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Pulmonary Rehabilitation

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Abstract

Disability in chronic respiratory diseases (CRD) represents the impact of the disease on the patient’s life. Chronic airway diseases, included but not limited to COPD, are leading this burden.

Overall, the mobility-related dyspnea and the resulting decrease in exercise capacity substantially contribute to increased risk of disability, even after taking lung function impairment into account. Therefore, non-pharmacological interventions such as pulmonary rehabilitation (PR) might be particularly beneficial for these symptomatic patients to limit and to counteract the progressive loss of physical function and related problems.

In this chapter we will discuss the most recent evidence related to the assessment of individual’s disability in this population, and we will describe the variety of methods used in the clinical process of care called PR.

To date, PR results in substantial effectiveness when applied at the very early onset of disability in individuals suffering from CRD. Programme composition and strategies aimed at behavioural changes in the long-term appear the keys for success in the clinical practice.

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References

  1. Harber P. Respiratory disability: what is it, how can we measure it, what causes it and is it important? Thorax. 2009;64(4):280–2.

    PubMed  Google Scholar 

  2. Eisner MD, Iribarren C, Blanc PD, Yelin EH, Ackerson L, Byl N, et al. Development of disability in chronic obstructive pulmonary disease: beyond lung function. Thorax. 2011;66(2):108–14.

    PubMed  Google Scholar 

  3. Barreiro E, Gea J. Respiratory and limb muscle dysfunction in COPD. COPD. 2015;12(4):413–26.

    PubMed  Google Scholar 

  4. Maltais F, Decramer M, Casaburi R, Barreiro E, Burelle Y, Debigare R, et al. An official American Thoracic Society/European Respiratory Society statement: update on limb muscle dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2014;189(9):e15–62.

    PubMed  PubMed Central  Google Scholar 

  5. Seymour JM, Spruit MA, Hopkinson NS, Natanek SA, Man WD, Jackson A, et al. The prevalence of quadriceps weakness in COPD and the relationship with disease severity. Eur Respir J. 2010;36(1):81–8.

    CAS  PubMed  Google Scholar 

  6. Shrikrishna D, Patel M, Tanner RJ, Seymour JM, Connolly BA, Puthucheary ZA, et al. Quadriceps wasting and physical inactivity in patients with COPD. Eur Respir J. 2012;40(5):1115–22.

    PubMed  Google Scholar 

  7. Bernard S, LeBlanc P, Whittom F, Carrier G, Jobin J, Belleau R, et al. Peripheral muscle weakness in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998;158(2):629–34.

    CAS  PubMed  Google Scholar 

  8. Gosselink R, Troosters T, Decramer M. Distribution of muscle weakness in patients with stable chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2000;20(6):353–60.

    CAS  PubMed  Google Scholar 

  9. Hopkinson NS, Tennant RC, Dayer MJ, Swallow EB, Hansel TT, Moxham J, et al. A prospective study of decline in fat free mass and skeletal muscle strength in chronic obstructive pulmonary disease. Respir Res. 2007;8(1):25.

    PubMed  PubMed Central  Google Scholar 

  10. Spruit MA, Gosselink R, Troosters T, Kasran A, Gayan-Ramirez G, Bogaerts P, et al. Muscle force during an acute exacerbation in hospitalised patients with COPD and its relationship with CXCL8 and IGF-I. Thorax. 2003;58(9):752–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Osthoff AK, Taeymans J, Kool J, Marcar V, van Gestel AJ. Association between peripheral muscle strength and daily physical activity in patients with COPD: a systematic literature review and meta-analysis. J Cardiopulm Rehabil Prev. 2013;33(6):351–9.

    PubMed  Google Scholar 

  12. Butcher SJ, Pikaluk BJ, Chura RL, Walkner MJ, Farthing JP, Marciniuk DD. Associations between isokinetic muscle strength, high-level functional performance, and physiological parameters in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2012;7:537–42.

    PubMed  PubMed Central  Google Scholar 

  13. Patel MS, Mohan D, Andersson YM, Baz M, Samantha Kon SC, Canavan JL, et al. Phenotypic characteristics associated with reduced short physical performance battery score in COPD. Chest. 2014;145(5):1016–24.

