Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary...
Transcript of Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary...
![Page 1: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/1.jpg)
Roberto A. RabinovichELEGI/Colt laboratory
Centre for Inflammation Research The University of Edinburgh20
Pulmonary Rehabilitation Clinicians Day
Evidence for early Pulmonary Rehabilitation following hospitalisation for exacerbation of COPD
Centre for InflammationResearch
![Page 2: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/2.jpg)
• Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that is not fully reversible
• The airflow limitation is usually progressive and is associated with an abnormal inflammatory response of the lungs to noxious particles and gases, primarily caused by cigarette smoking
• Although COPD affects the lungs, it also produces significant systemic consequences
Chronic Obstructive Pulmonary DiseaseDefinition
ATS/ERS Statement 2004
![Page 3: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/3.jpg)
ATS/ERS Severity
GOLD Post BdFEV1/FVC
FEV1% pred
At risk 0 > 70Cough and
sputum
> 80
Mild I < 70 > 80
Moderate II < 70 50-80
Severe III < 70 30-50
Very severe < 70 < 30
IV < 70 < 30o
< 50 plus CRF
Chronic Obstructive Pulmonary DiseaseClassification
![Page 4: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/4.jpg)
Celli B et al NEJM 2004; 350: 1005
FEV1
6MWD
MRC
BMI
≥65
≥ 350
0-1
>21
0
50-65
250-349
2
<21
1
36-49
150-249
3
2
≤35
≤ 149
4
3
Variable BODE Index Score
Months
0.2
0.4
0.6
0.8
1.0
0 10 30 40 5220
Score 0-2Score 3-4Score 5-6Score 7-10
Chronic Obstructive Pulmonary DiseasePhenotypes
Pro
babi
lity
ofD
eath
![Page 5: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/5.jpg)
Mador MJ, AJRCCM 2000;161: 447-453
Causes for stopping: Fatigue (60%)
no fatiguefatigue
baseline 10 min
40
60
80
100
120
140
Qua
dric
eps
Twitc
hFo
rce
(% o
fBas
elin
e)
Exercise Tolerance in COPDMore than lung function
![Page 6: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/6.jpg)
FatigueNo-fatigue
Saey D et al 2003 Am J Respir Crit Care Dis;168:425
Improvement in FEV1 12%
Qua
dric
eps
stre
ngth
( % o
f res
ting
valu
e)
Time (seconds)Rest 100 200 300 400 500
100
120
80
60
40
20
*+92%
Muscle Dysfunctionexercise tolerance
![Page 7: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/7.jpg)
5
10
15
20
25
30
control COPD
ControlCOPD
Muscle DysfunctionEndurance
Coronell, Eur Respir J 2004;24: 129-136
End
uran
cetim
e (m
inut
es)
*
![Page 8: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/8.jpg)
controlCOPD
Bernard S. , Am J Respir Crit Care Med 1998;158: 629-634
ControlCOPD
20
40
60
80
100
120120
Qua
dric
eps
stre
ngth
(Kg)
Thigh Cross Sectional Area
control COPD20 40 60 80 100 120 140 160
0.4
0.5
0.6
0.7
0.80.9
CSA thigh (cm2)
Muscle mass and strength
![Page 9: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/9.jpg)
Functional disorders
Physio-pathologicalChanges
StrengthResistanceFatigue
Bioenergetics Fiber type distributionCapillarization and O2 deliveryMuscle mass
It is characterized by two different, but possibly related, phenomena:
• Muscle wasting
• Malfunction of the remaining muscle
Chronic Obstructive Pulmonary DiseaseMuscle dysfunction
![Page 10: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/10.jpg)
0
10
20
30
40
50
60
70
Type I Type II
ControlCOPD
%
Jobin J, J Cardiopulm Rehabil, 1998;18(6): 432-437
