Abstract
Systemic inflammation and deconditioning syndrome lead to loss of structural and function of body muscle, particularly in extremity muscle. Longer period of inactivity due to dyspnea worsen the destruction of muscle. Regular and gradually increase exercise training as part of pulmonary rehabilitation (PR) can improve the function of essential muscles in doing daily life so stable Chronic Obstructive Pulmonary Disease (COPD) patient can maintenance their daily activities with minimal limitations. Pulmonary rehabilitation consists of exercise training, nutritional support, smoking cessation, and self-management of COPD. The prescription of exercise training is mandatory. Assessment of clinical condition to adjust the type of training, duration, frequency, and intensity of training must be completed before beginning the training session. Regular and gradually increased training gives significant impact in improving lung function, dyspnea scale, and quality of life in patient with stable COPD. However, in this covid era, the restriction of hospital attending PR was significantly affect PR program. As immunocompromised population, COPD patient have higher risk for COVID19 infection and develops more severe complications compare with normal population. So, the modified supervised and unsupervised training was needed to revise the classic type of PR. Tele-rehabilitation with teleconference, phone calls, and interactive web based PR can be the good alternative in decreasing hospital admission and improving quality of life in patient with COPD.
Highlights
Dyspnea is the main symptom of Chronic Obstructive Pulmonary Disease (COPD) that correlates with the limitation of daily activity [1, 2], anxiety and other psychological impacts [3, 4], low quality of life [5], and reduced survival rate [6]
A review article that compiles few meta-analyses, randomized controlled study, reviews, and the clinical trial showed that pulmonary rehabilitation gives positive impacts in COPD patients according to functional outcomes, dyspnea scale, and quality of life [16]
A high level of IL-6, IL-8, TNF-α showed in COPD patients and their levels have a role as predictors of worse outcomes in COPD [26, 30–32]
Summary
Dyspnea is the main symptom of Chronic Obstructive Pulmonary Disease (COPD) that correlates with the limitation of daily activity [1, 2], anxiety and other psychological impacts [3, 4], low quality of life [5], and reduced survival rate [6]. A study that compares endurance training, combined endurance and strength training, and pharmacological alone showed the improvement of dyspnea in endurance and combined training, but not in a pharmacological alone group It stated that strength training gives an additional impact on muscle force, but not different from endurance training alone in health status [13]. This is in line with the previous author’s study that showed 4 weeks of upper extremity exercise without strength training had demonstrated the improvement of dyspnea scale using the mMRC scale [14]. A review article that compiles few meta-analyses, randomized controlled study, reviews, and the clinical trial showed that pulmonary rehabilitation gives positive impacts in COPD patients according to functional outcomes, dyspnea scale, and quality of life [16]. Diaphragm breathing (DB) itself improves breathing patterns by coordinating the rib cage muscles and abdominal wall, reduce the activity of the accessory muscle, and lead to improving exercise tolerance [20]
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