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

muscle dysfunction in chronic obstructive pulmonary disease. A statement of the American Thoracic Society and European Respiratory Society. American Journal of Respiratory and Critical Care Medicine. 1999;**159**:S1-S40

[17] Wüst RC, Degens H. Factors contributing to muscle wasting and dysfunction in COPD patients. International Journal of Chronic Obstructive Pulmonary Disease. 2007;**2**:289-300

[18] Barreiro E, Gea J, Corominas JM, Hussain SN. Nitric oxide syntheses and protein oxidation in the quadriceps femoris of patients with chronic obstructive pulmonary disease. American Journal of Respiratory Cell and Molecular Biology. 2003;**29**:771-778

[19] Gosker HR, Hesselink MK, Duimel H, Ward KA, Schols AM. Reduced mitochondrial density in the vastus lateralis muscle of patients with COPD. The European Respiratory Journal. 2007;**30**:73-79

[20] Maltais F, Simard AA, Simard C, Jobin J, Desgagnés P, LeBlanc P. Oxidative capacity of the skeletal muscle and lactic acid kinetics during exercise in normal subjects and in patients with COPD. American Journal of Respiratory and Critical Care Medicine. 1996;**153**:288-293

[21] Whittom F, Jobin J, Simard PM, et al. Histochemical and morphological characteristics of the vastus lateralis muscle in patients with chronic obstructive pulmonary disease. Medicine and Science in Sports and Exercise. 1998;**30**:1467-1474

[22] Gosker HR, Zeegers MP, Wouters EF, Schols AM. Muscle fibre type shifting in the vastus lateralis of patients with COPD is associated with disease

severity: A systematic review and metaanalysis. Thorax. 2007;**62**:944-949

[23] Jobin J, Maltais F, Doyon JF, et al. Chronic obstructive pulmonary disease: Capillarity and fiber-type characteristics of skeletal muscle. Journal of Cardiopulmonary Rehabilitation. 1998;**18**:432-437

[24] Anzueto A. Impact of exacerbations on COPD. European Respiratory Review. 2010;**19**:113-118

[25] Casaburi R. Exercise training in chronic obstructive lung disease. In: Casaburi R, Petty TL, editors. Principles and Practice of Pulmonary Rehabilitation. Philadelphia: W.B. Saunders; 1993. pp. 204-224

[26] Nici L, Donner C, Wouters E, et al. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. American Journal of Respiratory and Critical Care Medicine. 2006;**173**:1390-1413

[27] Casaburi R, Patessio A, Ioli F, Zanaboni S, Donner CF, Wasserman K. Reductions in exercise lactic acidosis and ventilation as a result of exercise training in patients with obstructive lung disease. The American Review of Respiratory Disease. 1991;**143**:9-18

[28] Casaburi R et al. Pulmonary rehabilitation for management of COPD. The New England Journal of Medicine. 2009;**360**:1329-1335

[29] Rochester CL et al. An official American Thoracic Society/European Respiratory Society policy statement: Enhancing implementation, use, and delivery of pulmonary rehabilitation. American Journal of Respiratory and Critical Care Medicine. 2015;**192**:1373-1386

[30] Lacasse Y, Goldstein R, Lasserson Toby J, et al. Pulmonary

**16**

*Cardiorespiratory Fitness*

[1] Speizer FE, Ware JH. Exploring different phenotypes of COPD. The New England Journal of Medicine.

[10] Harken DE, Carter BN, DeBakey ME. Reconditioning and rehabilitation. In: Coates JB Jr, Berry FB, Mcfetridge EM, editors. Surgery In World War II. Thoracic Surgery. Volume 1. United States: Army Medical Department; pp. 306-319

[11] Crouch R, Ryan K. Physical therapy and respiratory care: Integration as a team in pulmonary rehabilitation. In: Hodgkin JE, Celli BR, Connors GL, editors. Pulmonary Rehabilitation: Guidelines to Success. 3rd ed. Philadelphia: Lippincott Williams &

Wilkins; 2000. pp. 173-211

[12] American Thoracic Society. Pulmonary rehabilitation: Official American Thoracic Society position statement. The American Review of Respiratory Disease. 1981;**124**:663-666

[13] Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, et al. ATS/ERS task force on pulmonary rehabilitation. An official American Thoracic Society/European Respiratory Society statement: Key concepts and advances in pulmonary rehabilitation. American Journal of Respiratory and Critical Care Medicine.

[14] Rochester et al. An official ATS/ ERS policy statement: Enhancing implementation, use and delivery of pulmonary rehabilitation. American Journal of Respiratory and Critical Care

[15] Vogelmeier CF et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD executive summary. American Journal of

Respiratory and Critical Care Medicine.

[16] American Thoracic Society. European Respiratory Society. Skeletal

Medicine. 2015;**192**:1373-1386

2017;**195**(5):557-582

2013;**188**:e13-e64

[2] Vestbo J et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. American Journal of

Respiratory and Critical Care Medicine.

[4] Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Medicine.

[5] Kessler R, Partridge MR, Miravitlles M, et al. Symptom variability in patients with severe COPD: A pan-European cross-sectional study. The European Respiratory Journal. 2011;**37**(2):264-272

[6] Casaburi R. Skeletal muscle function in COPD. Chest. 2000;**117**(5 Suppl 1):

[7] O'Donnell DE, Webb KA. The major limitation to exercise performance in COPD is dynamic hyperinflation. Journal of Applied Physiology.

[8] Lan et al. Benefits of pulmonary rehabilitation in patients with COPD and Normal exercise capacity.

[9] Corhay et al. PR and COPD:

Respiratory Care. 2013;**58**(9):1482-1488

Providing patients a good environment for optimizing therapy. International Journal of COPD. 2014;**9**:27-39

[3] Lopez AD, Shibuya K, Rao C, Mathers CD, Hansell AL, Held LS, et al. Chronic obstructive pulmonary disease: Current burden and future projections. The European Respiratory Journal.