    PubMed  Google Scholar 

  14. Gosselink R, Troosters T, Decramer M. Peripheral muscle weakness contributes to exercise limitation in COPD. Am J Respir Crit Care Med. 1996;153(3):976–80.

    CAS  PubMed  Google Scholar 

  15. Swallow EB, Reyes D, Hopkinson NS, Man WD, Porcher R, Cetti EJ, et al. Quadriceps strength predicts mortality in patients with moderate to severe chronic obstructive pulmonary disease. Thorax. 2007;62(2):115–20.

    PubMed  Google Scholar 

  16. Nyberg A, Saey D, Maltais F. Why and how limb muscle mass and function should be measured in patients with chronic obstructive pulmonary disease. Ann Am Thorac Soc. 2015;12(9):1269–77.

    PubMed  Google Scholar 

  17. Engelen MP, Schols AM, Does JD, Wouters EF. Skeletal muscle weakness is associated with wasting of extremity fat-free mass but not with airflow obstruction in patients with chronic obstructive pulmonary disease. Am J Clin Nutr. 2000;71(3):733–8.

    CAS  PubMed  Google Scholar 

  18. Schols AM, Soeters PB, Dingemans AM, Mostert R, Frantzen PJ, Wouters EF. Prevalence and characteristics of nutritional depletion in patients with stable COPD eligible for pulmonary rehabilitation. Am Rev Respir Dis. 1993;147(5):1151–6.

    CAS  PubMed  Google Scholar 

  19. Baarends EM, Schols AM, Mostert R, Wouters EF. Peak exercise response in relation to tissue depletion in patients with chronic obstructive pulmonary disease. Eur Respir J. 1997;10(12):2807–13.

    CAS  PubMed  Google Scholar 

  20. Kobayashi A, Yoneda T, Yoshikawa M, Ikuno M, Takenaka H, Fukuoka A, et al. The relation of fat-free mass to maximum exercise performance in patients with chronic obstructive pulmonary disease. Lung. 2000;178(2):119–27.

    CAS  PubMed  Google Scholar 

  21. Schols AM, Mostert R, Soeters PB, Wouters EF. Body composition and exercise performance in patients with chronic obstructive pulmonary disease. Thorax. 1991;46(10):695–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Mostert R, Goris A, Weling-Scheepers C, Wouters EF, Schols AM. Tissue depletion and health related quality of life in patients with chronic obstructive pulmonary disease. Respir Med. 2000;94(9):859–67.

    CAS  PubMed  Google Scholar 

  23. Marquis K, Debigare R, Lacasse Y, LeBlanc P, Jobin J, Carrier G, et al. Midthigh muscle cross-sectional area is a better predictor of mortality than body mass index in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2002;166(6):809–13.

    PubMed  Google Scholar 

  24. de Blasio F, Santaniello MG, de Blasio F, Mazzarella G, Bianco A, Lionetti L, et al. Raw BIA variables are predictors of muscle strength in patients with chronic obstructive pulmonary disease. Eur J Clin Nutr. 2017;71(11):1336–40.

    PubMed  Google Scholar 

  25. Maddocks M, Kon SS, Jones SE, Canavan JL, Nolan CM, Higginson IJ, et al. Bioelectrical impedance phase angle relates to function, disease severity and prognosis in stable chronic obstructive pulmonary disease. Clin Nutr. 2015;34(6):1245–50.

    PubMed  Google Scholar 

  26. de Blasio F, Scalfi L, Alicante P, Miracco Berlingieri G, Bellofiore B, de Blasio F. Malnutrition and sarcopenia in chronic obstructive pulmonary disease according to the new ESPEN definition and EWGSOP criteria. Eur Respir J. 2017;50(Suppl 61):PA400.

    Google Scholar 

  27. de Blasio F, Scalfi L, Di Gregorio A, Miracco Berlingieri G, De Martino M, de Blasio F. Raw bioelectrical impedance variables are predictors of survival in chronic obstructive pulmonary disease. Eur Respir J. 2017;50(Suppl 61):PA1094.

    Google Scholar 

  28. St-Onge MP, Wang J, Shen W, Wang Z, Allison DB, Heshka S, et al. Dual-energy x-ray absorptiometry-measured lean soft tissue mass: differing relation to body cell mass across the adult life span. J Gerontol A Biol Sci Med Sci. 2004;59(8):796–800.

