Journal of General Internal Medicine

, Volume 18, Issue 3, pp 213–221 | Cite as

Rehabilitation for patients with chronic obstructive pulmonary disease

Meta-analysis of randomized controlled trials
  • Ghassan F. Salman
  • Michael C. Mosier
  • Brent W. Beasley
  • David R. Calkins


OBJECTIVE: To develop a meta-analysis to determine the effectiveness of rehabilitation in patients with chronic obstructive pulmonary disease (COPD).

DATA SOURCES: MEDLINE, CINHAL, and Cochrane Library searches for trials of rehabilitation for COPD patients. Abstracts presented at national meetings and the reference lists of pertinent articles were reviewed.

STUDY SELECTION: Studies were included if: trials were randomized; patients were symptomatic with forced expiratory volume in one second (FEV1) <70% or FEV1 divided by forced vital capacity (FEV1/FVC) <70% predicted; rehabilitation group received at least 4 weeks of rehabilitation; control group received no rehabilitation; and outcome measures included exercise capacity or shortness of breath. We identified 69 trials, of which 20 trials were included in the final analysis.

DATA EXTRACTION: Effect of rehabilitation was calculated as the standardized effect size (ES) using random effects estimation techniques.

RESULTS: The rehabilitation groups of 20 trials (979 patients) did significantly better than control groups on walking test (ES=0.71; 95% confidence interval [95% CI], 0.43 to 0.99). The rehabilitation groups of 12 trials (723 patients) that used the Chronic Respiratory Disease Questionnaire had less shortness of breath than did the control groups (ES=0.62; 95% CI, 0.35 to 0.89). Trials that used respiratory muscle training only showed no significant difference between rehabilitation and control groups, whereas trials that used at least lower-extremity training showed that rehabilitation groups did significantly better than control groups on walking test and shortness of breath. Trials that included severe COPD patients showed that rehabilitation groups did significantly better than control groups only when the rehabilitation programs were 6 months or longer. Trials that included mild/moderate COPD patients showed that rehabilitation groups did significantly better than control groups with both short- and long-term rehabilitation programs.

CONCLUSION: COPD patients who receive rehabilitation have a better exercise capacity and they experience less shortness of breath than patients who do not receive rehabilitation. COPD patients may benefit from rehabilitation programs that include at least lower-extremity training. Patients with mild/moderate COPD benefit from short- and long-term rehabilitation, whereas patients with severe COPD may benefit from rehabilitation programs of at least 6 months.

