Summary : Chronic respiratory diseases (CRDs) are a group of disorders, primarily chronic obstructive pulmonary disease and asthma, that are characterized by high prevalence and disability, recurrent acute exacerbations, and multiple comorbidities, resulting in exercise limitations and reduced of health-related quality of life. Exercise training, an important tool in pulmonary rehabilitation, reduces adverse symptoms in patients by relieving respiratory limitations, increasing gas exchange, increasing central and peripheral hemodynamic forces, and improving skeletal muscle function. High-intensity aerobic, resistance, and intermittent exercises, and other emerging forms such as aquatic exercise and Tai Chi, effectively improve exercise capacity, fitness, and lung function in patients with CKD. The underlying mechanisms include improving the body’s immune response, better control of the inflammatory response, and accelerating the interaction between the vagus and sympathetic nerves to improve gas exchange. Here we review emerging evidence on the benefits and mechanisms of exercise intervention in the pulmonary rehabilitation of patients with chronic obstructive pulmonary disease, bronchial asthma, bronchiectasis, interstitial lung disease, and lung cancer. |
Comments
Training-based pulmonary exercise rehabilitation is effective in relieving symptoms of chronic respiratory diseases (CKD), including chronic obstructive pulmonary disease (COPD), according to a study published in the International Journal of Chronic Obstructive Pulmonary Disease .
Researchers conducted a review that examined the positive rehabilitative effects of exercise on COPD, bronchial asthma, bronchiectasis, interstitial lung disease, and lung cancer. In addition to relieving symptoms, they found that exercise improved patients’ quality of life, cardiovascular function, physical activity tolerance, and muscle function.
“Moderate-intensity aerobic exercise, resistance training, and [high-intensity interval training] are the most common forms of pulmonary rehabilitation exercises,” the authors wrote.
For people with COPD, the authors hypothesized that exercise would improve their immune response, leading to activation of their adaptive immune response. They said they came to this conclusion because of similar studies conducted on mice.
“In animal studies, aerobic exercise was found to prevent increases in macrophage and neutrophil counts in mice with COPD; “A similar trend was found in population trials, with a significant reduction in in vivo eosinophil counts after 6 weeks of resistance and strength training,” the authors wrote.
Additionally, a study in patients with COPD found that a 12-week exercise training regimen was associated with increased CD4+ T cells, a better immune response, and fewer COPD exacerbations and hospitalizations.
Due to these results, the authors concluded that exercise is an effective strategy for COPD patients to reduce pulmonary and systemic inflammation, alleviate symptoms, and prevent disease progression.
Patients with asthma, who are more prone to fatigue and breathing difficulties during exercise, are often encouraged to reduce or eliminate physical activity to avoid worsening symptoms or exercise-induced bronchoconstriction; This could lead to decreased physical fitness and exercise tolerance, ultimately leading to exercise avoidance.
Instead, the authors stated that patients with asthma are capable of physical activity and could improve their health status with it, since aerobic exercise helps them control airway inflammation.
“…It has been found that aerobic exercise effectively reduces eosinophilic expression in the airways, which in turn reduces inflammation, the dose of inhaled glucocorticoids (ICS) and acute exacerbations, under the premise of standardizing and optimizing medication ICS,” the authors wrote. “Aerobic training can also positively modulate airway inflammation and remodeling mediators.”
Consequently, aerobic training and medication together can help asthma patients.
Lung cancer patients may also benefit from exercise. Lung cancer, the leading cause of cancer-related death, is divided into 2 subtypes: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Pneumonectomy is currently the most effective treatment for stages I, II, and IIIA NSCLC and offers the best chance for long-term survival.
Exercise may benefit patients both pre- and post-operatively, as population-based trials have shown that resistance training improved participants’ muscle mass, strength, and sleep quality. Additionally, for those who were previously unable to undergo surgery due to poor preoperative assessments, 4 weeks of aerobic exercise and respiratory training improved both their lung function and their chances of undergoing surgery.
“Aerobic exercise improves exercise tolerance and cardiorespiratory fitness and reduces postoperative respiratory morbidity, length of hospital stay, cancer fatigue, anxiety, and depression,” the authors wrote.
Because of its positive effects, the authors considered exercise to be an effective complement to existing cancer therapies.
Patients with bronchiectasis benefit from exercise, as resistance training and aerobic exercises of the upper and lower extremities can improve exercise capacity, endurance, lung function, and peripheral and respiratory muscle strength. It can also reduce dyspnea and improve patients’ quality of life.
The authors noted that it is challenging for patients with bronchiectasis to maintain these benefits, as they find it difficult to adhere to the regimen as exercise cycles increase; As they exercise less, the positive cumulative effect decreases accordingly.
Patients with interstitial lung disease (ILD) are affected by dyspnea, exercise-induced hypoxemia, and exercise intolerance. It is difficult for patients to achieve adequate exercise intensity, the researchers wrote, but the standard aerobic exercise program for COPD appears to be effective.
The authors advised patients with PID to start exercising as soon as possible, as exercise becomes more difficult in the later stages of symptoms. Exercise reduces patients’ lung inflammation and glucocorticoid-induced damage to the immune system.
Overall, additional high-quality randomized controlled trials are required to further evaluate the effect of exercise in patients with CKD.
“Further studies are needed to investigate the pathophysiological mechanisms by which different forms of exercise improve CRD and determine alternatives to pulmonary rehabilitation in patients with exercise limitations,” the authors concluded.