Physiopathological changesfibre type
![Page 11: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/11.jpg)
05
101520253035404550
CS HADH
ControlCOPD
Maltais F, AJRCCM 1996;153: 288-293
mm
ol/m
in/g
Physiopathological changesBionergetics and oxidative capacity
![Page 12: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/12.jpg)
0
20
40
60
controlCOPD
0
2
4
6
10 20 30 40 50
[Pi]/
[Pcr
]Watt´s
control
Pcr recovery time
Sala E, Am J Respir Crot Care Med 1999;159: 1726-1734
COPD
Tim
e (s
ec)
Physiopathological changesBionergetics and oxidative capacity
![Page 13: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/13.jpg)
0
50
100
150
200
250
ControlesCOPD
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
ControlesCOPD
Capillaries/mm2 Capillaries/fibre
Jobin J, J Cardiopulm Rehabil 1998, 18(6), 432-437
Physiopathological changescapillarisation and O2 transport
![Page 14: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/14.jpg)
PatientsAdmissionsHospitalisationsGP appointmentsDDM of CTC
2.330
4.44.6
23±±±±
0.5162.43.2
2.70.5
3400±±
1.51.2
High LowHealth Resources
(N)
(N)
(dias)
(N)
(mg/d)
Decramer et al ERJ, 1997, 10, 417-423
Muscle DysfunctionHealth resources
![Page 15: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/15.jpg)
30
40
50
60
70
80
90
AgeFEV1DLCO QFPIm
axPEmax
HighLow
% p
red
* #
Decramer et al ERJ, 1997, 10, 417-423
Muscle DysfunctionHealth resources
![Page 16: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/16.jpg)
COPD : is a systemic condition affecting the peripheral muscles
EXERCISE TRAINING : is an intervention directed to re-establish normal muscle function
Pulmonary RehabilitationRationale for exercise training
![Page 17: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/17.jpg)
Meta-analysis n=277 TR, n=242 CO
Lacasse et al., Cochrane database, 2002
Benefits of Exercise TrainingHRQoL
ΔC
RD
Q (p
oint
s)
0.0
0.2
0.4
0.6
0.8
1.0
1.2
DYS FAT EMO MAS
MCID
![Page 18: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/18.jpg)
Benefits of Exercise TrainingExercise tolerance
GuellBendstrup
FinnertyGoldsteinEngström
CockroftWijkstra
CambachBooker
RingbaeckO´Donnell
Troosters
Troosters et al., Am J Respir Crit Care Dis 2005; 172: 19
0 25 50 75 100
6 minutes walking test
MCID
![Page 19: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/19.jpg)
Eaton T et al., Chron Respir Dis 2006; 3: 1-2
Porc
enta
je
0
25
50
75
100
6MWT EST
Troosters et al., Am J Respir Crit Care Dis 2005; 172: 19
0
25
50
75
100
Watt VO2 Const. Crítico
Benefits of Exercise TrainingExercise tolerance
![Page 20: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/20.jpg)
Benefits of Exercise Trainingeffect on exacerbations
Rehab
Control
8
7
5
2
0
Guell R et al. ERJ 2003; 21: 789-94
Group Per patient
250
200
150
100
50
0LTOT
n n
![Page 21: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/21.jpg)
Rehab
Control
Griffiths TL et al. Lancet 2000; 355: 362-368
Days ofhospitalisation
appointments
n
30
20
10
0
n
4
2
0
1
3
Benefits of Exercise Trainingeffect on exacerbations
![Page 22: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/22.jpg)
.25 .5 1.75 1.5
Bahnke(14/12)
Man(20/21)
Global
Murphy(13/13)
Risk of hospitalisation
Puhan M et al. Respir Research 2005; 6: 54
18 m
3 m
6 m
.05 .2 1.0.5 2.0 5.0.1
Risk of death
Benefits of Pulmonary Rehabilitationearly rehabilitation programmes after exacerbations
![Page 23: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/23.jpg)