Key words

rehabilitation obstructive lung disease shortness of breath exercise review 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Petty TL. Definition, causes, course, and prognosis of chronic obstructive pulmonary disease. Respir Care Clin N Am. 1998;4:345–58.PubMedGoogle Scholar
  2. 2.
    Keistinen T, Tuuponen T, Kivela SL. Survival experience of the population needing hospital treatment for asthma and COPD at age 50–54 years. Respir Med. 1998;92:568–72.PubMedCrossRefGoogle Scholar
  3. 3.
    American Thoracic Society. Pulmonary rehabilitation 1999. Am J Respir Crit Care Med. 1999;159:1666–82.Google Scholar
  4. 4.
    ACCP/AACVPR Pulmonary Rehabilitation Guidelines Panel. Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based guidelines. American College of Chest Physicians. American Association of Cardiovascular and Pulmonary Rehabilitation. Chest. 1997;112:1363–96.Google Scholar
  5. 5.
    Casaburi R. Exercise training in chronic obstructive pulmonary disease. In: Principles and Practice of Pulmonary Rehabilitation. Philadelphia: W. B. Saunders; 1993:204–24.Google Scholar
  6. 6.
    Moher D, Jadad AR, Nichol G, Penman M, Tugwell P, Walsh S. Assessing the quality of randomized clinical trials. Control Clin Trials. 1995;16:62–73.PubMedCrossRefGoogle Scholar
  7. 7.
    Guyatt GH, Sackett DL, Cook DJ. Users’ Guides to the medical literature. II. How to use an article about therapy or prevention. A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA. 1993;270:2598–601.PubMedCrossRefGoogle Scholar
  8. 8.
    Egger M, Smith GD, Altman DG. Systemic Reviews in Health Care. 2nd ed. London: BMJ Books; 2001.Google Scholar
  9. 9.
    Der-Simonian R, Laird NM. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88.CrossRefGoogle Scholar
  10. 10.
    Montori VM, Smieja M, Guyatt GH. Publication bias: a brief review for clinicians. Mayo Clin Proc. 2000;75:1284–88.PubMedGoogle Scholar
  11. 11.
    Lake RF, Henderson K, Briffa T, Openshaw J, Musk AW. Upper-limb and lower-limb exercise training in patients with chronic airflow obstruction. Chest. 1990;97:1077–82.PubMedGoogle Scholar
  12. 12.
    Weiner P, Azgad Y, Ganam R. Inspiratory muscle training combined with general exercise reconditioning in patients with COPD. Chest. 1992;102:1351–56.PubMedGoogle Scholar
  13. 13.
    Gosselink R, Troosters T, Rollier H. Pulmonary rehabilitation improves exercise capacity in COPD. Am J Respir Crit Care Med. 1996;153:976–80.PubMedGoogle Scholar
  14. 14.
    Goldstein RS, Gort EH, Stubbing D, Avendano MA, Guyatt GH. Randomized controlled trial of respiratory rehabilitation. Lancet. 1994;344:1394–97.PubMedCrossRefGoogle Scholar
  15. 15.
    Wijkstra PJ, TenVergert EM, vanAltena RV, et al. Long term benefits of rehabilitation at home on quality of life and exercise tolerance in patients with chronic obstructive pulmonary disease. Thorax. 1995;50:824–8.PubMedGoogle Scholar
  16. 16.
    Simpson K, Killian K, McCartney N, Stubbing DG, Jones NL. Randomized controlled trial of weightlifting exercise in patients with chronic airflow limitation. Thorax. 1992;47:70–5.PubMedGoogle Scholar
  17. 17.
    Guyatt G, Keller J, Singer J, Halcrow S, Newhouse M. Controlled trial of respiratory muscle training in chronic airflow limitation. Thorax. 1992;47:598–602.PubMedCrossRefGoogle Scholar
  18. 18.
    Strijbos JH, Postma DS, vanAltena RV, Gimeno F, Koeter GH. A comparison between an outpatient hospital-based pulmonary rehabilitation program and a home-care pulmonary rehabilitation program in patients with COPD. A follow-up of 18 months. Chest. 1996;109:366–72.PubMedGoogle Scholar
  19. 19.
    McGavin CR, Gupta SP, Lloyd EL, McHardy GJ. Physical rehabilitation for the chronic bronchitic: results of a controlled trial of exercise in the home. Thorax. 1977;32:307–11.PubMedGoogle Scholar
  20. 20.
    Cambach W, Chadwick RM, Wagenaar RC, van Keimpema AR, Kemper HC. The effects of a community pulmonary rehabilitation programme on exercise tolerance and quality of life: a randomized controlled trial. Eur Respir J. 1997;10:104–13.PubMedCrossRefGoogle Scholar