**References**

2015;**373**:185-186

2013;**187**(4):347-365

2006;**27**(2):397-412

2006;**3**(11):e442

267S-271S

2008;**105**(2):753-755

rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews. 2006;**4**:CD0037993. DOI: 10.1002/14651858.CD003793.pub2

[31] Garcia-Aymerich J, Lange P, Benet M, et al. Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: A population based cohort study. Thorax. 2006;**61**:772-778

[32] Griffiths TL, Burr ML, Campbell IA, et al. Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: A randomised controlled trial. Lancet. 2000;**355**:362-368

[33] Singh SJ, Jones PW, Evans R, et al. Minimum clinically important improvement for the incremental shuttle walking test. Thorax. 2008;**63**:775-777

[34] Cecins N et al. Reduction in hospitalisation following pulmonary rehabilitation in patients with COPD. Australian Health Review. 2008;**32**:415-422

[35] Rubi M et al. Effectiveness of pulmonary rehabilitation in reducing health resources use in chronic obstructive pulmonary disease. Archives of Physical Medicine and Rehabilitation. 2010;**91**:364-368. DOI: 10.1016/j. apmr.2009.09.025

[36] Seymour JM, Moore L, Jolley CJ. Outpatient pulmonary rehabilitation following acute exacerbations of COPD. Thorax. 2010;**65**:423-428

[37] Tselebis A et al. A pulmonary rehabilitation program reduces levels of anxiety and depression in COPD patients. Multidisciplinary Respiratory Medicine. 2013;**8**:41

[38] Coventry PA, Hind D. Comprehensive pulmonary rehabilitation for anxiety and

depression in adults with chronic obstructive pulmonary disease: Systematic review and meta-analysis. Journal of Psychosomatic Research. 2007;**63**:551-565

[39] Kirshner B, Guyatt G. A methodological framework for assessing health indices. Journal of Chronic Diseases. 1985;**38**:27-36

[40] Jones PW et al. A self-complete measure of health status for chronic airflow limitation: The St. George's respiratory questionnaire. American Review of Respiratory Disease. 1992;**145**:1321-1327

[41] Houchen-Wolloff L et al. Survival following pulmonary rehabilitation in patients with COPD: The effect of program completion and change in incremental shuttle walking test distance. International Journal of Chronic Obstructive Pulmonary Disease. 2018;**13**:37-44

[42] Ries AL, Kaplan RM, Limberg TM, et al. Effects of pulmonary rehabilitation on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease. Annals of Internal Medicine. 1995;**122**:823-832

[43] Hakamy A et al. The effect of pulmonary rehabilitation on mortality, balance, and risk of fall in stable patients with chronic obstructive pulmonary disease. Chronic Respiratory Disease. 2017;**14**:54-62. DOI: 10.1177/1479972316661925

[44] Jenkins S, Hill K, Cecins NM. State of the art: How to set up a pulmonary rehabilitation program. Respirology. 2010;**15**:1157-1173

[45] Spruit MA et al. An official American Thoracic Society/European Respiratory Society statement: Key concepts and advances in pulmonary rehabilitation. American Journal of

**19**

2008;**102**:819-824

[54] Berry MJ et al. Exercise

*Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease*

pulmonary disease stage. American Journal of Respiratory and Critical Care

Medicine. 1999;**160**:1248-1253

2002;**52**:574-578

[55] Chavannes N et al. Effects of physical activity in mild to moderate COPD: A systematic review. The British Journal of General Practice.

[57] Keating A, Lee A, Holland

Disease. 2011;**8**:89-99

1999;**13**:855-859

2009;**26**:813-831

2009;**64**:326-331

2008;**32**:218-228

[61] Clini EM, Ambrosino

[56] Puhan MA, Scharplatz M, Troosters T, Steurer J. Respiratory rehabilitation after acute exacerbation of COPD may reduce risk for readmission and mortality – A systematic review. Respiratory Research. 2005;**6**:54

AE. What prevents people with chronic obstructive pulmonary disease from attending pulmonary rehabilitation? A systematic review. Chronic Respiratory

[58] Young P, Dewse M, Fergusson W, Kolbe J. Respiratory rehabilitation in chronic obstructive pulmonary disease: Predictors of nonadherence. The European Respiratory Journal.

[59] Nazir SA, Erbland ML. Chronic obstructive pulmonary disease: An update on diagnosis and management issues in older adults. Drugs & Aging.

[60] Weekes CE, Emery PW, Elia M. Dietary counseling and food fortification in stable COPD: A randomised trial. Thorax.

N. Nonpharmacological treatment and relief of symptoms in COPD. The European Respiratory Journal.

[62] Vogiatzis I, Terzis G, Nanas S, et al. Skeletal muscle adaptations to interval training in patients with advanced COPD. Chest. 2005;**128**:3838-3845

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

Respiratory and Critical Care Medicine.

[46] Bolton CE et al. British Thoracic Society guideline on pulmonary rehabilitation in adults. Thorax.

[47] Evans RA et al. Pulmonary rehabilitation is successful for COPD irrespective of MRC dyspnoea grade. Respiratory Medicine.

[48] Ries AL, Make BJ, Lee SM, National Emphysema Treatment Trial Research Group, et al. The effects of pulmonary rehabilitation in the national emphysema treatment trial. Chest.

conditions do not affect shortterm outcome of multidisciplinary rehabilitation in chronic obstructive pulmonary disease. Archives of Physical Medicine and Rehabilitation.

[50] Haave E, Skumlien S, Hyland ME. Gender considerations in pulmonary rehabilitation. Journal of Cardiopulmonary Rehabilitation and

Prevention. 2008;**28**:215-219

and Ageing. 2008;**37**:530-535

[52] Garrod R, Marshall J, Barley E, Jones PW. Predictors of success and failure in pulmonary rehabilitation. The European Respiratory Journal. 2006;**27**:788-794

[53] Sabit R, Griffiths TL, Watkins AJ, et al. Predictors of poor attendance at an outpatient pulmonary rehabilitation programme. Respiratory Medicine.

rehabilitation and chronic obstructive

[51] Di Meo F et al. Age does not hamper the response to pulmonary rehabilitation of COPD patients. Age

[49] Trappenburg JC et al. Psychosocial

2013;**188**:e13-e64

2013;**68**:ii1-ii30

2009;**103**:1070-1075

2005;**128**:3799-3809

2005;**86**:1788-1792

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

Respiratory and Critical Care Medicine. 2013;**188**:e13-e64

*Cardiorespiratory Fitness*

rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews. 2006;**4**:CD0037993. DOI: 10.1002/14651858.CD003793.pub2

depression in adults with chronic obstructive pulmonary disease: Systematic review and meta-analysis. Journal of Psychosomatic Research.

