**3. COPD as a systemic disease**

Beside respiratory symptoms of dyspnea, COPD has been established to have extra-pulmonary manifestations. Some on them involve skeletal muscle dysfunction which results from physical inactivity and systemic inflammation in addition to hypoxemia, undernutrition, oxidative stress and systemic corticosteroid [16, 17].

Peripheral muscle dysfunction seen in COPD patients is a result of multitude of pathophysiological changes occurring in the skeletal muscles. Skeletal muscles in COPD patient have decreased oxidative capacity that can lead to early lactic

**3**

*Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease*

academia [18–20], decreased muscle fiber volume [21], redistribution of the muscle fiber type (from type 1 to type 2 fibers) [21–23], and abnormal muscle fiber capillarization [23]. These changes in the structure and functioning of the skeletal muscles can lead to higher concentration of lactate for a given work. This in turn can lead to increased ventilation, resulting in dynamic hyperinflation and overall increased ventilator burden. With muscle dysfunction there is a limitation in the activity and promotion of a sedentary lifestyle. A sedentary lifestyle inevitably leads to social isolation, depression and physical deconditioning. Exacerbations of COPD also promote the reduction of exercise performance, dyspnea, and the loss of

PR has no direct impact on lung mechanics or gas exchange [25]. Rather, it optimizes the function of other body systems so that the effect of lung dysfunction is minimized [26]. A comprehensive PR program can help COPD patients gradually improving muscle function by changing muscle biochemical structure. This leads to improved tolerance for higher work load in the patients [27]. PR additionally reduces the central perception of dyspnea and dynamic hyperinflation [28].

A usual pulmonary rehabilitation program can range anywhere from 6 weeks to 12 weeks at various centers which incorporate aerobic exercise, education, muscle strengthening etc. Usually patients undergo supervised training 2–3 times a week, for 30–60 minutes in each session. This could include any regimen for endurance training, interval training, resistance/strength training, walking exercises, flexibility, inspiratory muscle training and/or neuromuscular electrical stimulation. The

There are several benefits of PR not limited to improvement in symptoms like

PR results in reduction in symptoms of dyspnea and leg discomfort. Patients notice improved limb muscle strength and endurance. Most patients also experience improved functional capacity with more independence in activities of daily living (ADLs) [29]. In a Cochrane review [30] including 23 randomized controlled trials, PR was found to relieve dyspnea, and fatigue, improved emotional function and patient's sense of control over their condition. All these improvements were large

There has been increasing interest in physical activity, as inactivity has been linked with reduced survival, poorer quality of life and increased healthcare utilization [31]. In the same Cochrane review as above [30], patients were noted to have improved exercise capacity. Other studies from Griffith's et al. and Singh et al. have

PR has also been found to reduce unscheduled healthcare visits, COPD exacerbation and hospitalization in some literature [34]. Rubi et al. reported reduction in COPD exacerbation, hospitalization and days of hospitalization in 82 consecutive

interventions are individualized to maximize personal functional gains.

dyspnea, exercise tolerance and overall health status in stable patients.

*DOI: http://dx.doi.org/10.5772/intechopen.81742*

Health-related quality of life (HRQoL) [24].

**4. Clinical impact of pulmonary rehabilitation**

**4.1 Symptom control**

and statistically significant.

suggested similar findings [32, 33].

**4.3 Healthcare burden**

**4.2 Physical activity and exercise tolerance**

*Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease DOI: http://dx.doi.org/10.5772/intechopen.81742*

academia [18–20], decreased muscle fiber volume [21], redistribution of the muscle fiber type (from type 1 to type 2 fibers) [21–23], and abnormal muscle fiber capillarization [23]. These changes in the structure and functioning of the skeletal muscles can lead to higher concentration of lactate for a given work. This in turn can lead to increased ventilation, resulting in dynamic hyperinflation and overall increased ventilator burden. With muscle dysfunction there is a limitation in the activity and promotion of a sedentary lifestyle. A sedentary lifestyle inevitably leads to social isolation, depression and physical deconditioning. Exacerbations of COPD also promote the reduction of exercise performance, dyspnea, and the loss of Health-related quality of life (HRQoL) [24].

PR has no direct impact on lung mechanics or gas exchange [25]. Rather, it optimizes the function of other body systems so that the effect of lung dysfunction is minimized [26]. A comprehensive PR program can help COPD patients gradually improving muscle function by changing muscle biochemical structure. This leads to improved tolerance for higher work load in the patients [27]. PR additionally reduces the central perception of dyspnea and dynamic hyperinflation [28].
