Rehabilitation for people with COPD and other respiratory diseases.
(SEE ALSO – Exercise training)

BTS (2013) British Thoracic Society guideline on pulmonary rehabilitation in adults: accredited by NICE. Thorax, 68:ii1-ii30 doi:10.1136/thoraxjnl-2013-203808



PHYSIOTHERAPY GUIDELINES (2003-4) – Baines S, Garrod R, Morgan M
AARC GUIDELINES (2002) Respir Care, 47, 5, 622.

Nici L, Donner C, Wouters E et al (2006) American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med, 173, 12, 1390-1413.


Afolabi G, Stevens R, Turner M et al (2013) Development of a pulmonary rehabilitation service for people with COPD. J Cardiopulm Rehab Prev; 33(5):323-7

Albuquerque AL, Quaranta M, Chakrabarti B et al (2016) Exercise performance and differences in physiological response to pulmonary rehabilitation in severe chronic obstructive pulmonary disease with hyperinflation. J Bras Pneumol; 42(2):121-129

Al Haddad MA, John M, Hussain S et al (2016) Role of the timed up and go test in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil Prev; 36(1):49-55. doi: 10.1097/HCR.0000000000000143

Al Moamary MS, Alorainy H, Al-Hajjaj MA (2014) Pulmonary rehabilitation: A regional perspective evidenced-based review. Ann Thorac Med; 9(1):3. doi:10.4103/1817-1737.124408;year=2014;volume=9;issue=1;month=January-March

Andrews L, Barlow R, Easton I (2015) Differences in patient outcomes between a 6, 7 and 8 week pulmonary rehabilitation programme: A service evaluation. Physiother; 101(1):62-8. doi:10.1016/
• greatest improvements in exercise capacity found in an 8 week pulmonary rehabilitation programme

Ashmore JA (2005) Marital adjustment among patients with COPD who are participating in pulmonary rehabilitation. Heart Lung, 34, 4, 270-8

Atsou K, Crequit P, Chouaid C et al (2016) Simulation-based estimates of the effectiveness and cost-effectiveness of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease in France. PLoS One; 11(6):e0156514. doi: 10.1371/journal.pone.0156514

Basso-Vanelli RP, Di Lorenzo VA, Labadessa IG et al (2016) Effects of inspiratory muscle training and calisthenics-and-breathing exercises in COPD with and without respiratory muscle weakness. Respir Care; 61(1):50-60. doi: 10.4187/respcare.03947

Battaglia E, Fulgenzi A, Ferrero ME (2009) Rationale of the combined use of inspiratory and expiratory devices in improving maximal inspiratory pressure and maximal expiratory pressure of patients with chronic obstructive pulmonary disease. Arch Phys Med Rehabil, 90, 6, 913-18

Baumann HJ, Kluge S, Rummel K et al (2012) Low intensity, long-term outpatient rehabilitation in COPD: a randomised controlled trial. Respir Res, 13, 1, 86. doi: 10.1186/1465-9921-13-86

Benzo RP, Kirsch JL, Dulohery MM et al (2016) Emotional intelligence: a novel outcome associated with wellbeing and self-management in chronic obstructive pulmonary disease. Ann Am Thorac Soc; 13(1):10-6. doi: 10.1513/AnnalsATS.201508-490OC.

Bhandari NJ, Jain T, Marolda C et al (2013) Comprehensive pulmonary rehabilitation results in clinically meaningful improvements in anxiety and depression in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehab Prev, 33, 2, 123-127

Blackstock FC, ZuWallack R, Nici L et al (2016) Why don't our patients with chronic obstructive pulmonary disease listen to us? the enigma of nonadherence. Ann Am Thorac Soc; 13(3):317-23. doi: 10.1513/AnnalsATS.201509-600PS

Bourbeau J, Lavoie KL, Sedeno M et al (2016) Behaviour-change intervention in a multicentre, randomised, placebo-controlled COPD study: methodological considerations and implementation. BMJ Open; 6(4):e010109. doi: 10.1136/bmjopen-2015-010109.

