Physical activity in patients with COPD: The role of pulmonary rehabilitation

Abstract

As is the case for healthy adults, regular physical activity is important for patients with COPD. Individuals with COPD are often very sedentary, and those who are more physically inactive have a greater risk for hospitalization and mortality, even after controlling for cigarette consumption and severity of airflow limitation. Therefore, it makes sense to promote physical activity in these patients. There is a strong evidence base that pulmonary rehabilitation increases exercise tolerance in COPD. Although the number of studies is limited and results not uniform, it appears that pulmonary rehabilitation also increase physical activity levels in COPD. The improvement in activity in this setting, however, probably does not simply reflect the increased capacity to exercise. Pulmonary rehabilitation is more than just exercise training, and the educational component which stresses increased activity is probably equally important in this regard. The interplay between exercise capacity and performance can perhaps be conceptualized using the Leidy model of functional status, as depicted in figure 2. Pulmonary rehabilitation exercise training undoubtedly increases exercise capacity, as evidenced by increased walk test distances or increased time on treadmill endurance tests. However, this will not necessarily increase exercise performance in daily activities, as given by the horizontal bar. Patients who have assumed a sedentary lifestyle over years or decades might not readily change their behaviors. However, if patients can be instructed to get up and do things, this newly-achieved increased exercise capacity might be translated into more daily activities. Copyright © 2009 Via Medica.