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Chapter

Exercise Training and Pulmonary

Rehabilitation in COPD
Amira Permatasari Tarigan and Fannie Rizki Ananda

Abstract

Systemic inflammation and deconditioning syndrome lead to loss of structural

and function of body muscle, particularly in extremity muscle. Longer period of
inactivity due to dyspnea worsen the destruction of muscle. Regular and gradually
increase exercise training as part of pulmonary rehabilitation (PR) can improve
the function of essential muscles in doing daily life so stable Chronic Obstructive
Pulmonary Disease (COPD) patient can maintenance their daily activities with
minimal limitations. Pulmonary rehabilitation consists of exercise training, nutri-
tional support, smoking cessation, and self-management of COPD. The prescrip-
tion of exercise training is mandatory. Assessment of clinical condition to adjust the
type of training, duration, frequency, and intensity of training must be completed
before beginning the training session. Regular and gradually increased training
gives significant impact in improving lung function, dyspnea scale, and quality of
life in patient with stable COPD. However, in this covid era, the restriction of hos-
pital attending PR was significantly affect PR program. As immunocompromised
population, COPD patient have higher risk for COVID19 infection and develops
more severe complications compare with normal population. So, the modified
supervised and unsupervised training was needed to revise the classic type of PR.
Tele-rehabilitation with teleconference, phone calls, and interactive web based PR
can be the good alternative in decreasing hospital admission and improving quality
of life in patient with COPD.

Keywords: Pulmonary rehabilitation, exercise training, COPD, tele-rehabilitation,

covid-era

1. Introduction

Dyspnea is the main symptom of Chronic Obstructive Pulmonary Disease

(COPD) that correlates with the limitation of daily activity [1, 2], anxiety and other
psychological impacts [3, 4], low quality of life [5], and reduced survival rate [6].
Dyspnea can manifest across the degree of pulmonary obstruction. Either patients
with moderate or severe obstruction can experience dyspnea in their daily activities
[7]. All these facts cause dyspnea and exercise tolerance becoming the main focus in
COPD management in a few guidelines [8, 9].
Besides the pharmacological approach, pulmonary rehabilitation (PR) is con-
sidered an important part of comprehensive COPD treatment, particularly in group
B-D [10]. Almost all types of pulmonary rehabilitation have a positive impact on
the dyspnea scale of patients with COPD. Six-week of pulmonary rehabilitation was
given to the end-stage of COPD outpatients and provide a significant improvement

1
Chronic Obstructive Pulmonary Disease - A Current Conspectus

of dyspnea scale using a visual analog scale [11]. A meta-analysis study also sug-
gests including upper extremity exercise in pulmonary rehabilitation because it can
relieve dyspnea in COPD, although few studies showed the insignificant difference
of Borg scale after the training [12]. A study that compares endurance training,
combined endurance and strength training, and pharmacological alone showed the
improvement of dyspnea in endurance and combined training, but not in a phar-
macological alone group. It stated that strength training gives an additional impact
on muscle force, but not different from endurance training alone in health status
[13]. This is in line with the previous author’s study that showed 4 weeks of upper
extremity exercise without strength training had demonstrated the improvement of
dyspnea scale using the mMRC scale [14].
On the other side, an intervention study with 6 weeks of cardiopulmonary
exercise showed an insignificant improvement of dyspnea scale measured with
0–10 Category Ratio (CR) in COPD patients [15]. But as general, a review article
that compiles few meta-analyses, randomized controlled study, reviews, and the
clinical trial showed that pulmonary rehabilitation gives positive impacts in COPD
patients according to functional outcomes, dyspnea scale, and quality of life [16].
Different results might be caused by different dyspnea scales used in the various
study. But according to GOLD, the Borg scale and mMRC scale were recommended
to measure the dyspnea scale in COPD patients (Global Initiative for Chronic
Obstructive Lung Disease, 2019).
Breathing training as part of PR can improve regional ventilation and gas
exchange and respiratory muscle function that later improves the exercise toler-
ance and quality of life of patients [17]. Breathing training includes diaphragm
breathing, pursed-lip breathing, relaxation technique, and body position [18]. In
a study, diaphragm breathing alone and the combination of diaphragm breathing
and pursed-lip breathing can reduce the asynchrony of inspiration-expiration ratio
and increase lung volume [19]. A study also stated the combination of upper limb
training and pursed-lip breathing can decrease dyspnea, improve exercise capac-
ity, and quality of life in patients with stable COPD [14]. Diaphragm breathing
(DB) itself improves breathing patterns by coordinating the rib cage muscles and
abdominal wall, reduce the activity of the accessory muscle, and lead to improving
exercise tolerance [20].