[39] Kirshner B, Guyatt G. A

Diseases. 1985;**38**:27-36

1992;**145**:1321-1327

Disease. 2018;**13**:37-44

1995;**122**:823-832

2010;**15**:1157-1173

methodological framework for assessing health indices. Journal of Chronic

[40] Jones PW et al. A self-complete measure of health status for chronic airflow limitation: The St. George's respiratory questionnaire. American Review of Respiratory Disease.

[41] Houchen-Wolloff L et al. Survival following pulmonary rehabilitation in patients with COPD: The effect of program completion and change in incremental shuttle walking test distance. International Journal of Chronic Obstructive Pulmonary

[42] Ries AL, Kaplan RM, Limberg TM, et al. Effects of pulmonary rehabilitation on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease. Annals of Internal Medicine.

[43] Hakamy A et al. The effect of pulmonary rehabilitation on mortality, balance, and risk of fall in stable patients with chronic obstructive pulmonary disease. Chronic Respiratory

Disease. 2017;**14**:54-62. DOI: 10.1177/1479972316661925

[45] Spruit MA et al. An official American Thoracic Society/European Respiratory Society statement: Key concepts and advances in pulmonary rehabilitation. American Journal of

[44] Jenkins S, Hill K, Cecins NM. State of the art: How to set up a pulmonary rehabilitation program. Respirology.

2007;**63**:551-565

[31] Garcia-Aymerich J, Lange P, Benet M, et al. Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: A population based cohort study. Thorax. 2006;**61**:772-778

[32] Griffiths TL, Burr ML, Campbell IA, et al. Results at 1 year of outpatient

rehabilitation: A randomised controlled

multidisciplinary pulmonary

trial. Lancet. 2000;**355**:362-368

[33] Singh SJ, Jones PW, Evans R, et al. Minimum clinically important improvement for the incremental shuttle walking test. Thorax.

[34] Cecins N et al. Reduction in hospitalisation following pulmonary rehabilitation in patients with COPD. Australian Health Review.

[35] Rubi M et al. Effectiveness of pulmonary rehabilitation in reducing health resources use in chronic

2010;**91**:364-368. DOI: 10.1016/j.

[36] Seymour JM, Moore L, Jolley CJ. Outpatient pulmonary rehabilitation

following acute exacerbations of COPD. Thorax. 2010;**65**:423-428

[37] Tselebis A et al. A pulmonary rehabilitation program reduces levels of anxiety and depression in COPD patients. Multidisciplinary Respiratory

obstructive pulmonary disease. Archives of Physical Medicine and Rehabilitation.

2008;**63**:775-777

2008;**32**:415-422

apmr.2009.09.025

Medicine. 2013;**8**:41

[38] Coventry PA, Hind D. Comprehensive pulmonary rehabilitation for anxiety and

**18**

[46] Bolton CE et al. British Thoracic Society guideline on pulmonary rehabilitation in adults. Thorax. 2013;**68**:ii1-ii30

[47] Evans RA et al. Pulmonary rehabilitation is successful for COPD irrespective of MRC dyspnoea grade. Respiratory Medicine. 2009;**103**:1070-1075

[48] Ries AL, Make BJ, Lee SM, National Emphysema Treatment Trial Research Group, et al. The effects of pulmonary rehabilitation in the national emphysema treatment trial. Chest. 2005;**128**:3799-3809

[49] Trappenburg JC et al. Psychosocial conditions do not affect shortterm outcome of multidisciplinary rehabilitation in chronic obstructive pulmonary disease. Archives of Physical Medicine and Rehabilitation. 2005;**86**:1788-1792

[50] Haave E, Skumlien S, Hyland ME. Gender considerations in pulmonary rehabilitation. Journal of Cardiopulmonary Rehabilitation and Prevention. 2008;**28**:215-219

[51] Di Meo F et al. Age does not hamper the response to pulmonary rehabilitation of COPD patients. Age and Ageing. 2008;**37**:530-535

[52] Garrod R, Marshall J, Barley E, Jones PW. Predictors of success and failure in pulmonary rehabilitation. The European Respiratory Journal. 2006;**27**:788-794

[53] Sabit R, Griffiths TL, Watkins AJ, et al. Predictors of poor attendance at an outpatient pulmonary rehabilitation programme. Respiratory Medicine. 2008;**102**:819-824

[54] Berry MJ et al. Exercise rehabilitation and chronic obstructive pulmonary disease stage. American Journal of Respiratory and Critical Care Medicine. 1999;**160**:1248-1253

[55] Chavannes N et al. Effects of physical activity in mild to moderate COPD: A systematic review. The British Journal of General Practice. 2002;**52**:574-578

[56] Puhan MA, Scharplatz M, Troosters T, Steurer J. Respiratory rehabilitation after acute exacerbation of COPD may reduce risk for readmission and mortality – A systematic review. Respiratory Research. 2005;**6**:54

[57] Keating A, Lee A, Holland AE. What prevents people with chronic obstructive pulmonary disease from attending pulmonary rehabilitation? A systematic review. Chronic Respiratory Disease. 2011;**8**:89-99

[58] Young P, Dewse M, Fergusson W, Kolbe J. Respiratory rehabilitation in chronic obstructive pulmonary disease: Predictors of nonadherence. The European Respiratory Journal. 1999;**13**:855-859

[59] Nazir SA, Erbland ML. Chronic obstructive pulmonary disease: An update on diagnosis and management issues in older adults. Drugs & Aging. 2009;**26**:813-831

[60] Weekes CE, Emery PW, Elia M. Dietary counseling and food fortification in stable COPD: A randomised trial. Thorax. 2009;**64**:326-331

[61] Clini EM, Ambrosino N. Nonpharmacological treatment and relief of symptoms in COPD. The European Respiratory Journal. 2008;**32**:218-228

[62] Vogiatzis I, Terzis G, Nanas S, et al. Skeletal muscle adaptations to interval training in patients with advanced COPD. Chest. 2005;**128**:3838-3845

[63] Coppola S, Wood W. Occupational therapy to promote function and healthrelated quality of life. In: Hodgkin JE, Celli BR, Connors GL, editors. Pulmonary Rehabilitation: Guidelines to Success. 4th ed. St. Louis: Mosby; 2009

[64] Redelmeier DA et al. Interpreting small differences in functional status: The six minute walk test in chronic lung disease patients. American Journal of Respiratory and Critical Care Medicine. 1997;**155**:1278-1282

[65] Hillegass EA, Temes WC. Therapeutic interventions in cardiac rehabilitation and prevention. In: Essentials of Cardiopulmonary Physical Therapy. 2nd ed. Philadelphia, W. B: Saunders; 2001. pp. 676-726

