Pulmonary Rehabilitation and Physical Activity in COPD
DOI:
https://doi.org/10.12775/QS.2025.42.60478Keywords
chronic obstructive pulmonary disease, COPD, pulmonary rehabilitationAbstract
Introduction and Purpose: Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by chronic respiratory symptoms and airflow limitation. The purpose of this study was to present pathogenesis, symptoms, diagnosis and treatment of COPD and principal strategies and types of exercises of pulmonary rehabilitation in patients with COPD.
Description of State of Knowledge: Chronic obstructive pulmonary disease (COPD) leads to progressive respiratory dysfunction, muscle loss, and decreased exercise capacity, significantly impairing quality of life. Pulmonary rehabilitation (PR) is a key non-pharmacological intervention, combining exercise training, education, and self-management to improve functional capacity and reduce symptoms. Various training modalities have demonstrated benefits in enhancing endurance, muscle strength, and quality of life in COPD patients. Individualized programs based on patient capacity and symptom burden are essential for optimizing rehabilitation outcomes.
Conclusions: Pulmonary rehabilitation relieves dyspnoea and fatigue, improves emotional function and enhances the sense of control that individuals have over their condition. These improvements are moderately substantial and clinically significant. Rehabilitation serves as an essential component of the management of COPD and is beneficial in improving health-related quality of life and exercise capacity.
References
1. Agustí, A., et al., Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. Am J Respir Crit Care Med, 2023. 207(7): p. 819-837.
2. Gea, J., A. Agustí, and J. Roca, Pathophysiology of muscle dysfunction in COPD. J Appl Physiol (1985), 2013. 114(9): p. 1222-34.
3. Barreiro, E., et al., Chronic endurance exercise induces quadriceps nitrosative stress in patients with severe COPD. Thorax, 2009. 64(1): p. 13-9.
4. Saey, D., et al., Contractile fatigue, muscle morphometry, and blood lactate in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2005. 171(10): p. 1109-15.
5. Nolan, C.M., et al., The EQ-5D-5L health status questionnaire in COPD: validity, responsiveness and minimum important difference. Thorax, 2016. 71(6): p. 493-500.
6. Hogg, J.C. and W. Timens, The pathology of chronic obstructive pulmonary disease. Annu Rev Pathol, 2009. 4: p. 435-59.
7. Agustí, A. and J.C. Hogg, Update on the Pathogenesis of Chronic Obstructive Pulmonary Disease. New England Journal of Medicine, 2019. 381(13): p. 1248-1256.
8. Tuder, R.M. and I. Petrache, Pathogenesis of chronic obstructive pulmonary disease. J Clin Invest, 2012. 122(8): p. 2749-55.
9. Miravitlles, M. and A. Ribera, Understanding the impact of symptoms on the burden of COPD. Respiratory research, 2017. 18(1): p. 67.
10. Wouters, E.F.M., E.C. Creutzberg, and A.M.W.J. Schols, Systemic Effects in COPD. CHEST, 2002. 121(5): p. 127S-130S.
11. Watz, H., B. Waschki, T. Meyer, and H. Magnussen, Physical activity in patients with COPD. European Respiratory Journal. 33(2): p. 262-272.
12. Stage, K.B., T. Middelboe, T.B. Stage, and C.H. Sørensen, Depression in COPD--management and quality of life considerations. Int J Chron Obstruct Pulmon Dis, 2006. 1(3): p. 315-20.
13. van der Molen, T., M. Miravitlles, and J.W. Kocks, COPD management: role of symptom assessment in routine clinical practice. Int J Chron Obstruct Pulmon Dis, 2013. 8: p. 461-71.
14. Lynch, D.A., et al., CT-based Visual Classification of Emphysema: Association with Mortality in the COPDGene Study. Radiology, 2018. 288(3): p. 859-866.
15. Castillo-Saldana, D., C.J. Hague, H.O. Coxson, and C.J. Ryerson, Using Quantitative Computed Tomographic Imaging to Understand Chronic Obstructive Pulmonary Disease and Fibrotic Interstitial Lung Disease: State of the Art and Future Directions. J Thorac Imaging, 2020. 35(4): p. 246-254.