Brown AT, Hitchcock J, Schumann C et al (2016) Determinants of successful completion of pulmonary rehabilitation in COPD. Internat J COPD. 2016;11:391-397. doi:10.2147/COPD.S100254.

Burtin C, Langer D, van Remoortel H et al (2016) Physical activity counselling during pulmonary rehabilitation in patients with copd: a randomised controlled trial. PLoS ONE; 10(12):e0144989. doi: 10.1371/journal.pone.0144989.
Correction in: PLoS One. 2016; 11(2): e0148705.

Cleutjens FAHM (2017) The impact of cognitive impairment on efficacy of pulmonary rehabilitation in patients with COPD. J Am Med Dir Assoc; 18(5):420-426. doi: 10.1016/j.jamda.2016.11.016

Collins EG (2001) Breathing pattern retraining and exercise in persons with COPD. AACN Clin Issues, vol.12
• literature review

Curtis JR (2000) Communicating with patients and their families about advance care planning and end-of-life care. Respir Care, 45, 1385-98

De Albuquerque ALP, Quaranta M, Chakrabarti B et al (2016) Exercise performance and differences in physiological response to pulmonary rehabilitation in severe chronic obstructive pulmonary disease with hyperinflation. Jornal Brasileiro de Pneumologia; 42(2):121-129. doi: 10.1590/S1806-37562015000000078.

De Alvarenga GM, Remigio GH, Hellman EL et al (2016) Physiotherapy intervention during level i of pulmonary rehabilitation on chronic obstructive pulmonary disease: a systematic review . Open Respir Med J; 10:12-19. doi: 10.2174/1874306401610010012.
• with severe COPD, PR increases V̇O2 and reduces VCO2, with a commensurate decrease in respiratory drive

Donesky D, Citron TL, Hilling L et al (2015) Additional evidence for the long-term benefits of pulmonary rehabilitation. Respir Care; 60(8):1120-1129

Doyle C, Dunt D, Ames D et al (2013) Managing mood disorders in patients attending pulmonary rehabilitation clinics. Int J Chron Obstruct Pulmon Dis, 8, 15–20. doi: 10.2147/COPD.S36378

Dyer F, Callaghan J, Cheema K, Bott J (2012) Ambulatory oxygen improves the effectiveness of pulmonary rehabilitation in selected patients with chronic obstructive pulmonary disease. Chron Respir Dis, 9(2):83-91.

Engel RM, Gonski P, Beath K et al (2016) Medium term effects of including manual therapy in a pulmonary rehabilitation program for chronic obstructive pulmonary disease (COPD): a randomized controlled pilot trial. J Man Manip Ther; 24(2):80-9. doi: 10.1179/2042618614Y.0000000074

Figueiredo D, Cruz J, Jácome C et al (2016) Exploring the benefits to caregivers of a family-oriented pulmonary rehabilitation program. Respir Care; 61(8):1081-1089

Frazão M, Frazão W (2016) Pulmonary rehabilitation alters ventilatory and cardiac performances profile during exercise in moderate to severe COPD: 5 cases report. J Pulm Respir Med; 6:320. doi:10.4172/2161-105X.1000320
• 8 week pulmonary rehabilitation program increases functional capacity

Furness T, Bate N, Welsh L et al (2012) Efficacy of a whole-body vibration intervention to effect exercise tolerance and functional performance of the lower limbs of people with chronic obstructive pulmonary disease. BMC Pulm Med, 12, 71. doi:10.1186/1471-2466-12-71

Garuti G (2013) Pulmonary rehabilitation at home guided by telemonitoring and access to healthcare facilities for respiratory complications in patients with neuromuscular disease. Europ J Phys Rehab Med, 49(1):51-7

Garvey C, Bayles MP, Hamm LF et al (2016) Pulmonary rehabilitation exercise prescription in chronic obstructive pulmonary disease: review of selected guidelines: an official statement from the American Association of Cardiovascular and Pulmonary Rehabilitation. J Cardiopulm Rehabil Prev; 36(2):75-83. doi: 10.1097/HCR.0000000000000171