2. Deconditioning syndrome

Decondition syndrome refers to the change in the structure and function of

body muscle due to inactivity. This syndrome usually occurred in chronic car-
diovascular and lung disease, including Chronic Obstructive Pulmonary Disease
(COPD) [21, 22]. This change involved muscle, cardiac, lung, and vascular-related
to the history of the disease [23]. This syndrome consisted of three steps:

1. Mild deconditioning: this condition affects normal exercise in which a patient

will experience dyspnea and fatigue after doing some exercise include cycling,
biking, and swimming.

2. Moderate deconditioning: this condition affects daily activities including walk-

ing, shopping, and lifting some goods.

3. Severe conditioning: in this condition, the patient cannot do any activities and
just laying on the hospital bed.

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Exercise Training and Pulmonary Rehabilitation in COPD
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Decondition syndrome is a vicious cycle that occurred progressively. The longer

the period of inactivity, the more severe the deconditioning will be, and the longer
it will take to return to your previous level of functioning [21].
Generally, three basic mechanisms contribute to deconditioning syndrome in
chronic pulmonary disease. There is an imbalance between oxygen distributed
along with the systemic and respiratory muscles and the amount of oxygen served,
muscle dysfunctions include a structural and functional change in extremity and
respiratory muscle, and imbalance between ventilation capacity and the amount of
ventilation needed for running daily activities [24–26].
The disturbance of exercise capacity may result in systemic manifestation
rather than pulmonary disease. Systemic inflammation, hypoxia, and decon-
ditioning syndrome are caused by muscle atrophy and loss of muscle functions
[26]. Muscle atrophy occurs when there is an imbalance of protein synthesis due
to lower testosterone levels [21, 22] and protein degradation. Increased levels of
ubiquitin and TNF-α was seen in several studies [26, 27]. Further, malnutrition,
chronic hypoxia, oxidative stress will increase systemic inflammation and muscle
disturbance [26].

3. Pulmonary rehabilitation

Pulmonary rehabilitation is a substantial part of comprehensive treatment in

COPD in every stage. According to GOLD 2021, pulmonary rehabilitation is recom-
mended in stage B-D of stable COPD. Pulmonary rehabilitation includes exercise
training, smoking cessation, nutrition, and education for self-management inter-
vention [28]. Pulmonary rehabilitation should be offered to patients with COPD
to improve dyspnoea and health status by a clinically important amount. Besides,
pulmonary rehabilitation also alleviates psychological disturbance results in the
long-term effect of chronic pulmonary disease.

1. Exercise training
Exercise training is the main part of pulmonary rehabilitation. According
to GOLD 2020, regular exercise training can improve shortness of breath,
exercise tolerance, and quality of life status [29]. Exercise training includes
endurance/aerobic training, strength training, and inspiratory muscle train-
ing. According to GOLD 2021, the combination of these training gives better
outcomes compared with the method alone [28].

