Pulmonary rehabilitation in chronic obstructive pulmonary disease

Pulmonary rehabilitation has become part of the evidence-based care in patients with COPD who remain symptomatic and have reduced participation in everyday life, after optimal medical treatment. Pulmonary rehabilitation is—by definition—a multidisciplinary intervention. By consequence the assessment of patients before entering a rehabilitation program includes both physiological and psychosocial assessment. In addition nutritional status and physical activity participation needs to be assessed. Effects of pulmonary rehabilitation are clinically relevant and include effects on the above-mentioned dimensions. In general the effects of pulmonary rehabilitation are larger than the minimal clinically important difference and rehabilitation programs have shown to be highly cost-effective. This review focuses on the exercise training intervention. Different training modalities (endurance, interval and resistance training) are discussed and different ‘supplements’ are highlighted (oxygen, non-invasive mechanical ventilation, testosterone and inspiratory muscle training) along with their suggested indications for use. Lastly other interventions which may also be part of the rehabilitation program are briefly discussed.