16. Cavigli, E., et al., Whole-lung densitometry versus visual assessment of emphysema. Eur Radiol, 2009. 19(7): p. 1686-92.
17. Kim, V. and S.D. Aaron, What is a COPD exacerbation? Current definitions, pitfalls, challenges and opportunities for improvement. European Respiratory Journal, 2018. 52(5): p. 1801261.
18. Sidhaye, V.K., K. Nishida, and F.J. Martinez, Precision medicine in COPD: where are we and where do we need to go? Eur Respir Rev, 2018. 27(149).
19. Seemungal, T.A., et al., Long-term erythromycin therapy is associated with decreased chronic obstructive pulmonary disease exacerbations. Am J Respir Crit Care Med, 2008. 178(11): p. 1139-47.
20. Albert, R.K., et al., Azithromycin for prevention of exacerbations of COPD. N Engl J Med, 2011. 365(8): p. 689-98.
21. Celli, B.R. and J.A. Wedzicha, Update on Clinical Aspects of Chronic Obstructive Pulmonary Disease. N Engl J Med, 2019. 381(13): p. 1257-1266.
22. Cahill, K., S. Stevens, R. Perera, and T. Lancaster, Pharmacological interventions for smoking cessation: an overview and network meta‐analysis. Cochrane Database of Systematic Reviews, 2013(5).
23. [Recommendations of the French Language Society of Pneumology on the management of COPD (update 2009)]. Presse Med, 2010. 39(9): p. 895-8.
24. McCarthy, B., et al., Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, 2015(2).
25. Wongsurakiat, P., et al., Acute respiratory illness in patients with COPD and the effectiveness of influenza vaccination: a randomized controlled study. Chest, 2004. 125(6): p. 2011-20.
26. Osadnik, C.R., et al., Principles of rehabilitation and reactivation. Respiration, 2015. 89(1): p. 2-11.
27. Guiraud, T., et al., High-intensity interval training in cardiac rehabilitation. Sports Med, 2012. 42(7): p. 587-605.
28. Beaumont, M., P. Forget, F. Couturaud, and G. Reychler, Effects of inspiratory muscle training in COPD patients: A systematic review and meta-analysis. Clin Respir J, 2018. 12(7): p. 2178-2188.
29. Gosselink, R., et al., Impact of inspiratory muscle training in patients with COPD: what is the evidence? Eur Respir J, 2011. 37(2): p. 416-25.
30. Petrovic, M., et al., Effects of inspiratory muscle training on dynamic hyperinflation in patients with COPD. Int J Chron Obstruct Pulmon Dis, 2012. 7: p. 797-805.
31. Burtin, C., et al., Effectiveness of exercise training in patients with COPD: the role of muscle fatigue. Eur Respir J, 2012. 40(2): p. 338-44.
32. Hoppeler, H., Moderate Load Eccentric Exercise; A Distinct Novel Training Modality. Front Physiol, 2016. 7: p. 483.
33. Richardson, R.S., L.R. Frank, and L.J. Haseler, Dynamic knee-extensor and cycle exercise: functional MRI of muscular activity. Int J Sports Med, 1998. 19(3): p. 182-7.
34. Rocha Vieira, D.S., et al., Eccentric cycle exercise in severe COPD: feasibility of application. Copd, 2011. 8(4): p. 270-4.
35. Abbiss, C.R., et al., Single-leg cycle training is superior to double-leg cycling in improving the oxidative potential and metabolic profile of trained skeletal muscle. J Appl Physiol (1985), 2011. 110(5): p. 1248-55.
36. Jones, S., et al., Neuromuscular electrical stimulation for muscle weakness in adults with advanced disease. Cochrane Database Syst Rev, 2016. 10(10): p. Cd009419.
37. Maddocks, M., et al., Neuromuscular electrical stimulation to improve exercise capacity in patients with severe COPD: a randomised double-blind, placebo-controlled trial. Lancet Respir Med, 2016. 4(1): p. 27-36.
38. Abdellaoui, A., et al., Skeletal muscle effects of electrostimulation after COPD exacerbation: a pilot study. Eur Respir J, 2011. 38(4): p. 781-8.
39. Hill, K., et al., Neuromuscular electrostimulation for adults with chronic obstructive pulmonary disease. Cochrane Database Syst Rev, 2018. 5(5): p. Cd010821.
