Photo Credit: Jacob Wackerhausen

Researchers have developed an exercise regimen for patients with COPD designed to increase adherence and improve functioning and outcomes.

Studies have shown that an exercise training program after an acute exacerbation of chronic obstructive pulmonary disease (COPD) is effective in stemming the downward spiral in health that patients often experience afterward. However, many logistical challenges can prevent patients from following an exercise regimen, thus endangering their health.

Thierry Troosters, PT, PhD, and colleagues recently developed an exercise training regimen that accounts for the obstacles patients face when prescribed a progressive and rehabilitative exercise regimen. They published their findings in Physiotherapy.

Physician’s Weekly (PW) spoke with Dr. Troosters about how primary care physicians (PCPs) can apply the study findings at the point of care.

PW: Why did you investigate this exercise regimen for COPD?

Dr. Troosters: Exacerbations are important events in the disease trajectory of patients with COPD. They are the main drivers of cost, impair patients’ function and health-related QOL, and speed up the deterioration of patients with COPD.

Pulmonary rehabilitation that includes exercise training is an effective way to interrupt the downward spiral of increasing disease severity due to exacerbations. Most guidelines include the prescription of rehabilitation after exacerbations. Unfortunately, uptake of these programs is low as programs may not be available, and the logistics of center-based rehabilitation may not fit with the needs of patients who have a rather severe chronic disease. Making programs more accessible and closer to patients’ homes is an important task we tried to do in the present study.

We worked together with primary care physical therapists, general practitioners, chest physicians, and patients to develop a program that would be feasible to implement in a primary care physical therapy (PT) practice. In Belgium, we found that such PT practices are available within a few kilometers of the houses of our patients. Appointments can be made more flexibly than in center-based rehabilitation. A possible drawback is the lack of multidisciplinary support.

What are the most important findings from your study for PCPs?

We developed a practical program for primary care physiotherapists, which is described in detail in the paper. The program offers progressively more difficult exercises for patients after exacerbations and requires limited infrastructure. Patients referred to the program thought it was feasible, and physiotherapists could follow the guidance. A randomized controlled study on the effectiveness of the program is currently underway.

How can these findings be incorporated into practice?

The program is free to adopt and can be used by colleagues in primary care to train their patients after acute exacerbations. For many physical therapists, it is new that the emphasis is not on breathing exercises but rather on reconditioning, with resistance training for the lower limbs and whole-body exercise training (after a few weeks). The program is freely available online and includes YouTube clips for the exercises. It can be progressed as patients improve.

What makes this issue particularly urgent?

More patients should be offered the opportunity to engage in exercise training after an acute exacerbation of COPD. Pharmacotherapy will not reverse the consequences of these exacerbations on skeletal muscle end exercise tolerance. Patients lose their confidence to engage in physical activity and ultimately become much more disabled than needed based on their lung problems.

General practitioners and chest physicians should have a plan for referring their patients to a training program. With this program, we hope to inspire primary care physiotherapists to set up such programs as a care package in their practices.

What still needs to be explored in future research? 

We are currently evaluating the program’s effectiveness in a larger patient population and hope to share those results soon. Obviously, the short and long-term effects of such programs need to be investigated. These programs are no substitute for center-based rehabilitation but may provide options for patients for whom center-based rehabilitation is not possible.

Is there anything else you would like to add?

Please do not discharge a patient with a COPD exacerbation from your service without an operational plan for exercise training adapted to the capabilities of your patient. Your medical treatment is not reversing the systemic consequences of the acute event, and patients will lose skeletal muscle strength and functional exercise tolerance while under your service. This needs to be restored as quickly as possible; otherwise, patients will quickly experience their next respiratory exacerbation. Exercise is the best medicine, so you need a plan, as exercise does not come in a “puff” or a pill.