2. Nutritional support
In COPD patients, the high level of katabolic cytokines contributed to malnu-
trition [30]. A high level of IL-6, IL-8, TNF-α showed in COPD patients and
their levels have a role as predictors of worse outcomes in COPD [26, 30–32].
Also, high broadcasting of leptin in COPD patient play roles in decreased ap-
petite consequently in decreased muscle mass and functions [33, 34]. Twenty-
five to forty percent of COPD patients experienced malnutrition and 25% of
them has moderate to severe malnutrition with low fatty fat mass [35].
The nutritional intervention showed a significant increase in muscle mass
and function leads to exercise tolerance improvement. Antioxidant proper-
ties in vegetables and fruit may increase the antioxidant resulted in decreas-
ing systemic inflammation [36]. Besides, high fat with low carbohydrate
food also showed the improvement of pulmonary function in stable COPD

3
Chronic Obstructive Pulmonary Disease - A Current Conspectus

patients [37]. So, after the exercise training intervention, nutritional support
must be considered as a substantial part of pulmonary rehabilitation.

3. Self-care management of COPD

Individual management of COPD is an important part of pulmonary rehabili-
tation. We have to educate the patient about steps of smoking cessation, an
inhaler used, recognition of exacerbation, and when to admit to the hospital.
The patient should be known his condition, including the risk and complica-
tions of his disease, and the risk of not taking medicine regularly. They should
be informed about the factors contributing to exacerbation and how to handle
them. In this session, physicians must collaborate not only with the patient
but also with his patient’s family. Motivate the patient to stop smoking or
even changed his job if it contributed to the uncontrolled symptom of COPD.
Education also involved how to convincing the patient for taking the exercise
training regularly and continue attending the session of exercise training by
himself after discharge from the hospital [28].

4. Exercise training preparation

Before beginning the session of training, we must assess the baseline condition
of the patient to prepare the individual dose of training.
Following assessment must be undergone for every stable COPD patient [28]:

1. A detailed history and physical examination of the patient. This must be im-
portant to rule out the group of the patient and the risk for exacerbation.

2. Measurement of airway obstruction using spirometer before and after bron-

chodilator

3. Assessment of exercise capacity using the six-minute walking test. In the avail-
able facilities, cycle ergometer and treadmill exercise can be used to measure
the physiological variables that impact the exercise capacity, including maxi-
mum oxygen consumption, maximum heart rate, and maximum work per-
formed [28].

4. Health status and the impact of breathlessness in doing exercise

5. Assessing the respiratory and limb muscle in patients with muscle wasting

6. Individual patient goals and expectations

4.1 Prescription of exercise training in COPD

There are few parameters must be considered to prescribe an exercise training in

COPD patient. There was no guideline plainly stated that exercise training cannot
be done in an exacerbated state. The frequency, intensity, time, and type of exercise
training, abbreviate by FITT must be reviewed before beginning the session of
training. And these parameters also correlated with outcomes [29].
According to one systematic review, there was dose-related training and out-
comes. High-intensity training tends to have more significance to exercise tolerance
measured by maximal heart rate and oxygen uptake in exercise (VO2max) [38]. But
the problem is the practical and economic reasons, the duration of lasting longer

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Exercise Training and Pulmonary Rehabilitation in COPD
DOI: http://dx.doi.org/10.5772/intechopen.97704

than 6–8 weeks of supervised training considered to highly economic demands [39]
considered to be significant. According to consensus, exercise training is arranged
for 6–12 weeks duration with two to three supervised sessions per week with
60–90 minutes for 1 session [39–42].

4.2 Frequency of supervised training

1. Exercise training programs should be two-five times a week [39, 43]

2. Supervised of pulmonary rehabilitation should be minimum 2 times a week, other

sessions can be undergone at home without supervised by physicians or therapist

4.3 Duration of supervised training

1. 30 minutes of physical activity gives a positive impact on a healthy subject

[39, 43]

2. 6–12 weeks of training are recommended in all types of exercise training.

3. Long term training (more than six months of training) for outpatient give a
more significant impact on exercise tolerance, exacerbation events, and quality
of life [44]

4. Intermittent exercise can be arranged for a patient who cannot tolerate contin-
uous training. In initial training, moderate to severe COPD tend to have only a
few minutes of training and we can increase it gradually by about 5–10 minutes
every 1–2 weeks [45].