40. Gloeckl, R., et al., Effects of whole body vibration in patients with chronic obstructive pulmonary disease--a randomized controlled trial. Respir Med, 2012. 106(1): p. 75-83.
41. Rauch, F., et al., Reporting whole-body vibration intervention studies: recommendations of the International Society of Musculoskeletal and Neuronal Interactions. J Musculoskelet Neuronal Interact, 2010. 10(3): p. 193-8.
42. Troosters, T., et al., Resistance training prevents deterioration in quadriceps muscle function during acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2010. 181(10): p. 1072-7.
43. Man, W.D., et al., Abdominal muscle and quadriceps strength in chronic obstructive pulmonary disease. Thorax, 2005. 60(9): p. 718-22.
44. Ferreira, I.M., D. Brooks, Y. Lacasse, and R.S. Goldstein, Nutritional support for individuals with COPD: a meta-analysis. Chest, 2000. 117(3): p. 672-8.
45. O'Donnell, D.E., C. D'Arsigny, and K.A. Webb, Effects of hyperoxia on ventilatory limitation during exercise in advanced chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2001. 163(4): p. 892-8.
46. Palange, P., et al., Effect of heliox on lung dynamic hyperinflation, dyspnea, and exercise endurance capacity in COPD patients. J Appl Physiol (1985), 2004. 97(5): p. 1637-42.
47. ATS/ACCP Statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med, 2003. 167(2): p. 211-77.
48. Oga, T., et al., The effects of oxitropium bromide on exercise performance in patients with stable chronic obstructive pulmonary disease. A comparison of three different exercise tests. Am J Respir Crit Care Med, 2000. 161(6): p. 1897-901.
49. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med, 2002. 166(1): p. 111-7.
50. Singh, S.J., et al., Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax, 1992. 47(12): p. 1019-24.
51. Revill, S.M., et al., The endurance shuttle walk: a new field test for the assessment of endurance capacity in chronic obstructive pulmonary disease. Thorax, 1999. 54(3): p. 213-22.
52. Ozalevli, S., A. Ozden, O. Itil, and A. Akkoclu, Comparison of the Sit-to-Stand Test with 6 min walk test in patients with chronic obstructive pulmonary disease. Respir Med, 2007. 101(2): p. 286-93.
53. Man, W.D., P. Kemp, J. Moxham, and M.I. Polkey, Skeletal muscle dysfunction in COPD: clinical and laboratory observations. Clin Sci (Lond), 2009. 117(7): p. 251-64.
54. Casaburi, R., et al., Physiologic benefits of exercise training in rehabilitation of patients with severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 1997. 155(5): p. 1541-51.
55. Zeng, Y., et al., Exercise assessments and trainings of pulmonary rehabilitation in COPD: a literature review. Int J Chron Obstruct Pulmon Dis, 2018. 13: p. 2013-2023.
56. Beauchamp, M.K., et al., Interval versus continuous training in individuals with chronic obstructive pulmonary disease--a systematic review. Thorax, 2010. 65(2): p. 157-64.
57. Leung, R.W., J.A. Alison, Z.J. McKeough, and M.J. Peters, Ground walk training improves functional exercise capacity more than cycle training in people with chronic obstructive pulmonary disease (COPD): a randomised trial. J Physiother, 2010. 56(2): p. 105-12.
58. Troosters, T., R. Casaburi, R. Gosselink, and M. Decramer, Pulmonary rehabilitation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2005. 172(1): p. 19-38.
59. Ortega, F., et al., Comparison of effects of strength and endurance training in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2002. 166(5): p. 669-74.
60. Holland, A.E., C.J. Hill, A.Y. Jones, and C.F. McDonald, Breathing exercises for chronic obstructive pulmonary disease. Cochrane Database Syst Rev, 2012. 10(10): p. Cd008250.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Natalia Tylczyńska, Kinga Tylczyńska, Zuzanna Skiba, Jakub Skiba, Aleksandra Zielińska, Szymon Szypulski, Kinga Kowalik, Maria Michalska, Sebastian Iwaniuk, Ignacy Maciejewski

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 113
Number of citations: 0