Chest
Volume 112, Issue 5, November 1997, Pages 1363-1396
Journal home page for Chest

Special Report
Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Guidelines

https://doi.org/10.1378/chest.112.5.1363Get rights and content

Section snippets

EPIDEMIOLOGY OF COPD

In the United States, the overall prevalence of COPD in adult white populations is 4 to 6%; in men and 1 to 3%; in women. In persons older than 55 years, COPD is recognized in approximately 10 to 15%;.1, 2 As of 1985, the prevalence rates of COPD in adults 65 years and older was 167/1,000 in men and 126/1,000 in women.3 Recent trends suggest that disease prevalence is stable to decreasing in men, but increasing among women. The 1993 National Health Interview Survey estimated that 14 million

Background

Rehabilitation for patients with chronic lung diseases is well established and widely accepted as a means of enhancing standard therapy in order to alleviate symptoms and optimize function.7, 8, 9, 10, 11, 12, 13 The primary goal of rehabilitation is to restore the patient to the highest possible level of independent function. This goal is accomplished by helping patients to increase their activity through exercise training and to reduce and gain control of their symptoms. Patients and

DEFINITIONS

In 1974, the American College of Chest Physicians (ACCP) Committee on Pulmonary Rehabilitation adopted the following definition quoted in an ATS statement:

“Pulmonary rehabilitation may be defined as an art of medical practice wherein an individually tailored, multidisciplinary program is formulated which through accurate diagnosis, therapy, emotional support, and education, stabilizes or reverses both the physio- and psychopathology of pulmonary diseases and attempts to return the patient to

METHOD FOR THE GUIDELINES PANEL

The Guidelines Panel was organized under the joint sponsorship of the ACCP and the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). In addition to the Chair (Dr. Ries), each organization appointed four representatives: Drs. Casaburi, Celli, Mahler, and Make represented the ACCP; Drs. Carlin, Carrieri-Kohlman, Emery, and Hodgkin represented the AACVPR. Dr. Judah Skolnick served as the Liaison from the ACCP Health and Science Policy Committee.

The primary purpose of

Recommendation

Pulmonary rehabilitation may improve survival in patients with COPD.

Strength of Evidence=C Scientific Evidence

Six studies have assessed the effect of comprehensive pulmonary rehabilitation on survival in patients with COPD. One

FUTURE RECOMMENDATIONS FOR RESEARCH

As the field of pulmonary rehabilitation has matured over the past several decades, much has been learned about the effectiveness and benefits of such programs. The practice of rehabilitation for persons with chronic lung diseases was founded in the physiology and pathophysiology of pulmonary medicine but has grown to encompass also the behavioral and social consequences that are important in understanding the impairments, disabilities, and handicaps of individuals with chronic disease.

First page preview

First page preview
Click to open first page preview

Reference (185)

  • A.L. Ries et al.

    Upper extremity exercise training in chronic obstructive pulmonary disease

    Chest

    (1988)
  • F.J. Martinez et al.

    Supported arm exercise vs unsupported arm exercise in the rehabilitation of patients with severe chronic airflow obstruction

    Chest

    (1993)
  • J.I. Couser et al.

    Pulmonary rehabilitation that includes arm exercise reduces metabolic and ventilatory requirements for simple arm elevation

    Chest

    (1993)
  • K.J. Killian et al.

    Respiratory muscles and dyspnea

    Clin Chest Med

    (1988)
  • D.A. Mahler et al.

    Evaluation of clinical methods for rating dyspnea

    Chest

    (1988)
  • B.A. Preusser et al.

    High- vs low-intensity inspiratory muscle interval training in patients with COPD

    Chest

    (1994)
  • R. Goldstein et al.

    Applicability of a threshold loading device for inspiratory muscle testing and training in patients with COPD

    Chest

    (1989)
  • P.N. Dekhuijzen et al.

    Target-flow inspiratory muscle training during pulmonary rehabilitation in patients with COPD

    Chest

    (1991)
  • R.W. Light et al.

    Prevalence of depression and anxiety in patients with COPD

    Chest

    (1985)
  • J. Porzelius et al.

    Respiratory function, cognitions, and panic in chronic obstructive pulmonary patients

    Behav Res Ther

    (1992)
  • C.F. Emery et al.

    Psychological outcomes of a pulmonary rehabilitation program

    Chest

    (1991)
  • M.W. Higgins et al.

    Incidence, prevalence, and mortality: intra- and intercountry differences

  • M. Feinleib et al.