[66] Martín-Valero R, Cuesta-Vargas AI, Labajos-Manzanares MT. Types of physical exercise training for COPD patients. In: Ong K-C, editor. Chronic Obstructive Pulmonary Disease-Current Concepts and Practice. Croacia: Intechweb.org; 2012. pp. 351-374

[67] Gimenez M, Servera E, Vergara P, et al. Endurance training in patients with chronic obstructive pulmonary disease: A comparison of high versus moderate intensity. Archives of Physical Medicine and Rehabilitation. 2000;**81**:102-109

[68] Maltais F, LeBlanc P, Jobin J, et al. Intensity of training and physiologic adaptation in patient with chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine. 1997;**155**:555-561

[69] Vogiatzis I, Nanas S, Roussos C. Interval training as an alternative modality to continuous exercise in patients with COPD. The European Respiratory Journal. 2002;**15**:517-525

[70] Coppoolse R, Schols AM, Baarends EM, et al. Interval versus continuous training in patients with severe

COPD: A randomized clinical trial. The European Respiratory Journal. 1999;**14**:258-263

[71] American Thoracic Society Committee on Pulmonary Function Standards. Guidelines for methacholine and exercise challenge testing—1999. American Journal of Respiratory and Critical Care Medicine. 2000;**161**:309-329

[72] Datta D, ZuWallack R. High versus low intensity exercise training in pulmonary rehabilitation: Is more better? Chronic Respiratory Disease. 2004;**1**:143-149

[73] Gloeckl R, Halle M, Kenn K. Interval versus continuous training in lung transplant candidates: Arandomized trial. The Journal of Heart and Lung Transplantation. 2012;**31**:934-941

[74] Gloeckl R, Marinov B, Pitta F. Practical recommendations for exercise training in patients with COPD. European Respiratory Review. 2013;**22**:178-186

[75] Neder JA, Sword D, Ward SA, et al. Home based neuromuscular electrical stimulation as a new rehabilitative strategy for severely disabled patients with chronic obstructive pulmonary disease (COPD). Thorax. 2002;**57**:333-337

[76] Puente-Maestu L, Sanz ML, Sanz P, et al. Comparison of effects of supervised versus self-monitored training programs in patients with chronic obstructive pulmonary disease. The European Respiratory Journal. 2000;**15**:517-525

[77] Exercise Prescription in Patients with Pulmonary Disease. In: Ehrman JK, editor. ACSM's Resource Manual for Guidelines for Exercise Testing and Prescription. 6th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2009. pp. 575-599

**21**

*Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease*

heart failure. American Journal of Critical Care. 2003;**12**:444-453

[86] O'Shea SD, Taylor NF, Paratz JD. Progressive resistance exercise improves muscle strength and may improve elements of performance of daily activities for people with COPD: A systematic review. Chest.

[87] Houchen L, Steiner MC, Singh SJ. How sustainable is strength training in chronic obstructive pulmonary disease? Physiotherapy.

[88] Holland AE, Hill CJ, Nehez E, et al. Does unsupported upper limb exercise training improve symptoms and quality of life for patients with chronic obstructive pulmonary disease? Journal of Cardiopulmonary Rehabilitation.

[89] Liao WH, Chen JW, Chen X, et al. Impact of resistance training in subjects with COPD: A systematic review and meta-analysis. Respiratory Care.

[91] Spruit MA, Gosselink R, Troosters T, De Paepe C, Decramer M. Resistance versus endurance training in patients with COPD and skeletal muscle weakness. The European Respiratory

[90] Ortega F, Toral J, Cejudo P, Villagomez R, Sanchez H, Castillo J, et al. Comparison of effects of strength and endurance training in patients with chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine.

2009;**136**:1269-1283

2009;**95**:1-7

2004;**24**:422-427

2015;**60**:1130-1145

2002;**166**:669-674

Journal. 2002;**19**:1072-1078

[92] Lacasse Y, Martin S, Lasserson TJ, et al. Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease: A Cochrane systematic review. Europa Medicophysica. 2007;**43**:475-485

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

[79] Hassanein SE, Narsavage GL. The dose effect of pulmonary rehabilitation

exertion,and quality of life. Journal of Cardiopulmonary Rehabilitation and

on physical activity, perceived

Prevention. 2009;**29**:255-260

Wilkins; 2009

[80] American College of Sports Medicine, Thompson WR, Gordon NF, Pescatello LS. ACSM's Guidelines for Exercise Testing and Prescription. 8th ed. Philadelphia: Lippincott Williams &

[81] Garvey C et al. Pulmonary rehabilitation exercise prescription in chronic obstructive pulmonary disease: Review of selected guidelines: An official statement from The American Association of Cardiovascular and Pulmonary Rehabilitation. Journal of Cardiopulmonary Rehabilitation and

Prevention. 2016;**36**:75-83

[82] American College of Sports

Medicine, Pescatello LS, Arena R, Riebe D, Thompson PD. ACSM's Guidelines for Exercise Testing and Prescription. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2014

[83] Ries AL, Bauldoff GS, Carlin BW, et al. Pulmonary rehabilitation: Joint ACCP/AACVPR evidence-based clinical practice guidelines. Chest. 2007;**131**:4-42

[84] Plankeel JF, McMullen B, MacIntyre NR. Exercise outcomes after pulmonary rehabilitation depend on the initial mechanism of exercise limitation among non-oxygen-dependent COPD patients.

[85] Sneed NV, Paul SC. Readiness for behavioral changes in patients with

Chest. 2005;**127**:110-116

[78] Endurance Training – Lower Limb. Pulmonary Rehabilitation Tool Kit. 2016. Available from: https:// pulmonaryrehab.com.au/importanceof-exercise/exercise-prescriptionand-training/endurance-lower-limb/ duration/ [Accessed: Aug 1, 2018]

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

[78] Endurance Training – Lower Limb. Pulmonary Rehabilitation Tool Kit. 2016. Available from: https:// pulmonaryrehab.com.au/importanceof-exercise/exercise-prescriptionand-training/endurance-lower-limb/ duration/ [Accessed: Aug 1, 2018]

*Cardiorespiratory Fitness*

1997;**155**:1278-1282

[65] Hillegass EA, Temes

WC. Therapeutic interventions in cardiac rehabilitation and prevention. In: Essentials of Cardiopulmonary Physical Therapy. 2nd ed. Philadelphia, W. B: Saunders; 2001. pp. 676-726

[66] Martín-Valero R, Cuesta-Vargas AI, Labajos-Manzanares MT. Types of physical exercise training for COPD patients. In: Ong K-C, editor. Chronic Obstructive Pulmonary Disease-

Current Concepts and Practice. Croacia:

[67] Gimenez M, Servera E, Vergara P, et al. Endurance training in patients with chronic obstructive pulmonary disease: A comparison of high versus moderate intensity. Archives of Physical Medicine and Rehabilitation.

