Pulmonary rehabilitation for dyspnea in the palliative-care setting

Although pulmonary rehabilitation has reproducibly improved dyspnea and quality of life indices in patients with chronic obstructive pulmonary disease (COPD), its suitability to the palliative-care setting is not well established. Evolutions in exercise design, self-monitored home-based programs, and understanding of the patient populations that may benefit are rendering pulmonary rehabilitation more feasible for patients with significant impairment. In this review, we focus on the recent developments that translate most successfully into the palliative-care setting.

Several lower intensity protocols--including interval training and single-leg ergometry--compare positively with the gold standard of high-intensity aerobic exercise in improving dyspnea and functional capacity. Passive strategies such as neuromuscular electrical stimulation have been demonstrated to improve muscle strength and mass and reduce exertional dyspnea. Home-based, self-monitored programs compare favorably with outpatient hospital-based programs. There is increasing evidence that pulmonary rehabilitation is well tolerated and effective for patients with severe COPD, and that other diseases associated with disabling dyspnea may improve symptomatically with pulmonary rehabilitation.

Recent innovations in pulmonary rehabilitation interventions and setting allow the flexibility to facilitate its incorporation into an individualized palliative plan of care. Appropriately tailored, pulmonary rehabilitation may provide additional opportunities to optimize functional capacity and reduce symptom burden.