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Pulmonary Rehabilitation Exercise Prescription in Chronic Obstructive Lung Disease: US SURVEY AND REVIEW OF GUIDELINES AND CLINICAL PRACTICES

Garvey, Chris FNP, MSN, MPA; Fullwood, M. Dot MS; Rigler, Julia RRT, BA

Journal of Cardiopulmonary Rehabilitation and Prevention: September/October 2013 - Volume 33 - Issue 5 - p 314–322
doi: 10.1097/HCR.0b013e318297fea4
Pulmonary Disease
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Chronic obstructive pulmonary disease is a common, progressive disorder associated with disabling symptoms, skeletal muscle dysfunction, and substantial morbidity and mortality. Current national guidelines recommend pulmonary rehabilitation (PR) to improve dyspnea, functional capacity, and quality of life. Many PR exercise programs are based on guidelines from the American College of Sports Medicine. Recommendations have also been published by the American Association of Cardiovascular and Pulmonary Rehabilitation and the American Thoracic Society. Translating exercise science into effective training and clinical care requires interpretation and the use of diverse national PR guidelines and recommendations. Pulmonary rehabilitation clinicians often vary in their education and background, with most nurses and respiratory care practitioners lacking formal training in exercise physiology. Patients often have comorbidities that may further complicate exercise provision and prescription. This article describes the results of an informal, nonscientific survey of the American Association of Cardiovascular and Pulmonary Rehabilitation members exploring current PR exercise prescription practices as a basis for discussion and reviews current national exercise recommendations for chronic obstructive pulmonary disease. Further, it describes areas of uncertainty regarding exercise prescription in PR and suggests strategies for providing effective exercise training, given the diversity of guidelines, clinician preparedness, and patient complexity.

Three major US guidelines outline pulmonary rehabilitation (PR) exercise recommendations for chronic obstructive pulmonary disease. This article describes results from an informal, nonscientific survey of PR practitioners, reviews current US exercise guidelines for chronic obstructive pulmonary disease and areas of uncertainty, and suggests strategies for providing effective exercise training in PR.

Seton Pulmonary and Cardiac Rehabilitation, Daly City, California (Mrs Garvey, Mr Fullwood, and Ms Rigler); and Department of Sleep Disorders, University of California Medical Center, San Francisco (Mrs Garvey).

Correspondence: Chris Garvey, FNP, MSN, MPA, Seton Pulmonary and Cardiac Rehabilitation, 1900 Sullivan Ave, Daly City, CA 94015 (chrisgarvey@dochs.org).

The authors declare no conflicts of interest.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins