Pulmonary rehab with minimal equipment: effective?
Pulmonary rehabilitation is an essential component of chronic obstructive pulmonary disease (COPD) management with strong evidence supporting its efficacy.
Clinically significant improvements in exercise capacity, symptoms of dyspnoea and fatigue, quality of life and reductions in hospital readmission have been documented. However, only 2-5% of people worldwide with COPD have access to programs, (and even less so in developing countries), often unavailable to them because of costs of exercise equipment.
Can low cost programs with minimal equipment achive similar benefits and hence increase availability of rehab?
This RCT compared 11 studies that compared low-cost exercises for endurance and strength to no training and results are positive: exercise capacity was increased and dyspnoe decreased.
Key elements of pulmonary rehab are:
-supervised exercise training programs of at least 2-3 sessions per week.
-for 6-8 weeks in duration.
-each exercise session include endurance exercise training and resistance training.
-task specific; ie mimicking daily activities.
Furthermore, the inclusion of education, anxiety and dyspnoea management, smoking cessation support, and nutritional advice enhances the outcome of a comprehensive pulmonary rehab programme.
In this RCT compared 11 trials that provided pulmonary rehab with use of minimal, low cost equipment for endurance and strength training.
Aerobic exercises included: a progressive walking programme, sit-to-stand, stepping, stairs, and exercise on music. Resistance training consisted of mostly elastic band exercises, but also seated row, lunges, lifting, and bridging. Also, Tai Chi was found to be moderately effective.
Performance on both functional exercise capacity (evaluated with the 6MWT) and QoL (measured with the St. George's Respiratory Questionnaire) was significantly improved compared to no training.
The demand for pulmonary rehabilitation and the lack of available programs requires focus on alternatives to conventional equipment-based exercise training that can be more widely offered. There is growing evidence that exercise training using minimal equipment is effective in improving outcomes of functional exercise capacity and health-related quality of life in people with COPD. In terms of maintenance of benefits, it is possible that programs using minimal equipment may transfer to the home environment more easily and promote continued exercise.
Is it time to invest in Theraband and a functional exercise circuit rather than treadmills?
> From: Alison et al., J Thorac Dis 6 (2015) 1606-1614. All rights reserved to Pioneer Bioscience Publishing Company. Click here for the Pubmed summary.