1) Recognise physiological factors limiting exercise (with or without psychogenic limiting factors);
2) Identify these factors as potential therapeutic targets
3) Allow quantification of the level of impairment
4) Assess the effects of an intervention
5) Provide prognostic information
Most patients with chronic obstructive pulmonary disease (COPD) complain of dyspnea during and following exercise, and the development of intrinsic positive end-expiratory pressure (PEEP) is thought to contribute to lung hyperinflation and dyspnea.
COPD is characterised by an irreversible decrease in lung function.
Advanced-stage COPD is a long and painful process of gradually increasing and ultimately disabling breathlessness as the main symptom.
Today the international consensus is that rehabilitation programs are an important part of COPD treatment, which follows from the realisation that drug therapy for COPD is inadequate.
A vicious cycle of deterioration in physical capacity, shortness of breath, anxiety, and social isolation develops.
Rehabilitation can break this cycle by introducing physical training, psychological support and networking with other COPD patients.
Reduction in muscle strength is a major cause of reduced exercise capacity and physical functional level. A minor study showed that muscle mass in the quadriceps was approximately 15% less and muscle strength about 50% lower in elderly men with COPD than in healthy, physically inactive peers.
Evidence-based physical training
Most programs were of 12-week or 8-week duration with an overall range of 4–52 weeks.
The authors found statistically significant improvement for all included outcomes. In four important domains of quality of life (Chronic Respiratory Questionnaire (CRQ) scores for dyspnea, fatigue and emotional function.
Most studies use high-intensity walking exercise.
One study compared the effect of walking or cycling at 80% of VO2max vs working out in the form of Calisthenics exercises and found that high-intensity training increased fitness while the workout program increased arm muscle stamina. Both programs had a positive effect on the experience of dyspnea
Oxygen treatment in conjunction with intensive training for patients with COPD
It is recommended that oxygenation therapy should be provided at the end of training if the patients are hypoxic or become desaturated during the training (American Thoracic Society, 1999).
Training to music gave better results than without music (Bauldoff et al., 2002), presumably because patients who run with music perceive the physical exertion to be less, even though they are doing the same amount of exercise. Specific training for inspiratory muscles increased the stamina of these muscles but did not give the patients a lower perception of dyspnea or improved fitness (Schereret al., 2000).
Thus, strong evidence exists that endurance training as part of pulmonary rehabilitation in patients with COPD improves exercise capacity and health-related quality of life. However, dyspnea limits the exercise intensity.