4.4 Intensity of training

1. 50–80% maximal workload must be arranged in exercise. According to Ameri-

can Sports Medicine, it is divided into [45]:
Light intensity: 30–40% peak work rate.
Vigorous-intensity: 60–80% peak work rate

2. American Thoracic Society and European Respiratory Society recommend

initial training with >60% maximal work rate [40].

3. Workload defined as VO2 max and maximum heart rate with the formula
is 220-age

4. Targeted of intensity is 60–70% RM (Repetition Maximum) or 100% of 8–12 RM

5. American Association of Cardiovascular and Pulmonary Rehabilitation

(AACRP) recommended initiating the training with light intensity and gradu-
ally increased it until reaches the maximal target [46].

4.5 Type of training

1. Endurance training
Endurance training is the most common training prescribed for severe COPD.
Endurance training can improve aerobic exercise capacity so the patient can do

5
Chronic Obstructive Pulmonary Disease - A Current Conspectus

his daily activities more comfortably without shortness of breath [47]. Endur-
ance training also can improve peripheral muscle function in severe COPD
patients [48]. But according to the Casaburi study, endurance training with
high intensity has a greater impact compared with low intensity [22]. But this
intensity can be gradually increased in line with the patient’s condition. Walk-
ing and cycling are the most recommended endurance training for exercising
the lower limb [49]. Fatigue in large muscles in the thigh including quadriceps
femur muscle and hamstring muscle often occurs at the beginning of the train-
ing [50, 51]. But, it will decrease after a few sessions of training, so a gradually
increased dose is needed in the training arrangement. Further, walking on the
ground give a more significant impact in improving the walking capacity in
severe COPD patients [49]. Upper extremity exercise involved biceps, triceps,
deltoid, and accessory respiratory muscles including latissimus dorsi muscle
and pectoralis mayor should be trained to give additional effect in alleviating
shortness of breath [14].
A six-minutes walking test (6-MWT) is the most recommended examina-
tion for assessing the impact of endurance training [39]. Due to its eco-
nomic aspect, easy to do, low side effect, 6-mwt is recommended in every
guideline [39, 40]. But, a cardiopulmonary exercise test (CPET) has been
a gold standard in assessing exercise capacity. We can measure cardiore-
spiratory performance and VO2 max [45]. However, this method is expen-
sive and needs more equipment so it cannot be done performed in every
facility, particularly in healthcare facilities without a standard pulmonary
rehabilitation center. Other measures can sit to stand tests (STST), incre-
mental shuttle walking test (ISWT), and endurance shuttle walking test
(ESWT) [49].

2. Strength training
Disturbance of muscle structure and function in COPD patients has been
discussed before. Strength training or resistance training give a more sig-
nificant impact on muscle enhancement in COPD patients [40, 42, 47]. Its
impact in peripheral and large muscle alleviate dyspnea and improving the
activity which gives more effort including climbing the stairs, standing,
and arm elevation [47]. So, if combining with endurance training, a sys-
tematic review shows a greater impact on the quality of life of a patient with
COPD [52].
Frequency, intensity, repetition, and type of strength training contribute to
the impact of training. Large individual variations further affect the quality of
training. Six until twelve repetitions about 15–45 minutes for 2–3 days recom-
mended in strength training in some guidelines [41]. The patient can take a
break when begin to experience dyspnea. A short bronchodilator should be
given immediately with oxygen supplementation.

3. Inspiratory muscle training

Different from endurance and strength training, inspiratory muscle training
focused on the enhancement of the diaphragm [17]. In COPD, the emphy-
sema process made the disturbance of the elasticity of the diaphragm to make
contraction and relaxation, showed in the hyperinflated lung, narrowed and
more vertical heart, and flattened diaphragm in radiographic appearance.

