Low-cost pulmonary rehabilitation for chronic respiratory diseases: a narrative review

Pulmonary rehabilitation (PR) is a cornerstone in the management of chronic respiratory diseases (CRD), but access remains severely limited in low- and middle-income countries (LMICs) because of cost, infrastructure, and workforce barriers. This mini narrative review synthesized evidence on the effectiveness, feasibility, and implementation of low-cost PR strategies designed with minimal equipment and simplified delivery models. Low-cost PR was considered not only as exercise training using minimal or improvised equipment, but as a context-adapted rehabilitation model that preserves essential PR components while adapting to local health-system, workforce, cultural, and socioeconomic constraints. Searches were conducted in PubMed, Scopus, Web of Science, and SciELO (2014-2024); twenty publications were included, comprising randomized controlled trials, quasi-experimental studies, systematic reviews, clinical guidelines, and implementation research. Across studies, low-cost PR consistently improved exercise capacity, symptoms, and health-related quality of life, measured by 6MWT, ISWT, SGRQ, and CAT. Home-based and community programs demonstrated feasibility and safety, often comparable to conventional PR; supervision and structured education enhanced adherence, while properly instructed unsupervised programs also showed non-inferior outcomes. Tai Chi and Nordic walking emerged as culturally adaptable, low-cost alternatives. However, evidence remains heterogeneous and predominantly COPD-focused, with limited data for other CRD and few studies in primary healthcare, restricting generalizability to the broader CRD burden in LMICs. Effective scale-up requires attention to workforce availability, primary healthcare integration, contextual barriers to home-based rehabilitation, digital accessibility, education, equity, and long-term sustainability. Further high-quality trials and implementation studies are needed to consolidate evidence and inform policies that integrate context-adapted, affordable PR into healthcare systems.