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      Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease: Highly Effective but Often Overlooked

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          Abstract

          Patients with chronic obstructive pulmonary disease receive a range of treatments including but not limited to inhaled bronchodilators, inhaled and systemic corticosteroids, supplemental oxygen, and pulmonary rehabilitation. Pulmonary rehabilitation is a multidisciplinary intervention that seeks to combine patient education, exercise, and lifestyle changes into a comprehensive program. Programs 6 to 8 weeks in length have been shown to improve health, reduce dyspnea, increase exercise capacity, improve psychological well-being, and reduce healthcare utilization and hospitalization. Although the use of pulmonary rehabilitation is widely supported by the literature, controversy still exists regarding what should be included in the programs. The goal of this review was to summarize the evidence for pulmonary rehabilitation and identify the areas that hold promise in improving its utilization and effectiveness.

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          Most cited references78

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          Pulmonary rehabilitation for chronic obstructive pulmonary disease.

          Widespread application of pulmonary rehabilitation (also known as respiratory rehabilitation) in chronic obstructive pulmonary disease (COPD) should be preceded by demonstrable improvements in function (health-related quality of life, functional and maximal exercise capacity) attributable to the programmes. This review updates the review reported in 2006.
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            An Official American Thoracic Society/European Respiratory Society Policy Statement: Enhancing Implementation, Use, and Delivery of Pulmonary Rehabilitation.

            Pulmonary rehabilitation (PR) has demonstrated physiological, symptom-reducing, psychosocial, and health economic benefits for patients with chronic respiratory diseases, yet it is underutilized worldwide. Insufficient funding, resources, and reimbursement; lack of healthcare professional, payer, and patient awareness and knowledge; and additional patient-related barriers all contribute to the gap between the knowledge of the science and benefits of PR and the actual delivery of PR services to suitable patients.
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              Characteristics of physical activities in daily life in chronic obstructive pulmonary disease.

              Quantification of physical activities in daily life in patients with chronic obstructive pulmonary disease has increasing clinical interest. However, detailed comparison with healthy subjects is not available. Furthermore, it is unknown whether time spent actively during daily life is related to lung function, muscle force, or maximal and functional exercise capacity. We assessed physical activities and movement intensity with the DynaPort activity monitor in 50 patients (age 64 +/- 7 years; FEV1 43 +/- 18% predicted) and 25 healthy elderly individuals (age 66 +/- 5 years). Patients showed lower walking time (44 +/- 26 vs. 81 +/- 26 minutes/day), standing time (191 +/- 99 vs. 295 +/- 109 minutes/day), and movement intensity during walking (1.8 +/- 0.3 vs. 2.4 +/- 0.5 m/second2; p < 0.0001 for all), as well as higher sitting time (374 +/- 139 vs. 306 +/- 108 minutes/day; p = 0.04) and lying time (87 +/- 97 vs. 29 +/- 33 minutes/day; p = 0.004). Walking time was highly correlated with the 6-minute walking test (r = 0.76, p < 0.0001) and more modestly to maximal exercise capacity, lung function, and muscle force (0.28 < r < 0.64, p < 0.05). Patients with chronic obstructive pulmonary disease are markedly inactive in daily life. Functional exercise capacity is the strongest correlate of physical activities in daily life.
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                Author and article information

                Journal
                Tuberc Respir Dis (Seoul)
                Tuberc Respir Dis (Seoul)
                TRD
                Tuberculosis and Respiratory Diseases
                The Korean Academy of Tuberculosis and Respiratory Diseases
                1738-3536
                2005-6184
                October 2020
                10 August 2020
                : 83
                : 4
                : 257-267
                Affiliations
                Exercise Physiology Research Laboratory, Departments of Medicine and Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
                Author notes
                Address for correspondence: Christopher B. Cooper, M.D. Exercise Physiology Research Laboratory, Departments of Medicine and Physiology, David Geffen School of Medicine, University of California, Los Angeles 10833 Le Conte Avenue, 43-229 CHS, Los Angeles, CA 90095- 1690, USA Phone: 1-310-470-3983, Fax: 1-310-206-8211 E-mail: ccooper@ 123456mednet.ucla.edu
                Author information
                http://orcid.org/0000-0002-6314-0903
                Article
                trd-2020-0064
                10.4046/trd.2020.0064
                7515680
                32773722
                d93a2013-bde8-400f-a9f3-2a31e9f8d335
                Copyright © 2020 The Korean Academy of Tuberculosis and Respiratory Diseases

                It is identical to the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/).

                History
                : 17 June 2020
                : 22 July 2020
                : 6 August 2020
                Categories
                Review Article
                COPD

                Respiratory medicine
                pulmonary disease, chronic obstructive,pulmonary rehabilitation,exercise limitation,exercise prescription

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