Spruit, M. A. Thorax, 2003
No exercise training
Teme (Days)
0
75
150
50
125
100
25
175
8 903
Qua
dric
eps
stre
ngth
(Nm
)
Pitta, F. Chest, 2006
Day 3 Day 8
0
150
50
100
200
COPD ExacerbationsImpact on the muscle
*
![Page 24: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/24.jpg)
Exacerbations of COPDEffect on Physical Activity
•Patients with COPD complain about feeling tired and not being able to cope with daily life activities early during exacerbations
Kessler, R. Chest 130:133-142
Day 2 Day 7
0
75
150
50
125100
25
175
1 Month
**
StableCOPD
Pitta, F. Chest, 2006
Tim
e W
alki
ng(m
in)
Garcia-Aymerich Thorax 2006; 61: 772
0.00
0.25
0.50
0.75
1.00
0 5 15 2010
HighModerate
LowVery Low
years
Hos
pita
lisat
ion
Pro
babl
ity
0.00
0.25
0.50
0.75
1.00
0 5 15 2010years
Ris
k of
dea
th
HighModerateLowVery low
![Page 25: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/25.jpg)
Not a good time for a walk…
DyspnoeaWeakness
Acidosis
Corticosteroids
Psychology
Hypoxemia
Physical ActivityEffect of exacerbations of COPD
![Page 26: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/26.jpg)
Pulmonary RehabilitationDuring exacerbations
6MW
D (m
)
Day 1 Day 10 Month 1 Month 2 Month 6Month 3
0
300
600
200
500
400
100
Hospital Home
Behnke M et al 2000 Res Med; 94: 1184
Control
Rehab
Vis
itsto
ER
(%)
0
30
40
50
60
10
20
*
Man W et al 2004 BMJ; 329: 1209
![Page 27: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/27.jpg)
Strength Training
2
5
3
4
6
0
75
25
50
100
D2 D3 D4 D5 D6 D7 D8
Sym
tom
s(0
-10)
Wei
ght(
%1R
M)
Troosters T et al. Am J Respir Crit Care Med, 2010
Pulmonary RehabilitationDuring exacerbations
FatigueDyspnoea
![Page 28: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/28.jpg)
90
120
100
110
0 10 20 30 40
0
0.75
0.25
0.5
Training Control
Qua
dric
eps
stre
ngth
(% d
ay2)
Myo
geni
n/ M
yoD
Troosters T et al. Am J Respir Crit Care Med, 2010
Pulmonary RehabilitationStrength training during exacerbations
ControlTraining
![Page 29: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/29.jpg)
Neder, J. A. Thorax, 2002
400 μs50 Hz
8 s On
20 s Off AmplitudSelectedBy patient
NMES:
• Frequency 50Hz
• Pulse duration 400 μs
• Cycle duty 8/20s On/Off
• Session duration 30 min
• Amplitud (mA) (on tolerance)
• Sessions: 14
Pulmonary RehabilitationNMES during exacerbations
![Page 30: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/30.jpg)
NMES
Pulmonary RehabilitationNMES during exacerbations
![Page 31: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/31.jpg)
Strength Strength
ScreeningWard
Stimulated leg
14 days of stimulation
Control leg
Hospital Home
Giavedoni S et al. ERS 2010
Pulmonary RehabilitationNMES during exacerbations
![Page 32: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/32.jpg)
Stimulatedleg
Controlleg
-30
-20
-10
0
10
20
ΔFu
erza
(%)
*
-5.8 %
7.8 %
Giavedoni S et al. ERS 2010
Pulmonary RehabilitationNMES during exacerbations
![Page 33: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/33.jpg)
-50
0
50
300 550 800 1050 1300
Σ mA
ΔFu
erza
(N)
R=0.94P < 0.05
Giavedoni S et al. ERS 2010
Pulmonary RehabilitationNMES during exacerbations
![Page 34: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/34.jpg)
-20 -10 0 10 20 30 40 50-25
0
25
50
ΔStr
engt
hSt
imul
ated
leg
(% B
asal
)
Δ Strength Control leg(% Basal)
Favours NMES
Favours Control
Giavedoni S et al. ERS 2010
Pulmonary RehabilitationNMES during exacerbations
