**2. Definition of pulmonary rehabilitation**

Pulmonary rehabilitation (PR), which is a cornerstone in the non-pharmacological management of COPD, is defined by the American Thoracic Society/European Respiratory Society (ATS/ERS) as a "comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies that include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease [2, 3]. PR is an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic lung disorders who are symptomatic and have some disability. Through stabilizing or reversing systemic signs of the disease, pulmonary rehabilitation aims to reduce symptoms, optimize functional state, increase participation, and reduce healthcare costs. To put it another way, depending on the stage of the disease, a symptomatic COPD patient has some functional compromise that can be rectified by rehabilitation [3]. In recent years, there has been increasing interest in the role of PR in the acute setting (either during or shortly after a hospital admission for AECOPD) [2].

Health behavior change is vital for optimization and maintenance of benefits from any intervention in chronic care, and PR has taken a lead in implementing strategies

**Figure 1.** *Spectrum of support for chronic obstructive pulmonary disease [5].* *Current and Contemporary Developments in Pulmonary Rehabilitation DOI: http://dx.doi.org/10.5772/intechopen.107050*

to achieve this goal. This model may provide more clarity on the material and methods used to achieve various levels of support. It aids in the defining of terminology and may assist practitioners in determining a person's requirements and the amount of care necessary [4]. Healthcare professionals interested in the field might use this tool to help construct interventions, identify appropriate outcome measures, and define the intervention in a standardized way. The most comprehensive PR program, which includes self-management, should be prioritized for the most severe patients, which is referred to as integrated care (**Figure 1**). The minimal "action plan" intervention may be sufficient for less complicated patients with basic demands [5]. Longterm health maintenance in the face of a progressive disease is challenging. Several studies have suggested that the only approach to maintain changes in health status is to change one's behavior. Cognitive behavioral approaches have been offered as therapies that could help people change their habits. The text recognizes self-efficacy as a critical component of behavior change. Behavior modification may be more successful if weaknesses in self-efficacy are identified and manipulated [5].

## **3. Rationale and outcomes**

Recent evidence-based reviews have confirmed the effect of PR on COPD outcomes, including improved exercise capacity, reduced dyspnea and leg discomfort, improved quality of life (QoL), enhanced self-efficacy, and improved activities of daily living. PR has positive impacts on lung health without having any discernible impact on standard lung function tests like forced expiratory volume in one second (FEV1) [3]. The fact that PR lessens the systemic symptoms of COPD and its prevalent comorbidities provides a clear explanation for this discrepancy. Peripheral muscle dysfunction as a result of physical inactivity or systemic inflammation, muscle wasting, inadequate self-management skills, anxiety, and depression are all significant systemic effects of COPD [5]. Systemic effects and comorbid conditions contribute to the disease burden and might be amenable to therapy. For example, physical conditioning of leg muscles through exercise training reduces lactate production and decreases ventilator load. COPD patients with a decreased ventilatory load can breathe more slowly during exercise, reducing dynamic hyperinflation. These effects usually reduce exertional dyspnea, even without a change in FEV1 [3, 5].
