CONTROVERSIES AND UPDATE IN RESPIRATORY MEDICINE 

Minerva Pneumologica 2011 March;50(1):47-61

Copyright © 2011 EDIZIONI MINERVA MEDICA

language: English

Pulmonary rehabilitation: an overview including new and innovative strategies

Evans R. A. Goldstein R. S.

Division of Respiratory Medicine, West Park Healthcare Centre, University of Toronto, Toronto, ON, Canada

Pulmonary rehabilitation (PR) is an exciting and continuously evolving field that has accomplished much over the last 25 years. At its core is a structured, evidenced based program for patients with chronic respiratory diseases targeting the secondary impairments of the diseases, comprising high intensity lower limb aerobic training, upper and lower limb strength exercises, multi-disciplinary education and self management. There is strong evidence demonstrating a reduction in dyspnea, increased exercise tolerance, improved health related quality of life and cost effectiveness. This review details the mechanisms behind the symptoms, who and when to refer for PR and the assessment process. The typical outcome measures used and the evidence behind the various components of PR are described. As the demand for PR exceeds the supply in most health care systems, different approaches involving home and community programs have been explored. Despite the great success of PR there is still much to be learnt about performance enhancement, how to maintain the benefits and the optimal timing of delivery. Traditionally PR was for stable disease, but there is increasing evidence for targeting therapy immediately postexacerbation. This review includes an overview of the new and inventive approaches for exercise training adjuncts aimed at relieving the ventilatory burden caused by chronic obstructive pulmonary disease. The growth and acceptance of PR as mainstream management opens the way for further innovations.