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Exercise Training and Pulmonary Rehabilitation in COPD
DOI: http://dx.doi.org/10.5772/intechopen.97704

Inspiratory muscle training improves diaphragm muscle strength and endur-

ance so it can reduce dyspnea [47]. This training is often combined with upper
and lower body training for maximizing the effect of pulmonary rehabilita-
tion in stable COPD.
This training was recommended in 5–7 days per week with a duration 7x2 min-
utes interval approach and 1-minute rest between intervals. The total duration
of this training is 15–20 minutes for each day [53, 54].

4.6 Variation of exercise training

There is no absolute content of exercise training in COPD. We can design our

method according to our facilities and human resources. In our setting, we have
arranged a few methods of exercise training and showed a significant impact on
breathing scale and quality of life.
Below is one of the type of exercise training in our setting. The procedures
include:
After taken the baseline data, patients in the intervention group were scheduled
for the training program. The training program was held twice a week for four
weeks. The procedures of the study were the following:

1. Heating. Participants were given infrared radiation for 10 minutes in their

chest to warm the chest muscle and facilitate sputum expectorant.

2. Chest therapy. In this session, the chest muscle was massaged, stretched, and
then vibrated to facilitate the sputum expectorant.

3. Upper limb endurance training with simple gymnastics using the neck, shoul-
der, and arm. Along with these procedures, pursed-lip breathing was per-
formed to facilitate breathing training

4. Upper limb strength training using dumbbell with personalized weight lift-
ing. First, we examined the maximal weight lifting in five repetitions. For the
1st week of practice, we used 60% of maximal weight lifting (kg) and then
increased progressively every week.

Upper limb endurance training in our setting consisted of few 10 moves

(Figures 1–10):

Figure 1.
Pursed lip breathing with exhaling while tilting your head towards your shoulder.

7
Chronic Obstructive Pulmonary Disease - A Current Conspectus

Figure 2.
Bird-like pattern with inhaling while body straightening, exhale while bending forward to the bottom.

Figure 3.
No-way pattern with pursed-lip breathing, seeing movement to left and right alternately.

Figure 4.
Shoulder shrug with pursed-lip breathing.

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Exercise Training and Pulmonary Rehabilitation in COPD
DOI: http://dx.doi.org/10.5772/intechopen.97704

Figure 5.
Fan-like movement with pursed-lip breathing, hands are bent together, then turn right and left.

Figure 6.
Chicken cuckoo like movements with rotating the shoulder with hands bent at the shoulder.

Figure 7.
Vampire-like movement, hands straight forward while inhaling, then rotating the body to the right, left, and
forwards while exhaling.

5. Supported vs. unsupported pulmonary rehabilitation

Long-term PR tends to gradually decrease over a while [55]. Many circumstances

contribute to discontinuous training after a short period of intensive PR, including
lack of motivation, support from friends and families, disease progressivity, and
distance from health facilities [56]. For the last reason, home-based PR might become

9
Chronic Obstructive Pulmonary Disease - A Current Conspectus

Figure 8.
Calling movement, the hand is lifted, then touched downwards, in the opposite direction.

Figure 9.
Butterfly-like pattern, hands stretched straight forward then hands stretch.

Figure 10.
Cooling down with pursed lip breathing.

an alternative. According to Swerts et al., the continuation of 12 weeks of supervised

training maintained 1-year of walking ability in stable COPD patients [57]. Further,
Ries et al. suggested a year of home-based PR with once a month of supervised
training at health facilities to control the procedure and the impact of PR in the stable
COPD patient. Ries et al. also evaluate the impact of maintenance PR by telephone for

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Exercise Training and Pulmonary Rehabilitation in COPD
DOI: http://dx.doi.org/10.5772/intechopen.97704

