Doing Exercises At Chronic Obstructive Pulmonary Disease - Article Example

? PATIENTS UNDERGOING PULMONARY REHABILITATION (PR) OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) Patients Undergoing Pulmonary Rehabilitation (PR)of Chronic Obstructive Pulmonary Disease (COPD) Exercise has been proven to improve health by increasing the tolerance limit of the various organs in the body while doing physical activities, and various studies generated enough data to support that at least two months of supervised low to moderate intensity exercise could improve overall health, especially for people with disorders affecting their capability to exercise regularly, such as people suffering from respiratory problems like chronic obstructive pulmonary disease (COPD) which prevent sufferers from breathing in air properly (National COPD Clinical Care Programme, NCCCP, 2013). Adding physical activity to these patients’ pulmonary rehabilitation (PR) treatment regimen is expected to improve their lung function and breathing due to the increased usage of the respiratory muscles and resulting in better functioning (Garber, et al., 2011). In addition, PR involving exercise must use a multi-disciplinary approach such as pharmacological and behavioral modification methods in COPD treatment to produce lasting results (Nici, et al., 2006). While the effectiveness of PR on improving COPD patients’ overall well-being or health-related quality of life (HRQL) may not be similar among all COPD levels, enough data are available to show the wide range of effects that PR can do for mild to moderate COPD patients such as improved breathing, increased physical activity capacity, better mood, among others (Ries, et al., 1995). But due to time and financial constraints for patients, they must be given alternatives that are cost-effective enough to prolong regimen adherence to further improve the symptoms of their COPD. The issue of finding out the minimum duration for exercise to create significant improvement in the condition of COPD patients was assessed since earlier studies mentioning a minimum of two months started to become debunked by more recent studies that found improvement among patients even at a minimum of three to four weeks supervised exercise compared with at least seven to eight weeks of increased physical activity. This essay intends to show the trends on the establishment of the minimum optimal durations necessary for exercise to improve COPD symptoms. The results of studies conducted prior to the release of exercise guidelines in 2006 would be presented first and any study after that year would be considered as recent studies, which all mention that performing the minimum optimal duration of exercise can cause significant and long-term improvements among COPD patients. This is significant in their part since it has been known that patients have troubles adhering to treatment regimens that prove costly and time-consuming (Mendes de Oliveira, et al., 2010). Various articles used for this article review were found using online databases for medical researchers, which includes PubMed, MEDLINE, and Google Scholar. Search terms used to further increase the specificity of results were: pulmonary rehabilitation; chronic obstructive pulmonary disease, COPD, rehabilitation, pulmonary rehabilitation effectiveness, exercise, exercise training, exercise effects, exercise guidelines, health-related quality of life, HRQL, pulmonary rehabilitation guidelines, facility-based pulmonary rehabilitation, home-based pulmonary rehabilitation, COPD education, clinical trial. Based on the American Thoracic Society and the European Respiratory Society, exercises done during PR should be managed and implemented among COPD patients by trained professionals and with the assistance of attending physicians, for a minimum of seven weeks for mild to moderate intensity exercise, and at least four weeks for high-intensity exercise (Nici, et al., 2006). Prior to publishing these results, most of the earliest studies on PR with physical activity mention that at least two months of increased physical activity among COPD patients could improve their respiratory muscles and exercise tolerance, establishing the optimal exercise duration among PR participants. These experiments used standard tests to measure any improvement in the patients using walking and endurance tests such as six-minute walking test (6MWT) and endurance shuttle walking test (ESWT) while measuring the volume of O2 intake before and after the rehabilitation. The studies were able to establish a range of 8-18 weeks or roughly 2-4 months minimum exercise duration to note any improvements on the patients in the results of their walking and endurance tests (Clark, 1994; Morgan, 1999; Reis, et al., 1995; Troosters, Gosselink & Decramer, 2000). Despite these results, not all studies had an agreement on the optimal duration and of the effectiveness of long-term physical activities in effectively improving COPD symptoms, and that there were also other studies which favor shorter exercise durations and thus have contradicting results. Some meta-analytic studies confirm the effectiveness of short-term exercise programs among COPD patients, and these did not agree with other published studies on the optimal 8-12 weeks duration of exercises in PR programs. Four to six weeks of additional physical activity among COPD patients while including other additional elements such as bronchodilators and other COPD treatment methods were effective in improving COPD symptoms and produced similar results to longer programs, but it was also added that the results were also dependent on the severity of the COPD among patients tested (Griffiths, et al., 2000; Lacasse, et al., 1996; Morgan, 1999). While the results did seem promising, the issues with the establishment of these results were the small numbers of published data that created limitations in the meta-analyses, in addition to the lack of established standards concerning the optimal exercise durations for PR. Nevertheless, the studies were able to generate enough evidence that any kind of physical activity can improve the health of COPD patients, and that the only thing that needs to be clarified is the optimal duration for exercises to give long-lasting effects to COPD