What specific type of patient will most likely to benefit from pulmonary rehabilitation?

• Patient assessment

• Program components

• Method of delivery

• Quality assurance

Before pulmonary rehabilitation begins, a health care provided makes an initial assessment of patient needs. This assessment is conducted in a hospital or clinic pulmonary rehabilitation center and includes the following:

• An exercise test

• A field exercise test

• Quality-of-life measurements

• Dyspnea assessment

• Nutritional status evaluation

• Occupational status evaluation

An adequate pulmonary rehabilitation program includes both endurance training and resistance training. The prescription is tailored to the patient's status and goals and progress is assessed regularly. The care team ideally includes an individual who has expertise in exercise, and health care providers who are trained in delivering rehabilitation.

In the past, pulmonary rehabilitation was reserved for patients with

However, an increasing body of evidence suggests a benefit to patients with

• Neuromuscular disorders

Studies done in patients with COPD have suggested that pulmonary rehabilitation should start before COPD becomes severe (ie, as identified by degree of airflow obstruction) because there appears to be a poor correlation between disease severity and exercise performance. Furthermore, even patients with less severe disease are likely to benefit from reduced dyspnea, improved exercise tolerance, improved muscle strength, conditioning, improvement of cardiac and pulmonary physiology, reduced dynamic hyperinflation, and the psychosocial benefits that accompany pulmonary rehabilitation (5 General references Pulmonary rehabilitation is the use of supervised exercise, education, support, and behavioral intervention to improve functional capacity and enhance quality of life in patients with chronic... read more ). However, most recent guidelines recommend consideration for referral to pulmonary rehabilitation for stable, moderate to severe COPD as defined by GOLD report (6 General references Pulmonary rehabilitation is the use of supervised exercise, education, support, and behavioral intervention to improve functional capacity and enhance quality of life in patients with chronic... read more ).

Contraindications are relative and include comorbidities (eg, untreated angina, left ventricular dysfunction) that could complicate attempts to increase a patient’s level of exercise. However, these comorbidities do not preclude application of other components of pulmonary rehabilitation.

There are no complications of pulmonary rehabilitation beyond those expected from physical exertion and exercise.

Pulmonary rehabilitation is best administered as part of an integrated program of

• Exercise training

• Education

• Psychosocial and behavioral interventions

Pulmonary rehabilitation is delivered by a team of physicians, nurses, respiratory therapists, physical and occupational therapists, and psychologists or social workers. The intervention should be individualized and targeted to the patient's needs. Pulmonary rehabilitation can be started at any stage of disease with the goal of minimizing disease burden and symptoms.

Exercise training involves aerobic exercise and respiratory muscle and upper and lower extremity strength training. There is increasing evidence to support doing both strength training and interval training of the extremities. Interval training is alternating short bursts (eg, 30 seconds) of intense activity with longer periods (eg, 2 minutes) of less intense activity.

Although the most optimal maintenance strategy is unknown, continued participation in an exercise program is essential to maintain the benefits of pulmonary rehabilitation.

• 1. Holland AE, Cox NS, Houchen-Wolloff L, et al: Defining Modern Pulmonary Rehabilitation. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 18(5):e12–e29, 2021. doi: 10.1513/AnnalsATS.202102-146ST

• 2. Lindenauer PK, Stefan MS, Pekow PS, et al: Association between initiation of pulmonary rehabilitation after hospitalization for COPD and 1-year survival among Medicare beneficiaries. JAMA 323(18):1813–1823, 2020. doi: 10.1001/jama.2020.4437

• 3. Morris NR, Kermeen FD, Holland AE: Exercise-based rehabilitation programmes for pulmonary hypertension. Cochrane Database Syst Rev 1(1):CD011285, 2017. doi: 10.1002/14651858.CD011285.pub2

• 4. Zhu P, Wang Z, Guo X, et al: Pulmonary rehabilitation accelerates the recovery of pulmonary function in patients With COVID-19. Front Cardiovasc Med 8:691609, 2021. doi: 10.3389/fcvm.2021.691609

• 5. Rochester CL, Vogiatzis I, Holland AE, et al: An Official American Thoracic Society/European Respiratory Society Policy Statement: Enhancing Implementation, Use, and Delivery of Pulmonary Rehabilitation. Am J Respir Crit Care Med 192:1373–1386, 2015. doi: 10.1164/rccm.201510-1966ST.

• 7. Beaumont M, Mialon P, Le Ber C, et al: Effects of inspiratory muscle training on dyspnoea in severe COPD patients during pulmonary rehabilitation: controlled randomised trial. Eur Respir J 51:1701107, 2018. doi: 10.1183/13993003.01107-2017

• 8. Benavides Córdoba VA, Orozco LM, Mosquera R, et al: Addition of neuromuscular electrical stimulation to conventional pulmonary rehabilitation treatment in patients with COPD. Eur Respir J 56 (Suppl. 64):714, 2020. doi: 10.1183/13993003.congress-2020.714