Gillespie P, O'Shea E, Casey D et al (2013) The cost-effectiveness of a structured education pulmonary rehabilitation programme for chronic obstructive pulmonary disease in primary care. BMJ Open; 3(11):e003479

Graves J, Sandrey V, Graves T (2010) Effectiveness of a group opt-in session on uptake and graduation rates for pulmonary rehabilitation. Chr Respir Dis, 7, 159-64
• group ‘opt-in session’ prior to assessment increased graduation rates and improved efficiency by improving knowledge of the benefits of rehabilitation and reducing the fear of failure or discomfort

Haave E, Hyland ME, Engvik H (2007) Improvements in exercise capacity during a 4-weeks pulmonary rehabilitation program for COPD patients do not correspond with improvements in self-reported health status or quality of life. Int J Chron Obstruct Pulmon Dis, 2, 3, 355–359.

Hagins M, Lamberg E (2006) Natural breath control during lifting tasks: effect of load. Euro J Appl Physiol, 96, 4, 453-8
• automatic breath-holding during lifting increases lumbar stability and is responsive to the timing and magnitude of the load

Harrison SL et al (2013) Physical activity monitoring: Addressing the difficulties of accurately detecting slow walking speeds. Heart Lung; 42(4):361-364

Harrison SL, Beauchamp MK, Sibley K et al (2016) Minimizing the evidence-practice gap - a prospective cohort study incorporating balance training into pulmonary rehabilitation for individuals with chronic obstructive pulmonary disease. BMC Pulm Med; 15:73. doi: 10.1186/s12890-015-0067-2

Heerema-Poelman A, Stuive I, Wempe JB (2013) Adherence to a maintenance exercise program 1 year after pulmonary rehabilitation: what are the predictors of dropout? J Cardiopulm Rehab Prev; 33(6):419-26

Hogg L, Grant A, Garrod R et al (2013) People with COPD perceive ongoing, structured and socially supportive exercise opportunities to be important for maintaining an active lifestyle following pulmonary rehabilitation: a qualitative study. J Physiother, 58, 3, 189-195

Holland AE, Mahal A, Hill CJ et al (2017) Home-based rehabilitation for COPD using minimal resources: a randomised, controlled equivalence. Thorax; 72(1):57-65. doi: 10.1136/thoraxjnl-2016-208514
• a home-based programme shows similar outcomes to conventional PR, even with minimal resources

Holmes ML, Manor B, Hsieh WH et al (2016) Tai Chi training reduced coupling between respiration and postural control. Neurosci Lett; 610:60-5.
• benefits of Tai Chi may stem from optimizing interaction between breathing & postural control

Janssen DJA (2010) Symptoms of anxiety and depression in COPD patients entering pulmonary rehabilitation. Chr Respir Dis, 7, 147-57
• anxiety is not associated with lung function or co-existing morbidity, but appears to be more common in current smokers
• depression is more common in those with severe breathlessness
• both are more common in patients with low BMI
• both are under-recognised
• both respond better to pulmonary rehabilitation than to drugs

Janaudis-Ferreira T, Hill K, Goldstein RS et al (2013) Relationship and responsiveness of three upper-limb tests in patients with chronic obstructive pulmonary disease. Physiother Can; 65(1):40-3

Jenkins S, Hill K, Cecins NM (2011) State of the art: How to set up a pulmonary rehabilitation program. Respirology, 15, 8, 1157-73
• a stepwise approach to establish, deliver and evaluate a pulmonary rehabilitation program

Jones SE, MaddocksM, Don SSC et al (2015) Sarcopenia in COPD: prevalence, clinical correlates and response to pulmonary rehabilitation. Thorax; 5(70):213-218. doi:10.1136/thoraxjnl-2014-206440
• sarcopaenia in COPD may be reversible by pulmonary rehabilitation

Jörres RA, Nowak D, Ochmann U (2012) Long-term efficacy of pulmonary rehabilitation: a state-of-the-art review. J Cardiopulm Rehab Prev, 32, 3, 117-126

Knowles AC, Mason LA, McNarry S et al (2017) Using expert patients to co-facilitate an introductory information session: does informed patient choice enhance engagement with pulmonary rehabilitation? Europ J Physiother; 19(4), 222-8.

