As regular readers of our articles can attest, we believe strongly in the COPD treatment, pulmonary rehabilitation, and its proven ability to reduce shortness of breath, improve physical endurance and strength, as well as its impact in improving COPD patient quality of daily living. Still, it remains an under-prescribed treatment by physicians and an underutilized resource by COPD patients.
As further evidence of pulmonary rehab’s effectiveness, a group of Dutch researchers examined the impact of a 12 week pulmonary rehab program in 18 moderate-to-severe COPD patients. They discovered the 12 week program of aerobic exercise and strength training improved cycling endurance of the study participants by 160% and walking distance achieved in a 6-minute timed test improved by 14%. In addition, at the end of the program, self-reported dyspnea (shortness of breath) during the activities tested had declined by 9-17%. [1]
The study was intended to assess whether conditioning tests traditionally used to validate pulmonary rehab’s effectiveness are better measures than observed improvements in training performance. In other words, is a comparison of 6 minute walk test distances recorded at the beginning and end of a rehab program a better way to determine whether COPD patients derived benefit from the program versus measuring increases in how much weight a patient could lift or how much more resistance a patient could withstand during cycling.
The researchers ultimately concluded that the traditional conditioning tests are better measurements of COPD patient improvement, but to us the value of the study was in reaffirming the benefits of pulmonary rehab in general – regardless of measurement preference.
The pulmonary rehab program in the study involved 1.5 hour exercise sessions, 3 days per week over a 12 week period. The exercises included in each session (with intermittent rest breaks) included:
• 20 minutes of interval cycling (alternating sessions of heavy and light intensity cycling),
• 5 minutes of unsupported arm dumbbell lifting exercises (2.5 minutes for each arm)
• 5 minute sit/walk slalom course designed to simulate everyday sit/walk activities at home
• 6-12 minutes of endurance walking exercise on a treadmill
• Additional strength resistance training of abdominal, shoulder, and leg muscle groups
Prior to beginning the rehab program, and again following the last rehab session, the researchers had the study participants perform three conditioning tests (constant work-rate cycling, 6-minute walk test and maximal incremental cycling). To determine the rehab program’s effectiveness, researchers evaluated the pre- and post- rehab conditioning test results of the study subjects. They also assessed improvements in the amount of weight lifted in the arm exercise and resistance load achieved during the interval cycling from the beginning of the program to the end.
While the patients did see significant improvements in amount of weight lifted, number of repetitions performed, and resistance load achieved during interval cycling, the researchers found the traditional conditioning tests to be a better gauge of the pulmonary rehabilitation program’s impact.
The study authors concluded, “Indeed, in the current study, exercise duration and walking distance during submaximal exercise tests (constant workrate cycling, 6-min walk test) increased by 160% and 14%, respectively, and both of these have been reported to be of clinical relevance…The current study also included the training activities in the evaluation. During the 12 weeks of training, all patients were able to perform training activities with higher loads and weight for a longer duration, and with a trend toward less dyspnea and fatigue.”
Pulmonary rehabilitation works and if you are a COPD patient interested in improving how you feel, you owe it to yourself to discuss pulmonary rehabilitation with your pulmonologist. If you can’t gain entry to a rehab program in your area (or if one is not offered), we recommend asking your doctor to recommend an exercise program appropriate for your particular circumstance.
Alternatively, we have created a pulmonary-rehab style exercise program based on guidelines established by the American Thoracic Society and European Respiratory Society that is available in our Breathe Better for Life guidebook, www.breathebetterforlife.com. Our program also incorporates guidelines established by the American College of Sports Medicine for those with chronic respiratory conditions.
[1] Hanneke A, et al. Exercises Commonly Used in Rehabilitation of Patients With Chronic Obstructive Pulmonary Disease: Cardiopulmonary Responses and Effect Over Time. Arch Phys Med Rehabil. 2011;92:111-117.
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