Abstract
Among the most prevalent multimorbidities that accompany the aging process, chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) stand out, representing the main causes of hospital admissions in the world. The prevalence of COPD coexistence in patients with CHF is higher than in control subjects, given the common risk factors associated with a complex process of chronic diseases developing in the aging process. COPD-CHF coexistence confers a marked negative impact on mechanical-ventilatory, cardiocirculatory, autonomic, gas exchange, muscular, ventilatory, and cerebral blood flow, further impairing the reduced exercise capacity and health status of either condition alone. In this context, integrated approach to the cardiopulmonary based on pharmacological optimization and non-pharmacological treatment (i.e., exercise-based cardiopulmonary and metabolic rehabilitation) can be emphatically encouraged by health professionals as they are safe and well-tolerated, reducing hospital readmissions, morbidity, and mortality. This review aims to explore aerobic exercise, the cornerstone of cardiopulmonary and metabolic rehabilitation, resistance and inspiratory muscle training and exercise-based rehabilitation delivery models in patients with COPD-CHF multimorbidities across the continuum of the disease. In addition, the review address the importance of adjuncts to enhance exercise capacity in these patients, which may be used to optimize the gains obtained in these programs.
Highlights
Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) are prevalent noncommunicable chronic conditions [1]
This process favor the augment in the prevalence of mutually coexistence of diseases [2], as the COPD-CHF that has been highlighted in recent years and associated with poor adverse outcomes [3, 4]
CHF is defined according to left ventricular ejection fraction (EF) and both types are possible to coexist, the reduced EF (HFrEF) is the most cited criterion to diagnose HF in patients with COPD
Summary
Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) are prevalent noncommunicable chronic conditions [1]. A recent review conducted by Anderson et al [22] highlights that home-based rehabilitation seem to be effective than those performed in CR centers when considering improving the quality of life in patients post myocardial infarction or revascularization and heart failure. It supports the continued expansion of home-based and evidence-based CR programs. Regardless of basic cardiac or pulmonary rehabilitation approaches, COPD and CHF have similar systemic manifestations such as limitation in exercise capacity, skeletal muscle dysfunction, dyspnea, deconditioning, reduced level of activities of daily living, and quality of life [23]. The main approach to rehabilitation delivery was undertaken in an outpatient setting, center-based or/and home-based, and almost all programs were comprehensive
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