[68] Maltais F, LeBlanc P, Jobin J, et al. Intensity of training and physiologic adaptation in patient with chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine. 1997;**155**:555-561

[69] Vogiatzis I, Nanas S, Roussos C. Interval training as an alternative modality to continuous exercise in patients with COPD. The European Respiratory Journal. 2002;**15**:517-525

[70] Coppoolse R, Schols AM, Baarends EM, et al. Interval versus continuous training in patients with severe

Intechweb.org; 2012. pp. 351-374

2000;**81**:102-109

[63] Coppola S, Wood W. Occupational therapy to promote function and healthrelated quality of life. In: Hodgkin JE, Celli BR, Connors GL, editors. Pulmonary Rehabilitation: Guidelines to Success. 4th ed. St. Louis: Mosby; 2009

COPD: A randomized clinical trial. The European Respiratory Journal.

[71] American Thoracic Society Committee on Pulmonary Function Standards. Guidelines for methacholine and exercise challenge testing—1999. American Journal of Respiratory and Critical Care Medicine.

[72] Datta D, ZuWallack R. High versus low intensity exercise training in pulmonary rehabilitation: Is more better? Chronic Respiratory Disease.

[74] Gloeckl R, Marinov B, Pitta F. Practical recommendations for exercise training in patients with COPD. European Respiratory Review.

[76] Puente-Maestu L, Sanz ML, Sanz P, et al. Comparison of effects of supervised versus self-monitored training programs in patients with chronic obstructive pulmonary disease. The European Respiratory Journal.

[77] Exercise Prescription in Patients with Pulmonary Disease. In: Ehrman JK, editor. ACSM's Resource Manual for Guidelines for Exercise Testing and Prescription. 6th ed. Philadelphia: Wolters Kluwer/Lippincott Williams &

Wilkins; 2009. pp. 575-599

[75] Neder JA, Sword D, Ward SA, et al. Home based neuromuscular electrical stimulation as a new rehabilitative strategy for severely disabled patients with chronic obstructive pulmonary disease (COPD). Thorax.

[73] Gloeckl R, Halle M, Kenn K. Interval versus continuous training in lung transplant candidates: Arandomized trial. The Journal of Heart and Lung Transplantation. 2012;**31**:934-941

1999;**14**:258-263

2000;**161**:309-329

2004;**1**:143-149

2013;**22**:178-186

2002;**57**:333-337

2000;**15**:517-525

[64] Redelmeier DA et al. Interpreting small differences in functional status: The six minute walk test in chronic lung disease patients. American Journal of Respiratory and Critical Care Medicine.

**20**

[79] Hassanein SE, Narsavage GL. The dose effect of pulmonary rehabilitation on physical activity, perceived exertion,and quality of life. Journal of Cardiopulmonary Rehabilitation and Prevention. 2009;**29**:255-260

[80] American College of Sports Medicine, Thompson WR, Gordon NF, Pescatello LS. ACSM's Guidelines for Exercise Testing and Prescription. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2009

[81] Garvey C et al. Pulmonary rehabilitation exercise prescription in chronic obstructive pulmonary disease: Review of selected guidelines: An official statement from The American Association of Cardiovascular and Pulmonary Rehabilitation. Journal of Cardiopulmonary Rehabilitation and Prevention. 2016;**36**:75-83

[82] American College of Sports Medicine, Pescatello LS, Arena R, Riebe D, Thompson PD. ACSM's Guidelines for Exercise Testing and Prescription. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2014

[83] Ries AL, Bauldoff GS, Carlin BW, et al. Pulmonary rehabilitation: Joint ACCP/AACVPR evidence-based clinical practice guidelines. Chest. 2007;**131**:4-42

[84] Plankeel JF, McMullen B, MacIntyre NR. Exercise outcomes after pulmonary rehabilitation depend on the initial mechanism of exercise limitation among non-oxygen-dependent COPD patients. Chest. 2005;**127**:110-116

[85] Sneed NV, Paul SC. Readiness for behavioral changes in patients with

heart failure. American Journal of Critical Care. 2003;**12**:444-453

[86] O'Shea SD, Taylor NF, Paratz JD. Progressive resistance exercise improves muscle strength and may improve elements of performance of daily activities for people with COPD: A systematic review. Chest. 2009;**136**:1269-1283

[87] Houchen L, Steiner MC, Singh SJ. How sustainable is strength training in chronic obstructive pulmonary disease? Physiotherapy. 2009;**95**:1-7

[88] Holland AE, Hill CJ, Nehez E, et al. Does unsupported upper limb exercise training improve symptoms and quality of life for patients with chronic obstructive pulmonary disease? Journal of Cardiopulmonary Rehabilitation. 2004;**24**:422-427

[89] Liao WH, Chen JW, Chen X, et al. Impact of resistance training in subjects with COPD: A systematic review and meta-analysis. Respiratory Care. 2015;**60**:1130-1145

[90] Ortega F, Toral J, Cejudo P, Villagomez R, Sanchez H, Castillo J, et al. Comparison of effects of strength and endurance training in patients with chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine. 2002;**166**:669-674

[91] Spruit MA, Gosselink R, Troosters T, De Paepe C, Decramer M. Resistance versus endurance training in patients with COPD and skeletal muscle weakness. The European Respiratory Journal. 2002;**19**:1072-1078

[92] Lacasse Y, Martin S, Lasserson TJ, et al. Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease: A Cochrane systematic review. Europa Medicophysica. 2007;**43**:475-485

[93] Bailey SP, Brown L, Bailey EK. Lack of relationship between functional and perceived quality of life outcomes following pulmonary rehabilitation. Cardiopulmonary Physical Therapy Journal. 2008;**19**:3-10

[94] Troosters T, Gosselink R, Langer D, et al. Pulmonary rehabilitation in chronic obstructive pulmonary disease. Respiratory Medicine: COPD Update. 2007;**3**:57-64