Kreizman IJ (2003) Intensive medical intervention and pulmonary rehabilitation of patients with advanced restrictive lung disease. Arch Phys Med Rehab, 84, 10, E4
• even with advanced restrictive disease, a rehab programme leads to improved quality of life

Kruijssen V, Staa A, Dwarswaard J et al (2015) Use of online self-management diaries in asthma and COPD: a qualitative study of subjects' and professionals' perceptions and behaviors. . Respir Care; 60(8):1146-1156

Lan C-C (2013) Benefits of pulmonary rehabilitation in patients with COPD and normal exercise capacity. Respir Care, 58(9):1482-8

Lee AL (2010) The effects of pulmonary rehabilitation in patients with non-cystic fibrosis bronchiectasis. BMC Pulm Med, 10, 5, doi:10.1186/1471-2466-10-5

Leupoldt AV, Taube K, Lehmann K et al (2011) The impact of anxiety and depression on outcomes of pulmonary rehabilitation in patients with COPD, Chest, 140, 3, 730-736

Lewko A, Bidgood PL, Jewell A, Garrod R (2014) Evaluation of multidimensional COPD-related subjective fatigue following a Pulmonary Rehabilitation programme. Respir Med; 108(1):95-102
• some dimensions of fatigue in COPD are modifiable by a 7-week PR programme

Liddell F, Janet Webber (2009) Pulmonary rehabilitation for chronic obstructive pulmonary disease: a pilot study evaluating a once-weekly versus twice-weekly supervised programme. Physiotherapy, 96, 1, 68-74
• once-weekly supervision may produce equivalent improvements in exercise tolerance as a twice-weekly programme, but HRQLme appeared to be poorer for once-weekly supervision

Lomundal BK, A Steinsbekk (2012) Five-year follow-up of a one-year self-management program for patients with COPD. Int J Chron Obstruct Pulmon Dis, 7, 87–93
• self management plan helps maintain the benefits 4 years after the programme

López-García A, Souto-Camba S, Blanco-Aparicio M et al (2016) Effects of a muscular training program on chronic obstructive pulmonary disease patients with moderate or severe exacerbation antecedents. Europ J Phys Rehab Med; 52(2): 169-75

Lord VM, Cave P, Hume VJ et al (2010) Singing teaching as a therapy for chronic respiratory disease - a randomised controlled trial and qualitative evaluation. BMC Pulm Med, 10:41.
• the control of breathing and posture that accompany singing lead to improved quality of life and reduced anxiety

Mador MJ, Modi K (2016) Comparing various exercise tests for assessing the response to pulmonary rehabilitation in patients with COPD. J Cardiopulm Rehab Prev; 36(2):132- 139

Man WD, Polkey MI, Donaldson N (2004) Community pulmonary rehabilitation after hospitalisation for acute exacerbations of chronic obstructive pulmonary disease: randomised controlled study. BMJ, 329, 7476, 1209
• early pulmonary rehabilitation after admission for acute exacerbation of COPD is safe and leads to improvements in exercise capacity and health status at three months.

Martin WH, Xian H, Wagner D et al (2014) Arm exercise as an alternative to pharmacologic stress testing: Arm exercise stress testing and outcome. Am Heart J; 167(2):169–177
• arm exercise tests are a substitute in the 50% of patients unable to perform treadmill exercise tests because of disabilities

McCarthy B, Casey D, Devane D et al (2015) Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD003793. doI: 10.1002/14651858.CD003793.pub3.