1 year after a short period of supervised training in health care facilities. This study
revealed that during the first 12 months, there were improvements in exercise toler-
ance and health status in patients undergone telephone supervised training and once
in a month controlled training at health facilities in chronic pulmonary disease [58].
There were no definite guidelines that recommend the duration of supported
and unsupported PR. But studies showed that 8–12 weeks of supported PR followed
by 12–24 months of giving substantial effect in exercise tolerance and quality of life
in a patient with COPD [56]. In another study, Guel et al. showed that 6 months of
intensive supervised training followed by 6 months of once-in-week supervised
exercise training give an improvement of dyspnea scale and quality of life compared
with the control group which no additional PR after intensive supervised training
[59]. Another study also showed the reduction of exacerbation with hospital admis-
sion after retreatment PR in outpatient with stable chronic pulmonary disease who
has stopped PR for 1 year, although there was no difference in exercise tolerance
and quality of life compare with the control group [60].
There are few modifications for unsupported PR. We can monitor once a week
or once a month to control the correct procedure and the impact that might be
occurred, both positive and negative impact.
More than 50% of the participant who attends long term PR was a loss to follow
up. Both once in a month or once in three months of supervised training with the rest
session is home-based PR showed no significant difference in the 1-year loss to follow
up [61]. Whereas, the impact of intensive and supervised PR for 8–12 weeks will disap-
pear after 1 year [56]. So, the long-term supported PR is needed to improve the exercise
capacity and dyspnea tolerance in stable COPD patients to maintain their daily life.

6. Tele-rehabilitation in Covid19 era

In this pandemic era, pulmonary rehabilitation was significantly affected. Strict

regulation to decrease hospital admission in people with COPD gives a significant
impact on stable COPD patients who attend regular pulmonary rehabilitation in the
hospital [62]. Further, COPD patients were susceptible to infections due to lack of
immunity and chronic inflammatory state. So, a new era of pulmonary rehabilita-
tion was needed to reform the classic pulmonary rehabilitation.
Theoretically, teleconference PR will enhance the adherence to attending PR ses-
sions in stable COPD patients, particularly patients whose address was far from the
PR center. But, data showed that there was no significant difference in the impact of
a patient who attends teleconference PR compare with conventional PR [62]. Few
factors contribute to the poor adherence to PR programs. They are including avail-
ability, accessibility, and attrition [63]. The alternative method including home-
based supervision, interactive web-based PR, videoconference with telehealth can
be implicated in the new settings of PR [64–66].
Teleconference PR or telerehabilitation has been discussed since early 2000.
Tele-rehabilitation was the new concept of PR where the patient was being at home
and used communication and information to provide PR [67]. This was promising
alternative ways in patients whose addresses were far from the PR center and in
this covid era. On the other side, this alternative way also has severe limitations
including short duration of intervention, small patient number, communication
error, limitation of technology facilities, and poor adherence of several compo-
nents of PR [65]. Specific guidelines of telerehabilitation must be accomplished
to achieve maximal impact on the patient. This needs the coordination of several
aspects including administration, organization, physical trainee, physicians, and
government [67].

11
Chronic Obstructive Pulmonary Disease - A Current Conspectus

In telerehabilitation particularly in chronic respiratory disease, few modules must