[95] Costi S, Crisafulli E, Antoni FD, et al. Effects of unsupported upper extremity exercise training in patients with COPD: A randomized clinical trial. Chest. 2009;**136**:387-395

[96] Porto EF, Castro AA, Velloso M, et al. Exercises using the upper limbs hyperinflate COPD patients more than exercises using the lower limbs at the same metabolic demand. Monaldi Archives for Chest Disease. 2009;**71**:21-26

[97] Biskobing DM. COPD and osteoporosis. Chest. 2002;**12**:609-620

[98] Dias CS, Kirkwood RN, Parreira VF, et al. Orientation and position of the scapula, head and kyphosis thoracic in male patients with COPD. Canadian Journal of Respiratory Therapy. 2009;**45**:30-34

[99] Greendale GA, Huang M, Karlamangla AS, et al. Yoga decreases kyphosis in senior women and men with adult-onset hyperkyphosis: Results of a randomized controlled trial. Journal of the American Geriatrics Society. 2009;**57**:1569-1579

[100] Munro PE et al. Pulmonary rehabilitation following lung transplantation. Transplantation Proceedings. 2009;**41**:292-295

[101] Make B. Collaborative selfmanagement strategies for patients with respiratory disease. Respiratory Care. 1994;**39**:566-579

[102] Rice KL et al. Disease management program for chronic obstructive pulmonary disease: A randomized controlled trial. American Journal of Respiratory and Critical Care Medicine. 2010;**182**:890-896

[103] Puhan M et al. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews. 2009;**21**(1):CD005305. DOI: 10.1002/14651858.CD005305.pub2

[104] Norweg A, Bose P, Snow G, Berkowitz ME. A pilot study of a pulmonary rehabilitation programme evaluated by four adults with chronic obstructive pulmonary disease. Occupational Therapy International. 2008;**15**:114-132

[105] Chan SC. Chronic obstructive pulmonary disease and engagement in occupation. The American Journal of Occupational Therapy. 2004;**58**:408-415

[106] Fraguas Cerezo MP. Terapia ocupacional en rehabilitación respiratoria. Ter ocup: Rev APETO. 2003;**31**:2-4

[107] American Occupational Therapy Association. Occupational therapy framework: Domain and process (2nd ed.). The American Journal of Occupational Therapy. 2008;**62**:625-683

[108] Morgan DD, White KM. Occupational therapy interventions for breathlessness at the end of life. The American Journal of Occupational Therapy. 2011;**65**:428-436

[109] Solway S, Brooks D, Lau L, Goldstein R. The short-term effect of a rollator on functional exercise capacity among individuals with severe COPD. Chest. 2002;**122**:56-65

**23**

*Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease*

Heart Study. The European Respiratory

[118] Shoup R et al. Body composition and health-related quality of life in patients with obstructive airways disease. European Respiratory Journal.

[119] Mostert R et al. Tissue depletion and health related quality of life in patients with chronic obstructive pulmonary disease. Respiratory Medicine. 2000;**94**:859-867

[120] Kobayashi A et al. The relation of fat-free mass to maximum exercise performance in patients with chronic obstructive pulmonary disease. Lung.

[121] Nishimura Y et al. Relationship between respiratory muscle strength and lean body mass in men with COPD. Chest. 1995;**107**:1232-1236

[122] Agusti A et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2018 report. American Journal of Respiratory and Critical Care

Medicine. 2017;**195**(5):557-582

[124] Yohannes AM, Connolly MJ. Pulmonary rehabilitation programmes in the UK: A national representative survey. Clinical Rehabilitation. 2004;**18**:444-449

[125] Janssen DJ, Spruit MA, Leue C, et al. Symptoms of anxiety and depression in COPD patients entering pulmonary rehabilitation. Chronic Respiratory Disease. 2010;**7**:147-157

2001;**53**:569-578

[123] Mills TL. Comorbid depressive symptomatology: Isolating the effects of chronic medical conditions on self-reported depressive symptoms among community-dwelling older adults. Social Science & Medicine.

Journal. 2002;**20**:539-544

1997;**10**:1576-1580

2000;**178**:119-127

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

limitation. Journal of Cardiopulmonary

[111] Probst V, Troosters T, Coosemans I, Spruit M, Pitta F, Decramer M, et al. Mechanisms of improvement in exercise capacity using a rollator in COPD. Chest. 2004;**126**:1102-1107

[112] Goldstein RS, Gort EH, Guyatt GH, Feeny D. Economic analysis of respiratory rehabilitation. Chest.

[113] Coll Artés R. Estrategias para el manejo de los problemas de la vida diaria: Terapia Ocupacional, soporte psicosocial y sexualidad. In: Güell Rous R, de Lucas Ramos P, editors. Rehabilitación respiratoria. Madrid: Medical & Marketing Comunications;

[114] Emery CF et al. Psychological and cognitive outcomes of a randomized trial of exercise among patients with chronic obstructive pulmonary disease. Health Psychology. 1998;**17**:232-240

[115] Engelen MP et al. Different patterns of chronic tissue wasting among patients with chronic obstructive pulmonary disease. Clinical Nutrition.

[116] Schols AM, Slangen J, Volovics L, Wouters EF. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. American Journal of

Respiratory and Critical Care Medicine.

[117] Prescott E, Almdal T, Mikkelsen KL, Tofteng CL, Vestbo J, Lange P. Prognostic value of weight change in chronic obstructive pulmonary disease: Results from the Copenhagen City

1997;**112**:370-379

1999. pp. 217-231

1999;**18**:275-280

1998;**157**:1791-1797

[110] Honeyman P, Barr P, Stubbing DG. Effect of a walking aid on disability,

oxygenation, and breathlessness in patients with chronic airflow

Rehabilitation. 1996;**16**:63-67

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

[110] Honeyman P, Barr P, Stubbing DG. Effect of a walking aid on disability, oxygenation, and breathlessness in patients with chronic airflow limitation. Journal of Cardiopulmonary Rehabilitation. 1996;**16**:63-67

*Cardiorespiratory Fitness*

Journal. 2008;**19**:3-10

2007;**3**:57-64

2009;**71**:21-26

2009;**45**:30-34

2009;**57**:1569-1579

[93] Bailey SP, Brown L, Bailey EK. Lack of relationship between functional and perceived quality of life outcomes following pulmonary rehabilitation. Cardiopulmonary Physical Therapy

respiratory disease. Respiratory Care.