![Page 35: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/35.jpg)
Pulmonary RehabilitationThe more, the best
Pulmonary RehabilitationIntensity
-35
-30
-25
-20
-15
-10
-5
0
Lact
ate
VE VO2
VCO
2
VE/V
O2
HR
-35
-30
-25
-20
-15
-10
-5
0
Lact
ate
VE VO2
VCO
2
VE/V
O2
HR
High Intensity Training Low Intensity Training
% c
hang
epo
st-tr
aini
ng
Casaburi Am Rev Respir Dis. 1981;144:1220
![Page 36: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/36.jpg)
Pulmonary RehabilitationDuration
• Short programmes (6-8 weeks) are effective in improving outcomes
• However a key goal of pulmonary rehabilitation is to change patient’s behavior
6MW
D (%
Pre
d)
3 Months 6 Months
0
60
80
100
20
40
% T
ime
Wal
king
3 Months 6 Months
0
30
40
50
60
10
20
Pitta F et al. CHEST 2008; 134: 273
*
![Page 37: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/37.jpg)
-1.6
-1.4
-1.2
-1
-0.8
-0.6
-0.4
-0.2
0
ESWT CRQt CRQd CRQf CRQe CRQm
Pulmonary RehabilitationDuration
7 w
eeks
–4
wee
ks
Green et al. Thorax 2001; 56:143-5
![Page 38: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/38.jpg)
505510515520525530535540545550555
Pulmonary RehabilitationDuration
met
ers
Berry et al. J Cardiop Rehab 2003; 23:60-8
0
10
20
30
40
50
60*
*
*
seco
nds
6MWT Steps Overhead
![Page 39: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/39.jpg)
start 6 months 18 months
-30
-20
-10
0
10
20
30
ΔC
RD
Q (p
oint
s)
start 6 months 18 months
-150
-100
-50
0
50
100
150
Δ 6
MW
D (m
)
Pulmonary RehabilitationEffect of 6 month (60sessions)
Troosters et al. AJM 2000; 109(3):207-12
Trainingcontrol
Longer pulmonary rehabilitation programs (beyond 12 weeks) produce greater sustained benefits than shorter programs (ACCP/AACVPR)
![Page 40: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/40.jpg)
Conclusions
• COPD is a complex disease affecting the lungs but incurring in several systemic
effects such as muscle dysfunction
• Muscle dysfunction, together with lung function impairment, causes exercise
intolerance
• Pulmonary rehabilitation, particularly exercise training, is an intervention aimed at
restoring normal muscl function
• PR improves exercise tolerance, HRQoL and improves rate of exacerbations and
hospitalisation days
• Early PR has the same beneficial effects that PR for stable COPD patients and
may have an impact on survival
![Page 41: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/41.jpg)
Conclusions
• Strength training and NMES may help preventing muscle dysfunction during
exacerbations and incur beneficial effects for the patients
• High intensity programmes are preferable to low intensity programmes since
achieve greater effects
• Longer programmes seems to achieve greater effect than shorter programmes
• It is generally believed that longer programes yield more endurable training effects
![Page 42: Evidence for early PR following exacerbation RRabinovitch · • Chronic Obstructive Pulmonary Disease is a preventable and treatable state characterized by airflow limitation that](https://reader030.fdocuments.in/reader030/viewer/2022020413/5b81da767f8b9ae47b8d39d0/html5/thumbnails/42.jpg)
Roberto A. RabinovichELEGI/Colt laboratory
Centre for Inflammation Research The University of Edinburgh20
Pulmonary Rehabilitation Clinicians Day
Evidence for early Pulmonary Rehabilitation following hospitalisation for exacerbation of COPD
Centre for InflammationResearch