Morgan M (2017) Expanding pulmonary rehabilitation capacity. One size won't fit all. Thorax; 72(1):4-5. doi:10.1136/thoraxjnl-2016-209345
• for COPD, PR brings a larger effect than can be obtained with any other medical therapy

Morisset J, Dubé BP, Garvey C et al (2016) The unmet educational needs of interstitial lung disease patients: setting the stage for tailored pulmonary rehabilitation. Ann Am Thorac Soc; 13(7):1026-33. doi: 10.1513/AnnalsATS.201512-836OC

Mukand JA et al (2003) The effects of dehydration on rehabilitation outcomes of elderly orthopedic patients. Arch Phys Med Rehab, 84, 58-61
• dehydration has a major effect on rehab outcomes (orthopaedic patients)

Neder JA (2002) Home based neuromuscular electrical stimulation as a new rehabilitative strategy for severely disabled patients with COPD. Thorax, 57, 333-7
• electrical stimulation of leg muscles in patients with COPD improves exercise tolerance and breathlessness

Neves LF, Reis MH, Gonçalves TR (2016) Home or community-based pulmonary rehabilitation for individuals with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Cad Saude Publica; 32(6). pii: S0102-311X2016000602001. doi: 10.1590/0102-311X00085915

Ng BHP, Tsang HWH (2009) Establishing a health Qigong protocol for rehabilitation of patients with COPD. Internat J Ther Rehabil, 16, 1, 25 - 33;article=IJTR_16_1_25_33
• Qigong shows potential benefit as an adjunct in rehabilitation of people with COPD

Ngaage DL (2004) The functional impact of an individualized, graded, outpatient pulmonary rehabilitation in end-stage COPD. Heart Lung, 33, 6, 381-9
• pulmonary rehabilitation in end-stage COPD can produce a measurable improvement in spirometry and ET

Ninot G et al (2002) Effects of an intensive-period inpatient rehabilitation programme on the perceived physical self in moderate COPD. Intern J Rehab Res, 25, 51-5
• depression, anxiety and fear of SOB affect prognosis, severity of illness and ability to cope

O’Neill B, McDonough SM, Wilson JJ et al (2017) Comparing accelerometer, pedometer and a questionnaire for measuring physical activity in bronchiectasis: a validity and feasibility study? Respir Res; 18:16

Ong HK, Lee AL, Hill CJ, Holland AE, Denehy L (2011) Effects of pulmonary rehabilitation in bronchiectasis. Chr Respir Dis, 8, 1, 21-31
• retrospective study supporting pulmonary rehabilitation for bronchiectasis patients

Ora J, Calzetta L, Pezzuto G et al (2013) A 6MWT index to predict O2 flow correcting exercise induced SpO2 desaturation in ILD. Respir Med; 107(12):2014-21. doi: 10.1016/j.rmed.2013.10.002

Plankeel JF, McMullen B, MacIntyre NR et al (2005) Exercise outcomes after pulmonary rehabilitation depend on the initial mechanism of exercise limitation among non-oxygen-dependent COPD patients. Chest, 127, 110–116

Postolache P, Cojocaru DC (2013) Pulmonary rehabilitation--from guidelines to practice. Rev Med Chir Soc Med Nat Iasi; 117(2):380-7
• PR reduces disability, hospitalizations, exacerbations, increases QoL and independence

Pradella, Cristiane O; Belmonte, Graziela M; Maia, Marcilene N et al (2015) Home-based pulmonary rehabilitation for subjects with COPD: a randomized study. Respir Care; 60(4):526-53

Puhan MA, Gimeno-Santos E, Scharplatz M (2011) Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev, Issue 10. DOI: 10.1002/14651858.CD005305.pub3.
• pulmonary rehabilitation reduces hospital admissions and mortality, increases health-related quality of life in people with COPD post-exacerbation

Qiu Z-H, Guo H-X, Lu G et al (2016) Physiological responses to Tai Chi in stable patients with COPD. Resp Physiol Neurobiol; 221:30-34