be carried out. Inhaler used training, smoking cessation, dietary and self-manage-
ment advice, physical exercise, and psychological support must be scheduled formally
through phone calls or video conference with a certain physiotherapist, dietician,
and pulmonologist [66, 68]. There were no guidelines regulate the definite duration,
frequency, and type of training in telerehabilitation. Bhatt study arranges 36 exercise
sessions in 12 weeks consists of a combination of stretching and breathing training for
warming up, aerobic exercise including ergometer bicycles until maximum heart rate
was achieved (60–80% maximal HR). Resistance training used resistance band was
performed with a video tutorial that was given before. Also, breathing training includ-
ing basic yoga training, diaphragm breathing training, paced-training, and pursed-lip
breathing was carried out in stable COPD patients. After few sessions, an educational
video conference was performed consisted of smoking cessation, psychological
support, appropriate inhaler technique, disease education, monitoring, and report-
ing exacerbation [66]. Another study performed 144 sessions for 12 months with
2 months of initial training PR programs in the PR center to educate the patients to
use the modal facilities and how to monitor the function of each piece of equipment.
In the next 10 months, patients were undergone self-exercise training with remote
monitoring. Educational programs including dietary, self-management, and psycho-
logical support were performed in a video conference. Strict monitoring of vital signs
during training particularly heart rate and oxygen saturation were recorded and send
to physicians after the end of each training session [68]. After all the training session,
several parameters can be measured to evaluate the impact of the teleconference,
including modified Medical Research Council dyspnoea scale (mMRC), COPD assess-
ment questionnaire (CAT), St. George’s Respiratory Questionnaire (SGRQ ), Hospital
Anxiety and Depression Scale (HADS), spirometer, pedometer, and hospitalization
event, length of stay, and Emergency Room visits [66, 68].
Few studies have proved that telerehabilitation has benefits to stable COPD
patients. Bhatt’s study showed that early telerehabilitation after the patient was dis-
charged from the hospital due to exacerbation has reduced 30 days of re-admission
in hospital from all causes of exacerbation [66]. Vasiloupoulou’s study also stated
that home-based maintenance telerehabilitation was the same effect as hospital-
based PR in reducing the risk of acute exacerbation and hospitalization [68].
New South Wales Health of Ministry has arranged telehealth pulmonology
rehabilitation in the covid19 era. It consisted of four main components including
patient assessment by phone calls and teleconference, home-based individual
exercise program by videoconferencing, patient education, and the re-assessment
of the patient after completed all the training programs [69].

1. Patient assessment
Phone calls and video conferences can be conducted in the patient assessment ses-
sions. It is included general medical history contains respiratory symptoms, social
history, the course of the disease, history of hospitalization, medication, vacci-
nations, and smoking history. Symptoms were evaluated by Borg scale, mMRC,
SGRQ, CAT, HADS, and CRQ. Objective measurement must be carried out
including height, weight, oxygen saturation, blood pressure, and heart rate. Fur-
ther, lower limb strength can be measured by 5 minutes sit to stand test (5STS)
while lower limb endurance is measured by a 1-minute sit to stand test (1STS).

2. Exercise programs
There are few types of telehealth PR. NSW Health recommends lower limb
endurance training using the walking method while the endurance training by

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Exercise Training and Pulmonary Rehabilitation in COPD
DOI: http://dx.doi.org/10.5772/intechopen.97704

5STS and squats-stand. Upper limb training used light hand weights for endur-
ance training and a resistance band for strength training.

a. Duration: lower limb endurance (start 10–15 minutes and continue in

30 minutes); upper limb endurance (10 mins); lower limb strength (10
mins); upper limb strength (10 mins)

b. Intensity: moderate to severe

c. Frequency: 2 days in PR center and other 2 days at home

d.Length of programs: 8 weeks

e. Type: continues, interval, and intermittent

3. Patient education

a. Description about lung disease

b. The benefit of exercise programs and physical activity

c. Symptom evaluation and management

d.Inhaler technique

e. Smoking cessation

f. Nutrition

g. Psychological support

4. Re-assessment

7. Conclusions

Last, COPD patient was advised to follow the pulmonary rehabilitation to do

exercise training by themselves. Pulmonary rehabilitation is comprehensive man-
agement and evaluation that involved a few basic knowledge including nutrition,
psychologist, physiotherapist, pulmonologist, and other specialist doctors depend
on the patient’s condition and co-morbid.

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Chronic Obstructive Pulmonary Disease - A Current Conspectus

Author details

Amira Permatasari Tarigan1* and Fannie Rizki Ananda2

1 Asthma and COPD Division, Department of Pulmonology and Respiratory

Medicine, Faculty of Medicine, Universitas Sumatera Utara, Indonesia

2 Department of Pulmonology and Respiratory Medicine, Faculty of Medicine,

Universitas Sumatera Utara, Indonesia

*Address all correspondence to: amira@usu.ac.id

© 2021 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms
of the Creative Commons Attribution License (http://creativecommons.org/licenses/
by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.

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Exercise Training and Pulmonary Rehabilitation in COPD
DOI: http://dx.doi.org/10.5772/intechopen.97704

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