Pulmonary rehabilitation is one of the few interventions that can improve symptom control and quality of life in COPD however there is still much to be learnt on how to optimize the exercise component of such programs. The current evidence on specific training of the respiratory muscles is equivocal but a new study in Australia is hoping to define its role.

Dr Peter Eastwood, senior research fellow at Sir Charles Gairdner Hospital, says his team has developed a method to optimally train the diaphragm and intercostal muscles.

Preliminary studies have shown that a high-intensity, interval-training program can optimize improvements in both the strength and endurance of the respiratory muscles. The current study will determine whether the improvement in respiratory muscle function translates into an improvement in overall functional capacity.

“We know that patients with COPD have weak respiratory muscles and currently pulmonary rehabilitation doesn’t address that. This is because general whole-body exercise training such as walking or cycling, while providing functional benefits, does not strengthen the respiratory muscles.”

The absence of specific respiratory muscle training in pulmonary rehabilitation programs is consistent with current guidelines. But if the results of the current study show improved outcomes, then respiratory muscle training would be a valuable addition to a generalized pulmonary rehabilitation program.

Specific respiratory muscle training requires a device that can increase the workload during breathing. Fortunately the commercially available, hand-held device that is being tested is relatively inexpensive and portable. It holds the promise of incorporating respiratory muscle training into home and community based pulmonary rehabilitation programs.

Dr Eastwood says people with COPD should have early access to pulmonary rehabilitation programs individualized for their circumstances and severity of illness.

“No-one will argue that there is a wrong time to reap the benefits of exercise on respiratory function, cardiovascular function, quality of life, general fitness and mood.”

“In my view the earlier the implementation of exercise-based rehabilitation, the better.”

The NHMRC funded project is still recruiting patients in WA with stable COPD who experience shortness of breath during exercise. They will undergo a twenty-minute training session, three times a week for eight weeks.

Standard outcome measurements from the study will include the six-minute walk distance, maximal oxygen consumption, lung function, and responses to a health-related quality of life questionnaire.

The collaborative study involves researchers from Sir Charles Gairdner Hospital, Curtin University of Technology and the University of Western Australia.

Source: COPD News June 12,2003