Dr B. Egger

Service de Pneumologie

Hôpital de Rolle

• COPD/rehabilitation introduction

• COPD rehabilitation programs :• Benefits• Components/Modalities

• COPD and congestive heart failure

• COPD and ischemic heart disease

• COPD and pulmonary hypertension

Planning

• COPD/rehabilitation introduction

• COPD rehabilitation programs :• Benefits• Components/Modalities

• COPD and congestive heart failure

• COPD and ischemic heart disease

• COPD and pulmonary hypertension

Planning

Eur Respir Rev 2014; 23: 131

COPD Comorbidities

www.goldcopd.org, update 2010

AJRCCM 2013; 188: e13

Pulmonary rehabilitation

BODE Index

NEJM 2004; 350: 1005

BODE 0-2

BODE 3-4

BODE 5-6

BODE >7

Indications

AJRCCM 2013; 188: e13

AJRCCM 2006; 173: 1390

Arch Phys Med Rehab 2005; 86: 1788

• Unstable or limiting disease !

Resiratory, Cardiac or Psychatric diseases

Orthopedic or neurologic diseases

Contraindications

• COPD/rehabilitation introduction

• COPD rehabilitation programs :• Benefits• Components/Modalities

• COPD and congestive heart failure

• COPD and ischemic heart disease

• COPD and pulmonary hypertension

Planning

www.goldcopd.org, update 2011

Benefits

Respiratory Research 2005; 6:54

Hospitalizations

Respiratory Research 2005; 6:54

Distance

Respiratory Research 2005; 6:54

Quality of life

Respiratory Research 2005; 6:54

Survival

ERJ 2005; 20: 630

• Berry et al.: 151 patients, 12 weeks:

- COPD: mild 99 patients - moderate 36 patients - severe 16 patients

AJRCCM 1999; 160: 1248

Severity of the lung disease

AJRCCM 2005; 172: 19

Clin Chest Med 2014; 35: 391

• COPD/rehabilitation introduction

• COPD rehabilitation programs :• Benefits• Components/Modalities

• COPD and congestive heart failure

• COPD and ischemic heart disease

• COPD and pulmonary hypertension

Planning

Components

• Comorbidities management• Self Management

AJRCCM 2013; 188: e13

J Appl Physiol; 115: 16

Types

Clin Chest Med 2014; 35: 303

Chest 2005; 127: 105

Inpatients:

• during min. 2-3 weeks, idealy 4 weeks

Outpatients:

• 6-26 weeks (min. 20 sessions)

• combination of supervised and self-managed sessions

Duration

J CardioPulm Rehab Prev 2016; 36: 75

J CardioPulm Rehab Prev 2016; 36: 75

J CardioPulm Rehab Prev 2015; 35: 163

J CardioPulm Rehab Prev 2009; 29: 126

E. Lynne Geddes et al., Resp Med 2008

Respiratory muscles training

Proc Am Thorac Soc 2006; 3: 66

Low intensity rehabilitation

Journal Cardio Pulm Rehab 2008; 28: 79

Clin Chest Med 2014; 35: 313

• COPD/rehabilitation introduction

• COPD rehabilitation programs :• Benefits• Components/Modalities

• COPD and congestive heart failure

• COPD and ischemic heart disease

• COPD and pulmonary hypertension

Planning

AJRCCM 2006; 173: 1390

Arch Phys Med Rehab 2005; 86: 1788

• Unstable or limiting disease !

Resiratory, Cardiac or Psychatric diseases

Orthopedic or neurologic diseases

Contraindications

Leading causes of mortality

R. Rodriguez-Roisin et al. Lancet 2009

R. Rodriguez-Roisin et al. Lancet 2009

Protective effect

• COPD/rehabilitation introduction

• COPD rehabilitation programs :• Benefits• Components/Modalities

• COPD and congestive heart failure

• COPD and ischemic heart disease

• COPD and pulmonary hypertension

Planning

J Appl Physiol; 115: 16

Muscle impairment

J Appl Physiol; 115: 16

J CardioPulm Rehab Prev 2007; 27: 368

• COPD/rehabilitation introduction

• COPD rehabilitation programs :• Benefits• Components/Modalities

• COPD and congestive heart failure

• COPD and ischemic heart disease

• COPD and pulmonary hypertension

Planning

Cardiovasc Drugs Ther 2015; 29: 147

FH Rutten et al., Arch Intern Med 2010

β-blockers

• COPD/rehabilitation introduction

• COPD rehabilitation programs :• Benefits• Components/Modalities

• COPD and congestive heart failure

• COPD and ischemic heart disease

• COPD and pulmonary hypertension

Planning

• Common rehabilitation program for 3 weeks (inpatient) - stable patients

• Additionnal exercise program 7d a week at low workloads (10-60W)

• Interval bicycle ergometer training (30’’ lower – 60’’ higher workload) during 10-25’/d = 60-80% of the heart rate reached during initial peak O2 uptake

• Intensity increased (individual tolerability and improvement)

• Limited by: peak HR (< 120 bpm) – satO2 > 85% - subjective physicalexertion

• 60’ of walking 5 d/week (flat and uphill) accompanied by a physiotherapist

• Dumbbell training with low weights (0.5-1 kg)

• 30’ of respiratory training (stretching, breathing techniques…)

• At home : Training manuel + bicycle 15-30’ pd + respiratory exercise + dumbbell 15-30’ + walk twice a week + supervised by phone

Exercise Training Program

• after 3 weeks : + 85 +/- 56 m + 12 +/- 37 m• after 15 weeks : + 96 +/- 61 m - 15 +/- 54 m

D. Mereles et al.; Circulation 2006, 114: 1482

Pr Training Gr Control Gr

Delta = 111 meters

• COPD and comorbidities

• Benefits: survival, QoL, dyspnea, exercise capacity…

• PR Components: more than exercise

• PR Modalities: endurance, resistance, arms training, interval training, inspiratory muscles, low intensity, neurostimulation, other

• Cardiac heart failure, ischemic heart disease, pulmonary hypertension:

• special considerations/focus for training, b-blockers => « protective » effect of the COPD

Conclusions

Thanks