-term supplemental oxygen therapy" and "Nutritional support in advanced lung disease" and "Respiratory muscle training and resting in COPD" and "Cardiac rehabilitation: Indications, efficacy, and safety in patients with coronary heart disease".)
Pulmonary rehabilitation is a broad therapeutic concept. It is defined by the American Thoracic Society and the European Respiratory Society as a "comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies that include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors" [2,3]. The indications for pulmonary rehabilitation have not been precisely defined. The Global Initiative for Chronic Obstructive Disease suggests that pulmonary rehabilitation be included in the management of patients with chronic obstructive pulmonary disease (COPD) categories B, C, and D (table 1) [4]. For respiratory diseases different from COPD, there have been no formal statements regarding patient selection, but it is common to consider pulmonary rehabilitation in symptomatic patients whose quality of life is impaired by their disease.
Frailty affects approximately one-fourth of patients with COPD and is a predictor of noncompletion of pulmonary rehabilitation. However, a study of 816 patients with stable COPD of whom 212 (26 percent) met criteria for frailty found that those who completed pulmonary rehabilitation experienced reduced dyspnea, improved exercise performance and physical activity level, and 61 percent no longer met criteria for frailty [5]. Thus, frailty is not necessarily a contraindication. Similarly, chronic hypercapnia due to advanced COPD is not a contraindication, as benefit has been demonstrated in these patients [6]. Advancing health through science, education and medicine ACSM Releases New Recommendations for Exercise Preparticipation Health Screening As of November 2015, ACSM's exercise preparticipation health screening process has been updated. Recent studies suggest that using the current ACSM exercise preparticipation health screening recommendations can result in excessive physician referrals, possibly creating a barrier to exercise participation.
In addition, there is considerable evidence for the following: Exercise is safe for most people and has many associated health and fitness benefits Exercise-related cardiovascular events are often preceded by warning signs/symptoms Cardiovascular risks associated with exercise lessen as individuals become more physically active/fit Based on a 2014 scientific roundtable convened by ACSM, a new model was proposed for preparticipation health screening based on factors that have been identified as having an influence on exercise-related cardiovascular events: An individual's current level of physical activity Presence of signs or symptoms and/or known cardiovascular, metabolic or renal disease Desired exercise intensity With these new guidelines, the objectives are to eliminate unnecessary barriers for an individual to begin and maintain a regular exercise program, and encourage healthy lifestyles through habitual physical activity. Read the roundtable consensus statement Information about the new guidelines is found throughout many ACSM resources and publications, all of which will be updated over the next 18 months, including the 10th edition of ACSM’s Guidelines For Exercise Testing and Prescription (GETP) and the 5th edition of ACSM’s Resources for the Personal Trainer, both scheduled for publication in March 2017.
Need more information on what this means for you? Please see below for additional resources and educational opportunities - also make sure and check back on this page for new resources and educational events as they are added! Related Resources: Frequently Asked Questions ACSM Members ACSM Certified Professionals Looking for content from our recent webinar? You can go here to view a recorded version of the webinar, and go here for the presentation materials. PowerPoint Presentation Download and view our infographic Should you have questions or needs not addressed by the above resources, please note the following contacts: Media, press and communications questions: Paul Branks Publications and content questions: Katie Feltman Certification questions: Certification ACSM is grateful for the expertise of our roundtable participants: David M. Buchner, M.D., M.P.H., FACSM JoAnn Eickhoff-Shemek, Ph.D. Carol Ewing Garber, Ph.D., FACSM Barry A. Franklin, Ph.D., FACSM Adrian Hutber, Ph.D. Elizabeth A. Joy, M.D., M.P.H., FACSM Gary Liguori, Ph.D., FACSM Meir Magal, Ph.D., FACSM Linda S. Pescatello, Ph.D., FACSM Deborah Riebe, Ph.D., FACSM Thomas Spring, M.S. Paul D. Thompson, M.D., FACSM Darren E.R. Warburton