  21. 21.
    Cockcroft AE, Saunders MJ, Berry G. Randomized controlled trial of rehabilitation in chronic respiratory disability. Thorax. 1981;36:200–3.PubMedGoogle Scholar
  22. 22.
    Jones DT, Thomson RJ, Sears MR. Physical exercise and resistive breathing training in severe chronic airway obstruction—are they effective? Eur J Respir Dis. 1985;67:159–66.PubMedGoogle Scholar
  23. 23.
    Bendstrup KE, Ingemann JJ, Holm S, Bengtsson B. Out-patient rehabilitation improves activities of daily living, quality of life and exercise tolerance in chronic obstructive pulmonary disease. Eur Respir J. 1997;10:2801–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Sassi-Dambron DE, Eakin EG, Ries AL, Kaplan RM. Treatment of dyspnea in COPD. A controlled clinical trial of dyspnea management strategies. Chest. 1995;107:724–29.PubMedGoogle Scholar
  25. 25.
    Griffiths TL, Burr ML, Campbell IA, et al. Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomized controlled trial. Lancet. 2000;355:362–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Engstrom CP, Persson LO, Larson S, Sullivan M. Long-term effects of a pulmonary rehabilitation programme in outpatients with chronic obstructive pulmonary disease: a randomized controlled trial. Scand J Rehabil Med. 1999;31:207–13.PubMedCrossRefGoogle Scholar
  27. 27.
    Wedzicha JA, Bestall JC, Garrod R, Garnham R, Paul EA, Jones PW. Randomized controlled trial of pulmonary rehabilitation in severe chronic obstructive pulmonary disease patients, stratified with the MRC dyspnoea scale. Eur Respir J. 1998;12:363–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Guell R, Casan P, Belda J, et al. Long term effects of outpatient rehabilitation of COPD: a rondomized trial. Chest. 2000;117:976–83.PubMedCrossRefGoogle Scholar
  29. 29.
    Troosters T, Gosselink R, Decramer M. Short- and long-term effects of outpatient rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Am J Med. 2000;109:207–12.PubMedCrossRefGoogle Scholar
  30. 30.
    Bauldoff GS, Hoffman LA, Sciurba F, Zullo TG. Home-based, upper-arm exercise training for patients with chronic obstructive pulmonary disease. Heart Lung. 1996;25:288–94.PubMedCrossRefGoogle Scholar
  31. 31.
    Begg, CB. Publication bias. In: Cooper H, Hedges LV, eds. The Handbook of Research Synthesis. New York: Russell Sage Foundation; 1994:399–409.Google Scholar
  32. 32.
    National Heart Lung and Blood Institute. Data fact sheet: chronic obstructive lung disease. March 24, 2002. Available at: Scholar
  33. 33.
    American Lung Association. Fact sheet: chronic obstructive pulmonary disease. March 2002. Available at: Accessed March 24, 2002.Google Scholar
  34. 34.
    Mannino DM, Gagnon RC, Petty TL, Lydick E. Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey, 1988–1994. Arch Intern Med. 2000;160:1683–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Lacasse Y, Wong E, Guyatt GH, King D, Cook DJ, Goldstein RS. Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease. Lancet. 1996;348:1115–19.PubMedCrossRefGoogle Scholar
  36. 36.
    Griffiths TL, Phillips CJ, Davies S, Burr ML, Campbell IA. Cost effectiveness of an outpatient multidisciplinary pulmonary rehabilitation programme. Thorax. 2001;56:779–84.PubMedCrossRefGoogle Scholar
  37. 37.
    Lertzman MM, Cherniak RM. Rehabilitation of patients with chronic obstructive pulmonary disease. Am Rev Respir Dis. 1976;114:1145–65.PubMedGoogle Scholar
  38. 38.
    Jensen PS. Risk, protective factors, and supportive interventions in chronic airway obstruction. Arch Gen Psychiatry. 1983;40:1203–7.PubMedGoogle Scholar
  39. 39.
    Bickford LS, Hodgkin JE. National pulmonary rehabilitation survey. Respir Care. 1988;33:1030–43.PubMedGoogle Scholar
  40. 40.
    Pierce AK, Taylor HF, Archer RK, Miller WF. Responses to exercise training in patients with emphysema. Arch Intern Med. 1964;113:28–36.PubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2003

Authors and Affiliations

  • Ghassan F. Salman
    • 1
  • Michael C. Mosier
  • Brent W. Beasley
  • David R. Calkins
  1. 1.Austin

Personalised recommendations