    PubMed  Google Scholar 

  29. Bestall J, Paul E, Garrod R, Garnham R, Jones P, Wedzicha J. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999;54(7):581–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  30. Sundh J, Janson C, Lisspers K, Ställberg B, Montgomery S. Dyspnoea, obstruction, smoking and exacerbation (DOSE) index and mortality in COPD. Eur Respir J. 2011;38(Suppl 55):542S.

    Google Scholar 

  31. Borg G. Ratings of perceived exertion and heart rates during short-term cycle exercise and their use in a new cycling strength test. Int J Sports Med. 1982;3(3):153–8.

    CAS  PubMed  Google Scholar 

  32. Aitken RC. Measurement of feelings using visual analogue scales. Proc R Soc Med. 1969;62(10):989–93.

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Goldstein RE. In: Walker HK, Hall WD, Hurst JW, editors. Clinical methods: The History P, and Laboratory Examinations. 3rd ed. Boston: Butterworths; 1990. Chapter 8.

    Google Scholar 

  34. Palange P, Ward SA, Carlsen KH, Casaburi R, Gallagher CG, Gosselink R, et al. Recommendations on the use of exercise testing in clinical practice. Eur Respir J. 2007;29(1):185–209.

    CAS  PubMed  Google Scholar 

  35. Weisman IM, Zeballos RJ. An integrated approach to the interpretation of cardiopulmonary exercise testing. Clin Chest Med. 1994;15(2):421–45.

    CAS  PubMed  Google Scholar 

  36. Sue DY, Wasserman K. Impact of integrative cardiopulmonary exercise testing on clinical decision making. Chest. 1991;99(4):981–92.

    CAS  PubMed  Google Scholar 

  37. Ferguson B. ACSM’s guidelines for exercise testing and prescription 9th Ed. 2014. J Can Chiropr Assoc. 2014;58(3):328.

    PubMed Central  Google Scholar 

  38. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1):111–7.

    Google Scholar 

  39. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377–81.

    CAS  PubMed  Google Scholar 

  40. Singh SJ, Morgan MD, Scott S, Walters D, Hardman AE. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax. 1992;47(12):1019–24.

    CAS  PubMed  PubMed Central  Google Scholar 

  41. Revill S, Morgan M, Singh S, Williams J, Hardman A. The endurance shuttle walk: a new field test for the assessment of endurance capacity in chronic obstructive pulmonary disease. Thorax. 1999;54(3):213–22.

    CAS  PubMed  PubMed Central  Google Scholar 

  42. Albarrati AM, Gale NS, Enright S, Munnery MM, Cockcroft JR, Shale DJ. A simple and rapid test of physical performance in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2016;11:1785–91.

    PubMed  PubMed Central  Google Scholar 

  43. Bohannon RW, Bubela DJ, Magasi SR, Wang YC, Gershon RC. Sit-to-stand test: performance and determinants across the age-span. Isokinet Exerc Sci. 2010;18(4):235–40.

    PubMed  PubMed Central  Google Scholar 

  44. Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013;188(8):e13–64.

    PubMed  Google Scholar 

  45. Holland AE, Wadell K, Spruit MA. How to adapt the pulmonary rehabilitation programme to patients with chronic respiratory disease other than COPD. Eur Respir Rev. 2013;22:577–86.

    PubMed  Google Scholar 

  46. Breyer MK, Breyer-Kohansal R, Funk GC, Dornhofer N, Spruit MA, Wouters EF, et al. Nordic walking improves daily physical activities in COPD: a randomised controlled trial. Respir Res. 2010;11:112.

    PubMed  PubMed Central  Google Scholar 

  47. Dolmage TE, Goldstein RS. Effects of one-legged exercise training of patients with COPD. Chest. 2008;133(2):370–6.

    PubMed  Google Scholar 

  48. Andrianopoulos V, Klijn P, Franssen FM, Spruit MA. Exercise training in pulmonary rehabilitation. Clin Chest Med. 2014;35(2):313–22.

    PubMed  Google Scholar 

  49. Normandin EA, McCusker C, Connors M, Vale F, Gerardi D, ZuWallack RL. An evaluation of two approaches to exercise conditioning in pulmonary rehabilitation. Chest. 2002;121(4):1085–91.

