O6.2 Exercise training

Exercise training is considered to be the essential component of pulmonary rehabilitation.(Nici et al., 2006),(Ries et al., 2007) Numerous randomised controlled trials in patients with moderate to severe COPD have shown decreased symptoms (breathless­ness and fatigue),increased exer­cise endurance and improved, health-related quality of life, emotional function and the patients’ self-control over their condition following exercise training alone(Lacasse et al., 2006) [evidence level I]. Improvements in muscle strength and self-efficacy have also been reported.(Ries et al., 2007) Exercise training also improves exercise tolerance in individuals with mild disease.(Chavannes et al., 2002)

Inspiratory muscle training (IMT), performed in isolation using a threshold loading device or target-flow resistive device at loads equal to or greater than 30% of an individual’s maximum inspiratory pressure generated against an occluded airway (PImax) has been shown to increase inspiratory muscle strength and endurance and reduce dyspnoea in patients with COPD (Lotters et al., 2002),(Geddes et al., 2008) [evidence level I]. It may result in modest improvements in 6 minute walk distance and health-related quality of life.(Geddes et al., 2008) It remains unclear whether IMT combined with a program of whole-body exercise training confers additional benefits in dyspnoea, exercise capacity or health-related quality of life in patients with COPD.(Lotters et al., 2002), (O'Brien et al., 2008) At present, the evidence does not support the routine use of IMT as an essential component of pulmonary rehabilitation.(Ries et al., 2007)

Some very disabled patients are shown how to reduce unnecessary energy expenditure during activities of daily living.(Nici et al., 2006) Some patients who experience marked oxygen desaturation on exertion may benefit from ambulatory oxygen during exercise training and activities of daily living. (see section P9).

Maintenance of regular physical activity is essential for continuing the benefits from the initial training program.(Ries et al., 2007) Transfer of the exercise and education components of the initial pulmonary rehabilitation program into the home setting should be emphasised in an attempt to encourage long-term adherence. Exacerbations are reported by patients with COPD to be the commonest reason for non-adherence with exercise.(Brooks et al., 2002) Several strategies for maintaining regular exercise and self-management have been studied; however, there is no consensus as to the most effective strategy for maintaining the benefits of pulmonary rehabilitation.(Nici et al., 2006),(Ries et al., 2007)