patients under PR programs with that involve exercises. The release of the joint statement between the American Thoracic Society and the European Respiratory Society about PR and guidelines were able to clearly define what PR is, what are its aims, activity limitations for COPD patients, body compositions of patients included in the program, self-management education, other patient considerations, how the program should be organized, and other suggested plans for the future. The guidelines were also able to address various aspects of PR, including the minimum duration needed to produce optimal results among COPD patients under PR programs. The guidelines established a minimum of seven weeks for mild to moderate intensity exercise, and at least four weeks for high-intensity exercise (Nici, et al., 2006). However, it was also written in the guidelines that aside from the number of sessions per week, the intensity must be adjusted according to the capacity of some COPD patients, as some patients have higher exercise tolerances than others and could benefit from longer and more intense exercise sessions, while others have low exercise tolerance and must remain with milder forms of physical activities to prevent their respiratory systems from overworking. After the establishment of the exercise duration guidelines, other studies that aim to find ways in finding out if exercise durations can be shortened but still have the benefits of physical activities to COPD patients. The most common and widely-accepted duration of PR programs in order to achieve results were around 8-12 weeks minimum, and these were commonly-accepted time durations since these correspond to the guidelines by the American Thoracic Society and the European Respiratory Society (Nici, et al., 2006). Many studies conducted after the guidelines were released had coinciding results, and the collation of their results came up proving that 8-12 weeks was the optimum duration for PR with exercise to be effective among COPD patients to improve their HQRL, exercise tolerance, and breathing (Mendes de Oliveira, et al., 2010; Solanes, et al., 2009; Spencer, Alison & McKeough, 2010). The results were consistent, whether the interventions were done in facilities or under outpatient conditions, confirming the established exercise guidelines for PR. Other studies also strengthen the premise that longer PR with exercise could make its benefits stay longer among COPD patients, especially since some patients do not reach their plateau within the suggested 8-12 week duration. Some studies with durations ranging from three months to three years were able to document the results of consistent physical activity during PR, and all supported the claim that longer exercise durations also have long-lasting improvements among COPD patients that underwent such programs (Baumann, et al., 2012; Beauchamp, et al., 2011; Roman, et al., 2013; Stav, Raz & Shpirer, 2009). These studies were able to link the effectiveness of setting a minimum duration of at least 8-12 weeks to improve the overall health conditions of COPD patients. While most of these researches focused more on proving that longer exercise durations could improve the health of COPD patients overall, there were still other researchers that put more emphasis on the effects of even the shortest duration of physical activity during the PR program, as mentioned in the American Thoracic Society and the European Respiratory Society guidelines. These studies were conducted in the hopes to find out whether the 8-12 week sessions can be shortened to produce data that also agreed with the established guidelines for intensive exercise training. The guidelines mentioned that apart from the minimal seven weeks of light to moderate exercise, it was also possible that at least four weeks of intense physical activity to produce the same results in an eight-week activity consisting of mild to moderate work-outs, provided that the patients do not have other underlying conditions such as cardiac problems (Nici, et al., 2006). These researchers were able to establish that a shortened and supervised PR program ranging from three to four weeks would be just as effective as a seven-week program, provided that there would be assessments done six months after program completion (Sewell, et al., 2006; von Leupoldt, et al., 2008). There were observed improvements in the results of tests such as the 6MWT before and after the rehabilitations, which further imply that the addition of any kind of physical activity in the everyday lives of COPD patients could improve their health, especially among mild to moderate-level patients. Based on studies ranging from the early 1990’s to 2013, data regarding the optimal duration of supervised exercises in COPD patients undergoing PR programs were generated. Studies found out that increased physical activities in PR could confirm HQRL improvement among PR program participants. After the American Thoracic Society and the European Respiratory Society released standardized guidelines on PR physical activities, numerous studies ranging from at least three weeks to three years were able to collate results showing that the minimum optimal duration for intense exercising is at least three weeks, and for mild to moderate at least 8-12 weeks. Short, intense three to four-week sessions could improve patient breathing and well-being to be comparable enough to previous studies that conducted studies of at least seven weeks whether at home or in a facility, giving patients cost-effective options for PR which further helps in COPD symptom improvement. Based on the studies in this review, it can be concluded that: 1) increasing physical activity levels among COPD patients undergoing PR can improve their HQRL and exercise tolerance; 2) any increase in physical activity levels per week for at least four weeks is beneficial; and 3) four weeks of moderate supervised physical activity produces results comparable to previously-published studies mentioning that at least seven to eight weeks duration is needed to improve respiratory function. These results suggest that even as short as three to four weeks in PR programs is significant enough for COPD patients to improve their overall well-being. 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