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The value of pulmonary rehabilitation (PR) for people with chronic respiratory disease has been firmly established. A large body of evidence supports its efficacy and cost-effectiveness, improving symptoms of breathlessness, exercise capacity and quality of life.1 Although clinical guidelines and quality frameworks support its delivery, access and adherence to PR remains a challenge2 3 (figure 1). In the UK, the National Asthma and Chronic Obstructive Pulmonary Disease (COPD) Audit Programme2 and PR accreditation scheme4 have been established to drive up standards and work towards a consistent model of PR delivery, however, up to 85% of those eligible never receive a referral2 and this unmet need has been exacerbated by the COVID-19 pandemic.5 Provision in low-income and middle-income countries is in general even more limited.6
However, questions remain around the optimal programme design including how exercise training, the cornerstone of PR should best be delivered. Current standards recommend that both endurance and resistance training should be considered essential.7 The response to exercise training within PR is task specific and ought to be individually prescribed and progressed.7 Hence, comparison of different approaches is complex.
In their Thorax paper Ward et al 8 report the …
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; externally peer reviewed.