    Trends in COPD morbidity and mortality in the United States

    Am Rev Respir Dis

    (1989)
  • L.M. Verbrugge et al.

    Seven chronic conditions: their impact on US adults' activity levels and use of medical services

    Am J Public Health

    (1995)
  • Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma

    Am J Rev Respir Crit Care Med

    (1995)
  • Mortality patterns—United States, 1993

    MMWR

    (1996)
  • N.M. Siafakas et al.

    Optimal assessment and management of chronic obstructive pulmonary disease (COPD): the European Respiratory Society Task Force

    Eur Respir J

    (1995)
  • A.L. Ries

    Position paper of the American Association of Cardiovascular and Pulmonary Rehabilitation: scientific basis of pulmonary rehabilitation

    J Cardiopulmonary Rehabil

    (1990)
  • Guidelines for pulmonary rehabilitation programs

    (1993)
  • R. Casaburi et al.

    Principles and practice of pulmonary rehabilitation

    (1993)
  • J.E. Hodgkin et al.

    Pulmonary rehabilitation: guidelines to success

    (1993)
  • Pulmonary rehabilitation

    Am Rev Respir Dis

    (1981)
  • A.P. Fishman

    Pulmonary rehabilitation research

    Am J Respir Crit Care Med

    (1994)
  • Cardiac rehabilitation: clinical practice guideline, No. 17

    (1995)
  • R. Casaburi

    Exercise training in chronic obstructive lung disease

  • R. Carter et al.

    Exercise training in patients with chronic obstructive pulmonary disease

    Med Sci Sports Exerc

    (1992)
  • B.R. Celli

    Exercise training in pulmonary rehabilitation

    Semin Respir Med

    (1993)
  • M.J. Belman

    Exercise in patients with chronic obstructive pulmonary disease

    Thorax

    (1993)
  • C.B. Cooper

    Determining the role of exercise in patients with chronic pulmonary disease

    Med Sci Sports Exerc

    (1995)
  • B.R. Celli

    Pulmonary rehabilitation in patients with COPD

    Am J Respir Crit Care Med

    (1995)
  • R. Casaburi

    Deconditioning

  • C.R. McGavin et al.

    Physical rehabilitation for the chronic bronchitic: results of a controlled trial of exercises in the home

    Thorax

    (1977)
  • A.E. Cockcroft et al.

    Randomised controlled trial of rehabilitation in chronic respiratory disability

    Thorax

    (1981)
  • A.J. Busch et al.

    Effects of a supervised home exercise program on patients with severe chronic obstructive pulmonary disease

    Phys Ther

    (1988)
  • P.J. Wijkstra et al.

    Quality of life in patients with chronic obstructive pulmonary disease improves after rehabilitation at home

    Eur Respir J

    (1994)
  • A.L. Ries et al.

    Effects of pulmonary rehabilitation on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease

    Ann Intern Med

    (1995)
  • M.J. Berry et al.

    Inspiratory muscle training and whole-body reconditioning in chronic obstructive pulmonary disease: a controlled randomized trial

    Am J Respir Crit Care Med

    (1996)
  • D.J. Sinclair et al.

    Controlled trial of supervised exercise training in chronic bronchitis

    BMJ

    (1980)
  • Cited by (412)

    • Effects of Pulmonary Rehabilitation on Exacerbation Number and Severity in People With COPD: An Historical Cohort Study Using Electronic Health Records

      2017, Chest
      Citation Excerpt :

      There may be unobserved confounding despite propensity matching. Reductions in LOS following rehabilitation have also been reported in some RCTs24,25 and observational studies,26 whereas a reduction in LOS was not observed in this cohort. Reasons for this finding may include the fact that patients in our analysis were older and frailer and possibly had more comorbidities than those who participated in the RCTs.

    • What means pulmonary rehabilitation in 2015?

      2015, Revue des Maladies Respiratoires
    • Serial changes in exercise capacity, quality of life and cardiopulmonary responses after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

      2018, Heart and Lung
      Citation Excerpt :

      We therefore suggest patients receive 16 to 24 sessions of PR. Our suggestion is consistent with the current guideline, which suggests 20 sessions for these patients.20 Similar to other studies, we found that exercise training did not improve airflow limitation.18

    View all citing articles on Scopus

    Reprint requests: Andrew L. Ries, MD, MPH, UCSD Rehabilitation Program, 269 Washington Street (West), San Diego, CA 92103-8377

    View full text