Improvement of physical activity in chronic obstructive pulmonary disease by pulmonary rehabilitation and pharmacological treatment
Chronic obstructive pulmonary disease (COPD) is characterized by a progressive restriction of airflow that is not fully recoverable. This leads to adverse effects on the respiratory tract and systemic consequences. COPD is currently seen as a complex disease, with manifestations of multiple systems and frequent comorbidities; therefore integrated care principles must be applied to optimize management.
Physical activity (PA) is defined as physical movement produced by skeletal muscles with energy consumption above rest levels. PA is closely related to reduced morbidity and mortality in chronic obstructive pulmonary disease (COPD). Questionnaires for self-reporting are often subject to recall bias. They also have a poor correlation with objectively qualified PA and do not offer an accurate estimate of the energy consumption of free lives.
PA can be objectively evaluated by newly developed triaxial accelerometers by quantifying steps or body movements over a period of time. Low intensity, home-based pulmonary rehabilitation (PR) using pedometer feedback improves PA. Improvement of physiological factors correlates with longer durations in stable elderly COPD patients. This review focuses on the effects of PR and pharmacological treatment on PA in COPD patients.
32 Studies were selected from their own literature study to evaluate the effects of PR and 11 studies that investigate the effects of pharmacological treatment on PA.The findings in both categories were not consistent. Nineteen studies showed a positive effect with PR, while 13 showed no effect. Eight studies showed a positive effect, while three studies revealed no effect of pharmacological intervention. Because both interventions increase exercise capacity without a consistent effect on PA, counseling with behavioral changes may be necessary to achieve a significant and lasting increase in PA. Changing PA behavior in COPD patients requires an interdisciplinary approach.
Changing PA behavior in COPD patients requires an interdisciplinary approach, bringing together specialists in respiratory medicine, rehabilitation, social and behavioral sciences. Future research in this area is justified to promote this scientific area, in particular with regard to the interaction of pharmacological and non-pharmacological interventions.