[102] Rice KL et al. Disease management

rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews. 2009;**21**(1):CD005305. DOI: 10.1002/14651858.CD005305.pub2

program for chronic obstructive pulmonary disease: A randomized controlled trial. American Journal of Respiratory and Critical Care Medicine.

[103] Puhan M et al. Pulmonary

[104] Norweg A, Bose P, Snow G, Berkowitz ME. A pilot study of a pulmonary rehabilitation programme evaluated by four adults with chronic obstructive pulmonary disease. Occupational Therapy International.

[105] Chan SC. Chronic obstructive pulmonary disease and engagement in occupation. The American Journal of Occupational Therapy. 2004;**58**:408-415

[106] Fraguas Cerezo MP. Terapia ocupacional en rehabilitación respiratoria. Ter ocup: Rev APETO.

[107] American Occupational Therapy Association. Occupational therapy framework: Domain and process (2nd ed.). The American Journal of Occupational Therapy. 2008;**62**:625-683

KM. Occupational therapy interventions for breathlessness at the end of life. The American Journal of Occupational

[108] Morgan DD, White

Therapy. 2011;**65**:428-436

[109] Solway S, Brooks D, Lau L, Goldstein R. The short-term effect of a rollator on functional exercise capacity among individuals with severe

COPD. Chest. 2002;**122**:56-65

1994;**39**:566-579

2010;**182**:890-896

2008;**15**:114-132

2003;**31**:2-4

[94] Troosters T, Gosselink R, Langer D, et al. Pulmonary rehabilitation in chronic obstructive pulmonary disease. Respiratory Medicine: COPD Update.

[95] Costi S, Crisafulli E, Antoni FD, et al. Effects of unsupported upper extremity exercise training in patients with COPD: A randomized clinical trial.

[96] Porto EF, Castro AA, Velloso M, et al. Exercises using the upper limbs hyperinflate COPD patients more than exercises using the lower limbs at the same metabolic demand. Monaldi Archives for Chest Disease.

[97] Biskobing DM. COPD and osteoporosis. Chest. 2002;**12**:609-620

[99] Greendale GA, Huang M,

[100] Munro PE et al. Pulmonary rehabilitation following lung transplantation. Transplantation Proceedings. 2009;**41**:292-295

[101] Make B. Collaborative self-

management strategies for patients with

Karlamangla AS, et al. Yoga decreases kyphosis in senior women and men with adult-onset hyperkyphosis: Results of a randomized controlled trial. Journal of the American Geriatrics Society.

[98] Dias CS, Kirkwood RN, Parreira VF, et al. Orientation and position of the scapula, head and kyphosis thoracic in male patients with COPD. Canadian Journal of Respiratory Therapy.

Chest. 2009;**136**:387-395

**22**

[111] Probst V, Troosters T, Coosemans I, Spruit M, Pitta F, Decramer M, et al. Mechanisms of improvement in exercise capacity using a rollator in COPD. Chest. 2004;**126**:1102-1107

[112] Goldstein RS, Gort EH, Guyatt GH, Feeny D. Economic analysis of respiratory rehabilitation. Chest. 1997;**112**:370-379

[113] Coll Artés R. Estrategias para el manejo de los problemas de la vida diaria: Terapia Ocupacional, soporte psicosocial y sexualidad. In: Güell Rous R, de Lucas Ramos P, editors. Rehabilitación respiratoria. Madrid: Medical & Marketing Comunications; 1999. pp. 217-231

[114] Emery CF et al. Psychological and cognitive outcomes of a randomized trial of exercise among patients with chronic obstructive pulmonary disease. Health Psychology. 1998;**17**:232-240

[115] Engelen MP et al. Different patterns of chronic tissue wasting among patients with chronic obstructive pulmonary disease. Clinical Nutrition. 1999;**18**:275-280

[116] Schols AM, Slangen J, Volovics L, Wouters EF. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine. 1998;**157**:1791-1797

[117] Prescott E, Almdal T, Mikkelsen KL, Tofteng CL, Vestbo J, Lange P. Prognostic value of weight change in chronic obstructive pulmonary disease: Results from the Copenhagen City

Heart Study. The European Respiratory Journal. 2002;**20**:539-544

[118] Shoup R et al. Body composition and health-related quality of life in patients with obstructive airways disease. European Respiratory Journal. 1997;**10**:1576-1580

[119] Mostert R et al. Tissue depletion and health related quality of life in patients with chronic obstructive pulmonary disease. Respiratory Medicine. 2000;**94**:859-867

[120] Kobayashi A et al. The relation of fat-free mass to maximum exercise performance in patients with chronic obstructive pulmonary disease. Lung. 2000;**178**:119-127

[121] Nishimura Y et al. Relationship between respiratory muscle strength and lean body mass in men with COPD. Chest. 1995;**107**:1232-1236

[122] Agusti A et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2018 report. American Journal of Respiratory and Critical Care Medicine. 2017;**195**(5):557-582

[123] Mills TL. Comorbid depressive symptomatology: Isolating the effects of chronic medical conditions on self-reported depressive symptoms among community-dwelling older adults. Social Science & Medicine. 2001;**53**:569-578

[124] Yohannes AM, Connolly MJ. Pulmonary rehabilitation programmes in the UK: A national representative survey. Clinical Rehabilitation. 2004;**18**:444-449

[125] Janssen DJ, Spruit MA, Leue C, et al. Symptoms of anxiety and depression in COPD patients entering pulmonary rehabilitation. Chronic Respiratory Disease. 2010;**7**:147-157

[126] Spruit MA et al. Differences in content and organisational aspects of pulmonary rehabilitation programmes. European Respiratory Journal. 2014;**43**:1326-1337

[127] Fernandez AM et al. Home-based pulmonary rehabilitation in very severe COPD: Is it safe and useful? Journal of Cardiopulmonary Rehabilitation and Prevention. 2009;**29**:325-331

[128] Maltais F, Bourbeau J, Shapiro S, et al. Chronic obstructive pulmonary disease Axis of respiratory health network, Fonds de recherche en santé du Québec. Effects of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: A randomized trial. Annals of Internal Medicine. 2008;**149**:869-878

[129] Sillen MJ, Speksnijder CM, Eterman RM, et al. Effects of neuromuscular electrical stimulation of muscles of ambulation in patients with chronic heart failure or COPD: A systematic review of the English-language literature. Chest. 2009;**136**:44-61