    PubMed  Google Scholar 

  50. Casaburi R, Patessio A, Ioli F, Zanaboni S, Donner CF, Wasserman K. Reductions in exercise lactic acidosis and ventilation as a result of exercise training in patients with obstructive lung disease. Am Rev Respir Dis. 1991;143(1):9–18.

    CAS  PubMed  Google Scholar 

  51. Janaudis-Ferreira T, Hill K, Goldstein R, Wadell K, Brooks D. Arm exercise training in patients with chronic obstructive pulmonary disease: a systematic review. J Cardiopulm Rehabil Prev. 2009;29(5):277–83.

    PubMed  Google Scholar 

  52. Vogiatzis I, Nanas S, Roussos C. Interval training as an alternative modality to continuous exercise in patients with COPD. Eur Respir J. 2002;20(1):12–9.

    CAS  PubMed  Google Scholar 

  53. Varga J, Porszasz J, Boda K, Casaburi R, Somfay A. Supervised high intensity continuous and interval training vs. self-paced training in COPD. Respir Med. 2007;101(11):2297–304.

    PubMed  Google Scholar 

  54. Kortianou EA, Nasis IG, Spetsioti ST, Daskalakis AM, Vogiatzis I. Effectiveness of interval exercise training in patients with COPD. Cardiopulm Phys Ther J. 2010;21(3):12–9.

    PubMed  PubMed Central  Google Scholar 

  55. Probst VS, Troosters T, Pitta F, Decramer M, Gosselink R. Cardiopulmonary stress during exercise training in patients with COPD. Eur Respir J. 2006;27(6):1110–8.

    CAS  PubMed  Google Scholar 

  56. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–59.

    PubMed  Google Scholar 

  57. Gloeckl R, Marinov B, Pitta F. Practical recommendations for exercise training in patients with COPD. Eur Respir Rev. 2013;22(128):178–86.

    PubMed  Google Scholar 

  58. O'Shea SD, Taylor NF, Paratz J. Peripheral muscle strength training in COPD: a systematic review. Chest. 2004;126(3):903–14.

    PubMed  Google Scholar 

  59. Ortega F, Toral J, Cejudo P, Villagomez R, Sanchez H, Castillo J, et al. Comparison of effects of strength and endurance training in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2002;166(5):669–74.

    PubMed  Google Scholar 

  60. Emtner M, Porszasz J, Burns M, Somfay A, Casaburi R. Benefits of supplemental oxygen in exercise training in nonhypoxemic chronic obstructive pulmonary disease patients. Am J Respir Crit Care Med. 2003;168(9):1034–42.

    PubMed  Google Scholar 

  61. Hawkins P, Johnson LC, Nikoletou D, Hamnegard CH, Sherwood R, Polkey MI, et al. Proportional assist ventilation as an aid to exercise training in severe chronic obstructive pulmonary disease. Thorax. 2002;57(10):853–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  62. Garrod R, Mikelsons C, Paul EA, Wedzicha JA. Randomized controlled trial of domiciliary noninvasive positive pressure ventilation and physical training in severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2000;162(4 Pt 1):1335–41.

    CAS  PubMed  Google Scholar 

  63. Wedzicha JA. Heliox in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2006;173(8):825–6.

    PubMed  Google Scholar 

  64. Mazzuca SA. Does patient education in chronic disease have therapeutic value? J Chronic Dis. 1982;35(7):521–9.

    CAS  PubMed  Google Scholar 

  65. Velloso M, Jardim JR. Study of energy expenditure during activities of daily living using and not using body position recommended by energy conservation techniques in patients with COPD. Chest. 2006;130(1):126–32.

    PubMed  Google Scholar 

  66. Bourbeau J, Nault D, Dang-Tan T. Self-management and behaviour modification in COPD. Patient Educ Couns. 2004;52(3):271–7.

    PubMed  Google Scholar 

  67. van Manen JG, Bindels PJ, Dekker FW, IJzermans C, van der Zee JS, Schade E. Risk of depression in patients with chronic obstructive pulmonary disease and its determinants. Thorax. 2002;57(5):412–6.