Reychler G, Mottart F, Boland M et al (2015) Influence of ambient music on perceived exertion during a pulmonary rehabilitation session: a randomized crossover study. Respir Care; 60(5):711-717

Reis LFF, Guimarães FS, Fernandes SJ et al (2013) A long-term pulmonary rehabilitation program progressively improves exercise tolerance, quality of life and cardiovascular risk factors in patients with COPD. Europ J Phys Rehab Med, 49(4):491-7

Ries AL, Bauldoff GS, Carlin BW (2007) Pulmonary rehabilitation. Joint ACCP/AACVPR evidence-based clinical practice guidelines. Chest, 131, 5 suppl 4S-42S

Ringbaek T et al (2008) Rehabilitation in COPD: the long-term effect of a supervised 7-week program succeeded by a self-monitored walking program. Chr Respir Dis, 5, 2, 75-80
• follow-up daily walking at home improved ET and health status throughout 1 year

Robertson N (2010) Running up that hill: How pulmonary rehabilitation can be enhanced by understanding patient perceptions of their condition. Chronic Resp Dis, 7, 4, 203-205
• 50% prevalence of depression and anxiety
• importance of focusing on patients’ own beliefs in PR, e.g. how they appraise their condition and treatment.
• individuals who view themselves as having little control over symptoms and their management are likely to report poorer outcomes

Ryerson CJ, Cayou C, Topp F et al (2014) Pulmonary rehabilitation improves long-term outcomes in interstitial lung disease: A prospective cohort study. Respir Med; 108(1):203-210

Santos C, Rodrigues F, Santos J et al (2015) Pulmonary rehabilitation in COPD: effect of 2 aerobic exercise intensities on subject-centered outcomes--a randomized controlled trial. Respir Care; 60(11):1603-1609

Schroff P, Hitchcock J, Schumann C et al (2017) Pulmonary rehabilitation improves outcomes in chronic obstructive pulmonary disease independent of disease burden. Ann Am Thorac Soc; 14(1):26-32. doi: 10.1513/AnnalsATS.201607-551OC
• pulmonary rehabilitation improves quality of life, SOB and functional capacity

Singh S, Morgan M (2012) One step beyond, does rehabilitation influence physical activity? Chronic Resp Dis, 9, 1, 3-4
• hard physical activity helps prevent hospital admission

Slinde F, Grönberg et al (2002) Individual dietary intervention in patients with COPD during multidisciplinary rehabilitation. Respir Med, 96, 330-6
• dietary intervention might be a prerequisite for physical training

Smith MD, Harvey EH, van den Hoorn W et al (2016) Out-patient pulmonary rehabilitation improves medial-lateral balance in subjects with chronic respiratory disease: proof-of-concept study. Respir Care; 61(4):510-520

Soler X (2013) Pulmonary rehabilitation improves sleep quality in chronic lung disease. COPD, 10(2):156-163.

Spencer LM, Alison JA, McKeough ZJ. Maintaining benefits following pulmonary rehabilitation: a randomised controlled trial. European Respiratory Journal 2009; doi: 10.1183/09031936.00073609.

Spruit MA, Singh SJ (2013) Maintenance programs after pulmonary rehabilitation: how may we advance this field? Chest; 144(4):1091-3

Spruit MA, Franssen FME (2010) What to do before pulmonary
rehabilitation to improve adherence? Chron Respir Dis, 7, 3, 131–133
• post-exacerbation pulmonary rehab, particularly for those with severe disease, has been shown to improve health status and reduce re-admissions

Spruit MA, Singh SJ, Garvey C et al (2013) An official American Thoracic Society/European Respiratory Society Statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med, 188(8):e13-e64. doi:10.1164/rccm.201309-1634ST

Stubbs B, Vancampfort D, Rosenbaum S et al (2016) Dropout from exercise randomized controlled trials among people with depression: A meta-analysis and meta regression. J Affect Disord; 190:457-66. doi: 10.1016/j.jad.2015.10.019

