Exercise Training in Pulmonary Rehabilitation

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Key points

  • Exercise training remains a cornerstone of pulmonary rehabilitation (PR) in patients with chronic respiratory disease.

  • The choice of type of exercise training depends on the physiologic requirements and goals of the individual patient as well as the available equipment at the PR center.

  • Current evidence suggests that, ground walking exercise training, Nordic walking exercise training, resistance training, water-based exercise training, tai chi, and nonlinear periodized exercise are all feasible

Endurance exercise training

Endurance training can be defined as an activity in which large muscle groups are used continuously.7 In the past, PR has focused primarily on aerobic endurance training (such as walking, cycling, stair climbing8), a training frequency of 3 to 4 days per week, with an initial work-phase duration of 10 to 15 minutes, progressively increasing up to 30 to 40 minutes.9, 10 Between 6 and 8 weeks of endurance exercise training is thought to be the minimum time frame needed to achieve substantial

Interval exercise training

Interval training can be defined as repeated short periods of exercise alternated with rest. The duration of the work interval and the recovery interval can vary greatly and depend on the duration of the work phase.31, 32 In healthy individuals the metabolic changes, including cardiorespiratory responses and low muscle lactate concentrations, during interval exercise are similar to those of continuous moderate exercise.33

Emerging research indicates that interval training is an attractive

Ground walking exercise training

Treadmill walking and stationary cycle training have traditionally been the prominent exercise training modalities in comprehensive PR.6, 50 However, ground walking exercise training in COPD can also make oxygen more efficient.51 A home-based unsupervised walking program, 6 days per week for 12 weeks, in patients with COPD almost doubled endurance walk time compared with a control group.52 A study that compared ground walking with stationary cycle training in patients with COPD showed that

Nordic walking exercise training

Nordic walking was developed as an off-season training method for competitive cross-country skiers and it is reputed to be Europe’s fastest growing form of exercise.57 It is an exercise technique characterized by diagonal locomotion using longer steps compared with regular walking,58 and requires coordinated movements for balance and stability, strength and endurance, varied cardiovascular efforts, agility, and visual acuity.59 In the last decade, Nordic walking has been promoted by the

Resistance training

Muscle strength is important for optimal health, functional performance, and quality of life.70, 71 The expected loss of muscle mass and strength with age can progress more slowly when elderly individuals participate in resistance exercise training programs.72 Resistance training is an intervention that can enhance or maintain muscle function (eg, maximal strength, muscle endurance and/or muscle mass).73 The fundamental principles of resistance training are progressive overload, variation, and

Water-based (or aquatic) exercise training

Water-based (or aquatic) exercise training is a lower extremity exercise in a low-impact, resistance-based environment, and uses similar training principles to land-based training. Water-based programs allow people to gain all the advantages of land-based exercise, but the buoyancy of water facilitates balance and gait without overt stress or strain on arthritic joints.91 Several exercises, such as walking, cycling, and lifting weight, can be performed in a swimming pool.92 Suggested water

Tai chi

Tai chi is a thirteenth century Chinese martial art rooted in Taoist philosophy and Chinese philosophic principles, and it includes gentle circular movements, balance exercise, weight lifting, breathing techniques, and mental concentration.111, 112, 113, 114, 115, 116 Traditional tai chi includes various movements that are performed in a slow, relaxed manner for 30 minutes.115 There are many styles of tai chi and each style has its own form. The most popular and widely practiced style of tai

NLPE

Traditional exercise training during PR uses a nonvaried, linear-progressive protocol.31 With this type of protocol an orderly increase in exercise stress (eg, intensity and duration) is placed on the body. A traditional session usually consists of a combination of endurance and resistance training with both the aerobic and anaerobic systems providing the necessary energy for muscular contractions. However, this mix-type protocol may compromise adaptations.31

Athletes use sophisticated nonlinear

Summary

Exercise training remains a cornerstone of PR in patients with chronic respiratory disease. Although treadmill walking and stationary cycle ergometry training constitute the most common forms of exercise training in PR50 and have been shown to improve muscle function, exercise performance, and health status, other types of exercise training may also be beneficial. The choice of type of exercise training depends on the physiologic requirements and goals of the individual patient as well as the

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      Qualitative data based on structured interviews suggest that these patients found the Tai Chi program to be enjoyable, it promoted exercise self-efficacy, and that participants planned to continue Tai Chi after the study ended [70]. These studies have led to the conclusion that Tai Chi could be considered part of a comprehensive interdisciplinary PR program [71]. To the best of our knowledge, there have been no studies examining the role of Tai Chi to maintain benefits gained after completion of a conventional supervised PR program.

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      In patients with chronic respiratory disease, general muscle training must be aimed at improving both the aerobic limitations and muscle dysfunction often seen in these diseases. Choice of training type will not only depend on the needs of the patient and planned objectives, but also to a large extent on the resources available in the rehabilitation clinic.115,116 The various studies consistently show that muscle training is the best treatment for muscle dysfunction in COPD patients.

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