[130] Vivodtzev I, Lacasse Y, Maltais F. Neuromuscular electrical stimulation of the lower limbs in patients with chronic obstructive pulmonary disease. Journal of Cardiopulmonary Rehabilitation and Prevention. 2008;**28**:79-91

[131] Ringbaek TJ, Broendum E, Hemmingsen L, et al. Rehabilitation of patients with chronic obstructive pulmonary disease: Exercise twice a week is not sufficient! Respiratory Medicine. 2000;**94**:150-154

[132] Chen R, Li X, Guan N, Guo B, Wu W, Zhou Z, et al. Effectiveness of neuromuscular electrical stimulation for the rehabilitation of moderate-to-severe COPD: A meta-analysis. International Journal of Chronic Obstructive Pulmonary Disease. 2016;**11**:2965-2975

[133] Abdellaoui A, Préfaut C, Gouzi F, Couillard A, Coisy-Quivy M, Hugon G, et al. Skeletal muscle effects of electrostimulation after COPD exacerbation: A pilot study. The European Respiratory Journal. 2011;**38**:781-788

[134] Dal Corso S, Nápolis L, Malaguti C, Gimenes AC, Albuquerque A, Nogueira CR, et al. Skeletal muscle structure and function in response to electrical stimulation in moderately impaired COPD patients. Respiratory Medicine. 2007;**101**:1236-1243

[135] Reid DC, Bowden J, Lynne-Davies P. Role of selected muscles of respiration as influenced by posture and tidal volume. Chest. 1976;**70**:636-640

[136] Weiner P, Magadle R, Beckerman M, et al. Maintenance of inspiratory muscle training in COPD patients: One year follow-up. The European Respiratory Journal. 2004;**23**:61-65

[137] Geddes EL, O'Brien K, Reid WD, et al. Inspiratory muscle training in adults with chronic obstructive pulmonary disease: An update of a systematic review. Respiratory Medicine. 2008;**102**:1715-1729

[138] Nici L, Raskin J, Rochester CL, et al. Pulmonary rehabilitation: What we know and what we need to know. Journal of Cardiopulmonary Rehabilitation and Prevention. 2009;**29**:141-151

[139] Cahalin LP, Braga M, Matsuo Y, et al. Efficacy of diaphragmatic breathing in persons with chronic obstructive pulmonary disease: A review of the literature. Journal of Cardiopulmonary Rehabilitation. 2002;**22**:7-21

[140] Tiep BL. Pursed lips breathing—Easing does it. Journal of Cardiopulmonary Rehabilitation and Prevention. 2007;**27**:245-246

[141] Bott J, Blumenthal S, Buxton M, et al. Guidelines for the physiotherapy

**25**

*Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease*

pulmonary disease. The European Respiratory Journal. 2002;**20**:20-29

[149] Ries AL, Kaplan RM, Myers R, Prewitt LM. Maintenance after pulmonary rehabilitation in chronic lung disease: A randomized trial. American Journal of Respiratory and Critical Care

Medicine. 2003;**167**:880-888

controlled trial. The European Respiratory Journal. 2010;**35**:571-577

[151] Hill K, Bansal V, Brooks D, Goldstein RS. Repeat pulmonary rehabilitation programs confer similar increases in functional exercise capacity to initial programs. Journal of Cardiopulmonary Rehabilitation and

Prevention. 2008;**28**:410-414

Ferreira T, Goldstein RS, Brooks D. Systematic review of supervised exercise programs after pulmonary rehabilitation in individuals with COPD. Chest. 2013;**144**:1124-1133

[152] Beauchamp MK, Evans R, Janaudis-

[153] Emery CF, Shermer RL, Hauck ER, Hsiao ET, MacIntyre NR. Cognitive and psychological outcomes of exercise in a 1-year follow-up study of patients with chronic obstructive pulmonary disease. Health Psychology. 2003;**22**:598-604

[154] Liu WT et al. Efficacy of a cell phone-based exercise programme for COPD. The European Respiratory Journal. 2008;**32**(3):651-659

[155] Stickland M et al. Using telehealth technology to deliver pulmonary rehabilitation in chronic obstructive pulmonary disease patients. Canadian Respiratory Journal. 2011;**18**:216-220

[156] Polisena J et al. Home telehealth for chronic obstructive pulmonary disease: A systematic review and meta-analysis. Journal of Telemedicine and Telecare.

2010;**16**:120-127

[150] Spencer LM, Alison JA, McKeough ZJ. Maintaining benefits following pulmonary rehabilitation: A randomised

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

management of the adult, medical, spontaneously breathing patient.

BH. Bronchopulmonary hygiene

[143] Gosselink R, De Vos J, van den Heuvel SP, Segers J, Decramer M, Kwakkel G. Impact of inspiratory muscle training in patients with COPD: What is the evidence? The European Respiratory Journal. 2011;**37**:416-425

[144] Foglio K, Bianchi L, Bruletti G, Battista L, Pagani M, Ambrosino N. Long-term effectiveness of pulmonary rehabilitation in patients with chronic airway obstruction. The European Respiratory Journal. 1999;**13**:125-132

[145] Bestall JC, Paul EA, Garrod R, Garnham R, Jones RW, Wedzicha AJ. Longitudinal trends in exercise capacity and health status after pulmonary rehabilitation in patients with COPD. Respiratory Medicine.

[146] Foglio K, Bianchi L, Ambrosino N. Is it really useful to repeat outpatient pulmonary rehabilitation programs in patients with chronic airway

obstruction? A 2-year controlled study.

[147] Güell MR, Cejudo P, Ortega F, Puy MC, Rodríguez-Trigo G, Pijoan JI, et al. Benefits of long-term pulmonary rehabilitation maintenance program in patients with severe chronic obstructive pulmonary disease. Three-year follow-up. American Journal of Respiratory and Critical Care Medicine. 2017;**195**(5):622- 629. DOI: 10.1164/rccm.201603-0602OC

[148] Brooks D, Krip B, Mangovski-Alzamora S, Goldstein RS. The effect of postrehabilitation programmes among individuals with chronic obstructive

Chest. 2001;**119**:1696-1704

2003;**97**:173-180

physical therapy for chronic obstructive pulmonary disease and bronchiectasis. Cochrane Database of Systematic Reviews. 2000;**2**:CD000045

Thorax. 2009;**64**:1-51

[142] Jones AP, Rowe