    PubMed  PubMed Central  Google Scholar 

  68. de Godoy DV, de Godoy RF. A randomized controlled trial of the effect of psychotherapy on anxiety and depression in chronic obstructive pulmonary disease. Arch Phys Med Rehabil. 2003;84(8):1154–7.

    PubMed  Google Scholar 

  69. Casaburi R, ZuWallack R. Pulmonary rehabilitation for management of chronic obstructive pulmonary disease. N Engl J Med. 2009;360(13):1329–35.

    CAS  PubMed  Google Scholar 

  70. Norwood R. Prevalence and impact of depression in chronic obstructive pulmonary disease patients. Curr Opin Pulm Med. 2006;12(2):113–7.

    PubMed  Google Scholar 

  71. Harrison SL, Greening NJ, Williams JE, Morgan MD, Steiner MC, Singh SJ. Have we underestimated the efficacy of pulmonary rehabilitation in improving mood? Respir Med. 2012;106(6):838–44.

    CAS  PubMed  Google Scholar 

  72. Haas F, Salazar-Schicchi J, Axen K. Desensitization to dyspnea in chronic obstructive pulmonary disease. In: Casaburi R, Petty TL, editors. Principles and practice of pulmonary rehabilitation. Philadelphia: W.B. Saunders; 1993. p. 241–51.

    Google Scholar 

  73. Vestbo J, Prescott E, Almdal T, Dahl M, Nordestgaard BG, Andersen T, et al. Body mass, fat-free body mass, and prognosis in patients with chronic obstructive pulmonary disease from a random population sample: findings from the Copenhagen City Heart Study. Am J Respir Crit Care Med. 2006;173(1):79–83.

    PubMed  Google Scholar 

  74. Gupta B, Kant S, Mishra R, Verma S. Nutritional status of chronic obstructive pulmonary disease patients admitted in hospital with acute exacerbation. J Clin Med Res. 2010;2(2):68–74.

    PubMed  PubMed Central  Google Scholar 

  75. Hallin R, Koivisto-Hursti UK, Lindberg E, Janson C. Nutritional status, dietary energy intake and the risk of exacerbations in patients with chronic obstructive pulmonary disease (COPD). Respir Med. 2006;100(3):561–7.

    PubMed  Google Scholar 

  76. Odencrants S, Ehnfors M, Ehrenberg A. Nutritional status and patient characteristics for hospitalised older patients with chronic obstructive pulmonary disease. J Clin Nurs. 2008;17(13):1771–8.

    PubMed  Google Scholar 

  77. Lacasse Y, Goldstein R, Lasserson TJ, Martin S. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2006;4:Cd003793.

    Google Scholar 

  78. Griffiths TL, Burr ML, Campbell IA, Lewis-Jenkins V, Mullins J, Shiels K, et al. Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial. Lancet. 2000;355(9201):362–8.

    CAS  PubMed  Google Scholar 

  79. Spruit MA, Troosters T, Trappenburg JC, Decramer M, Gosselink R. Exercise training during rehabilitation of patients with COPD: a current perspective. Patient Educ Couns. 2004;52(3):243–8.

    PubMed  Google Scholar 

  80. Carr SJ, Goldstein RS, Brooks D. Acute exacerbations of COPD in subjects completing pulmonary rehabilitation. Chest. 2007;132(1):127–34.

    PubMed  Google Scholar 

  81. Steele BG, Belza B, Cain KC, Coppersmith J, Lakshminarayan S, Howard J, et al. A randomized clinical trial of an activity and exercise adherence intervention in chronic pulmonary disease. Arch Phys Med Rehabil. 2008;89(3):404–12.

    PubMed  Google Scholar 

  82. Waterhouse JC, Walters SJ, Oluboyede Y, Lawson RA. A randomised 2 × 2 trial of community versus hospital pulmonary rehabilitation, followed by telephone or conventional follow-up. Health Technol Assess. 2010;14(6.):i–v, vii–xi):1–140.

    Google Scholar 

  83. Spruit MA, Singh SJ, Rochester CL, Greening NJ, Franssen FME, Pitta F, et al. Pulmonary rehabilitation for patients with COPD during and after an exacerbation-related hospitalisation: back to the future? Eur Respir J. 2018;51:1.

