Exercise and chronic obstructive pulmonary disease: modest fitness gains pay big dividends

Exercise cannot reverse the physiologic and structural deficits of chronic obstructive pulmonary disease, but it can reduce disability by improving endurance, breathing efficiency, and dyspnea tolerance, especially in severely impaired patients. An exercise prescription should begin with an assessment of cardiac risk and exercise capacity. Initial workloads should be light, increases gradual, and follow-up consistent. Patients need encouragement, and may also need supplemental oxygen and treatment with bronchodilators, mucolytics, and/or corticosteroids. Patients who follow an individualized program can often increase their work capacity 70% to 80% within 6 weeks.