Suler Y, Dinescu LI (2013) Safety considerations during cardiac and pulmonary rehabilitation program. Phys Med Rehabil Clin N Am; 23(2):433-40

Swigris JJ, Fairclough DL, Morrison M et al (2011) Benefits of pulmonary rehabilitation in idiopathic pulmonary fibrosis. Respir Care, 56, 6,783-9

Tomioka H, Mamesaya N, Yamashita S et al (2016) Combined pulmonary fibrosis and emphysema: effect of pulmonary rehabilitation in comparison with chronic obstructive pulmonary disease. BMJ Open Respir Res; 3(1):e000099. doi: 10.1136/bmjresp-2015-000099

Topalovic M, Helsen T, Troosters T et al (2016) Unexpected improvements of lung function in chronic obstructive pulmonary disease. Respir Med Case Reports; 18:81-84. doi: 10.1016/j.rmcr.2016.05.004

Triest FJJ, Singh SJ, Vanfleteren LEGW (2016) Cardiovascular risk, chronic obstructive pulmonary disease and pulmonary rehabilitation: can we learn from cardiac rehabilitation? Chronic Respir Dis; 13(3):286-94. doi: 10.1177/1479972316642367

Troosters T, Bourbeau J, Maltais F et al (2016) Enhancing exercise tolerance and physical activity in COPD with combined pharmacological and non-pharmacological interventions: PHYSACTO randomised, placebo-controlled study design. BMJ Open; 6(4):e010106. doi: 10.1136/bmjopen-2015-010106

Vainshelboim B, Fox BD, Oliveira J et al (2016) Exercise training in idiopathic pulmonary fibrosis. Expert Rev Respir Med; 10(1):69-77. doi: 10.1586/17476348.2016.1121104

Vogiatzis I, Zakynthinos S (2013) The physiological basis of rehabilitation in chronic heart and lung disease. J Appl Phys; 115(1):16-21. doi:10.1152/japplphysiol.00195.2013

Vogiatzis I, Rochester CL, Spruit MA et al (2016) Increasing implementation and delivery of pulmonary rehabilitation: key messages from the new ATS/ERS policy statement. Eur Respir J; 47(5):1336-41. doi: 10.1183/13993003.02151-2015

Wardini R, Dajczman E, Yang N et al (2013) Using a virtual game system to innovate pulmonary rehabilitation: safety, adherence and enjoyment in severe chronic obstructive pulmonary disease. Can Respir J; 20(5):357-61

Williams MT, Cafarella P, Catherine P (2015) Cognitive behavioral therapy for management of dyspnea: a pilot study. Respir Care; 60(9):1303-1313

Zakrisson AB, Hiyoshi A, Theander K et al (2016) A three-year follow-up of a nurse-led multidisciplinary pulmonary rehabilitation programme in primary health care: a quasi-experimental study. J Clin Nurs; 25(7-8):962-71. doi: 10.1111/jocn.13132

Zhang C (2013) Development and validation of a COPD self-management scale. Respir Care; 58(11):1931-6

Zhou LQ, Li XY, Li Y J et al (2016) Inspiratory muscle training followed by non-invasive positive pressure ventilation in patients with severe chronic obstructive pulmonary disease: a randomized controlled trial. Nan Fang Yi Ke Da Xue Xue Bao; 36(8):1069-74
• balancing rest and exercise by alternating IMT and NIV leads to improved ET & SOB

6MD = six-minute distance
AACN = American Association of Critical Care Nurses
AARC = American Association for Respiratory Care
ACCP = American College of Chest Physicians
ACPRC = Association of Chartered Physiotherapists in Respiratory Care
ATS = American Thoracic Society
BMI = body mass index
BMJ = British Medical Journal
BTS = British Thoracic Society
ERS = European Respiratory Society
ET = exercise tolerance
HRQL = health-related quality of life
IMT = inspiratory muscle training
NIV = noninvasive ventilation
PR = pulmonary rehabilitation
QoL = quality of life
SOB = shortness of breath