    Google Scholar 

  84. Vogiatzis I, Rochester CL, Spruit MA, Troosters T, Clini EM. Increasing implementation and delivery of pulmonary rehabilitation: key messages from the new ATS/ERS policy statement. Eur Respir J. 2016;47(5):1336–41.

    PubMed  Google Scholar 

  85. Robles PG, Mathur S, Janaudis-Fereira T, Dolmage TE, Goldstein RS, Brooks D. Measurement of peripheral muscle strength in individuals with chronic obstructive pulmonary disease: a systematic review. J Cardiopulm Rehabil Prev. 2011;31(1):11–24.

    PubMed  Google Scholar 

  86. Bachasson D, Wuyam B, Pepin JL, Tamisier R, Levy P, Verges S. Quadriceps and respiratory muscle fatigue following high-intensity cycling in COPD patients. PLoS One. 2013;8(12):e83432.

    PubMed  PubMed Central  Google Scholar 

  87. Evans RA, Kaplovitch E, Beauchamp MK, Dolmage TE, Goldstein RS, Gillies CL, et al. Is quadriceps endurance reduced in COPD? Chest. 2015;147(3):673–84.

    PubMed  Google Scholar 

  88. Vieira L, Bottaro M, Celes R, Viegas CA, Silva C. Isokinetic muscle evaluation of quadriceps in patients with chronic obstructive pulmonary disease. Rev Port Pneumol. 2010;16(5):717–36.

    PubMed  Google Scholar 

  89. Thompson WR, Gordon NF, Pescatello LS. ACSM’s guidelines for exercise testing and prescription. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2010.

    Google Scholar 

  90. Couillard A, Koechlin C, Cristol JP, Varray A, Prefaut C. Evidence of local exercise-induced systemic oxidative stress in chronic obstructive pulmonary disease patients. Eur Respir J. 2002;20(5):1123–9.

    CAS  PubMed  Google Scholar 

  91. Couillard A, Maltais F, Saey D, Debigaré R, Michaud A, Koechlin C, et al. Exercise-induced quadriceps oxidative stress and peripheral muscle dysfunction in patients with COPD. Am J Respir Crit Care Med. 2003;167:1664–9.

    PubMed  Google Scholar 

  92. Stark T, Walker B, Phillips JK, Fejer R, Beck R. Hand-held dynamometry correlation with the gold standard isokinetic dynamometry: a systematic review. PM R. 2011;3(5):472–9.

    PubMed  Google Scholar 

  93. O'Shea SD, Taylor NF, Paratz JD. Measuring muscle strength for people with chronic obstructive pulmonary disease: retest reliability of hand-held dynamometry. ArchPhysMed Rehabil. 2007;88(1):32–6.

    Google Scholar 

  94. Hartmann A, Knols R, Murer K, De Bruin ED. Reproducibility of an isokinetic strength-testing protocol of the knee and ankle in older adults. Gerontology. 2009;55(3):259–68.

    PubMed  Google Scholar 

  95. Dourado VZ. Relationship of upper-limb and thoracic muscle strength to 6-min walk distance in COPD patients. Chest. 2006;129(3):551–7.

    PubMed  Google Scholar 

  96. Burns SP, Spanier DE. Break-technique handheld dynamometry: relation between angular velocity and strength measurements. ArchPhysMed Rehabil. 2005;86(7):1420–6.

    Google Scholar 

  97. Burns SP, Breuninger A, Kaplan C, Marin H. Hand-held dynamometry in persons with tetraplegia: comparison of make- versus break-testing techniques. Am J Phys Med Rehabil. 2005;84(1):22–9.

    PubMed  Google Scholar 

  98. Bachasson D, Villiot-Danger E, Verges S, Hayot M, Perez T, Chambellan A, et al. Maximal isometric voluntary quadriceps strength assessment in COPD. Revue des Maladies Respiratoires. 2014;31(8):765–70.

    CAS  PubMed  Google Scholar 

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de Blasio, F., de Blasio, F., Clini, E. (2019). Pulmonary Rehabilitation. In: Cogo, A., Bonini, M., Onorati, P. (eds) Exercise and Sports Pulmonology. Springer, Cham. https://doi.org/10.1007/978-3-030-05258-4_11

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