- There is evidence that exercise facilitates tolerance to
and delays the appearance of dyspnea to higher levels
of exertion. No other intervention is able to produce
this desensitization, including medication and supple-
mental oxygen (Mink, 1997). - In COPD patients, exercise does not appear to signif-
icantly affect lung function directly. In a review of 29
trials that included spirometry, only two showed
improved FEV1 (Belman, 1996).
•A review of 18 studies found that VO2max improved in
only 10 studies (Belman, 1996).
•Even at very low training levels, aerobic training for
COPD patients reduces ventilation at comparable
oxygen consumption levels (although only to a third the
extent of that seen in normal subjects) (Mink, 1997).
•Exercise tolerance may improve following exercise
training because of gains in aerobic fitness or periph-
eral muscle strength; enhanced mechanical skill and
efficiency of exercise; improvements in respiratory
muscle function, breathing pattern, or lung hyperin-
flation; as well as reduction in anxiety, fear, and dys-
pnea associated with exercise (Bourjeily, 2000). - Both high- and low-intensity programs produce sig-
nificant improvements in exercise tolerance and
reductions in minute ventilation and dyspnea, even
when the disease is severe (Killian et al, 1992). - European Respiratory Society (ERS), American
Thoracic Society(ATS), and British Thoracic Society
(BTS) guidelines support the use of pulmonary reha-
bilitation (Ferguson, 2000).
•Exercise training and pulmonary rehabilitation should
be considered for all patients who experience exercise
intolerance despite optimal medical therapy (Bourjeily,
2000). - Before prescribing an exercise program, COPD
patients require careful evaluation to assess cardiac
risk and exercise capacity (Mink, 1997).
OSTEOARTHRITIS
•Patients with arthritis have substantially worse health-
related quality of life than those without arthritis (The
Centers for Disease Control and Prevention, 2000).
- Studies show that exercise improves the pain and dis-
ability of patients with osteoarthritis (Van Baar et al,
1999). - Aerobic exercise for patients with OA has been shown
to improve cardiovascular fitness, reduce symptoms,
and improve functional capacity (DiNubile, 1997). - Data from the Fitness Arthritis and Seniors Trial sug-
gested that beneficial effects of exercise on functional
capacity in OA patients are independent of exercise
type (Ettinger et al, 1997).- Strength training of the whole body appears to be
more beneficial than limiting work to the muscles
around the affected joint (DiNubile, 1991). - One review found that available data supports the
theory that in the absence of joint abnormalities, phys-
ical activity that remains within the limits of comfort
and normal range of motion does not lead to OA
(Bouchard, Shepard, and Stephens, 1993). - High-impact activities that include running and jump-
ing may be detrimental for established OA of lower
extremity joints (Buckwalter and Lane, 1996).
•Treatment guidelines for OA from the American
College of Rheumatology and American Academy of
Orthopedic Surgeons advocate exercise as an impor-
tant therapeutic modality (Hochberg et al, 1995; Pate
et al, 1995 ).
- Strength training of the whole body appears to be
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