By Gerene Bauldoff, PhD, RN, MAACVPR | July 9, 2019
Exercise training is the cornerstone of pulmonary rehabilitation (PR). While we individualize the exercise programs to the patient, the evidence continues to emerge recommending specific exercise activities based on the underlying disease. In the July 4th, 2019 edition of Respirology, Matthew Armstrong and Ioannis Vogiatzis provide a comprehensive review of personalized exercise training modalities.
This review describes endurance training modalities (high-intensity, interval training vs. low-intensity, continuous training) and equipment options (treadmill, stationary bicycle, flat walking, stair climbing, stepping, Nordic walking and water-based exercise). One-legged cycling is detailed where each leg is trained for ½ half of the traditional cycling time. Upper limb training is also detailed, with these exercises targeting the biceps, triceps, deltoids, latissimus dorsi and the pectorals. Other details modalities include water-based rehabilitation, tai chi, yoga, and whole-body vibration training (where the patient stands on a vibrating platform that produces sinusoidal oscillations. This results in muscle contractions from the leg through the trunk.
Additionally, the authors also described exercises for selected, specific lung diseases that present for PR.
- Due to the heterogeneity of the COPD patient presenting for PR, the standard exercise recommendation includes moderate-/high-intensity aerobic endurance training (cycling or walking) and both lower- and upper-extremity resistance training. Additionally, patients with more severe disease, high-intensity interval training has been found to be effective.
- In patients with cystic fibrosis, a combined exercise program that includes aerobic and anaerobic exercise has been shown to be effective. This patient population requires a program at least six weeks in length of “tolerable duration” that progresses to 20-30 minutes at 55-65% maximum heart rate three to five days per week.
- In pulmonary arterial hypertension, the impact of exercise is less clear. However, recent systematic reviews report significant improvements in common exercise outcomes (six minute walk, incremental cardiopulmonary exercise testing). No specific exercise regimens are described.
- For patients with interstitial lung disease, training strategies described include aerobic exercise alone or a combined aerobic and resistance training. However, the most effective exercise training strategy is not confirmed.
- In asthma, no specific exercise training has been described.
What does this mean for the PR Professional?
While we strive to utilize the “best” exercise strategy for our patients, the evidence is still limited and providing direction for disease processes beyond COPD. Careful exercise prescription and ongoing assessment of exercise tolerance and symptoms remains the signet of the PR professional in delivering safe and effective exercise training to all our patients.
Reference: Armstrong M, & Vogiatzis I. (2019). Personalized exercise training in chronic lung diseases. Respirology. doi: 10.1111/resp.13639