Clinical practice guideline for physical therapy in patients with Chronic Obstructive Pulmonary Disease (COPD): portuguese version

Langer, D; Probst, VS; Pitta, F; Burtin, C; Hendriks, E; Schans, CPVD; Paterson, WJ; Verhoef-Dewijk, MCE; Straver, RVM; Klaassen, M; Troosters, T; Decramer, M; Ninane, V; Delguste, P; Muris, J; Gosselink, R

doi:10.1590/S1413-35552009005000034

Abstracts

INTRODUCTION: In the context of international collaboration for the development of practice guidelines, the Royal Dutch Society for Physical Therapy (Koninklijk Nederlands Genootschap voor Fysiotherapie, KNGF) has developed guidelines for the clinical practice of physical therapy in patients with Chronic Obstructive Pulmonary Disease (COPD). It has also stimulated its translation into other languages to make it accessible to international audiences. OBJECTIVES: The present document brings the Portuguese version of the KNGF Clinical Practice Guidelines for physical therapy in COPD patients. Its purpose was to describe evidence-based physical therapy for COPD patients with impairments in pulmonary function, peripheral and respiratory muscle function, exercise capacity, mucus clearance and quality of life, in addition to limitations in physical activity in daily life due to dyspnea and/or exercise intolerance. CONCLUSION: The guideline provides practical and therapeutic recommendations based on currently available scientific evidence to help the physical therapist provide the best possible treatment to COPD patients.

COPD; practice guidelines; evidence-based physical therapy

INTRODUÇÃO: No contexto da colaboração internacional para desenvolvimento de guias práticos (ou guidelines), a Sociedade Real Holandesa de Fisioterapia (Koninklijk Nederlands Genootschap voor Fysiotherapie, KNGF) se propôs a desenvolver um guia para esclarecimento sobre a prática clínica de Fisioterapia em pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC), assim como também optou por estimular a sua tradução para outras línguas, a fim de torná-lo acessível para públicos internacionais. OBJETIVOS: O presente guia é a versão em língua portuguesa do Guia para Prática Clínica de Fisioterapia em pacientes com DPOC desenvolvido pela KNGF, que teve como objetivo descrever a Fisioterapia baseada em evidências para pacientes com DPOC que apresentam limitação da função pulmonar, da função muscular respiratória e periférica, da capacidade de exercício, da depuração mucociliar e da qualidade de vida, além de limitações em relação à atividade física na vida diária pela dispneia e/ou intolerância ao exercício. CONCLUSÃO: O guia propõe-se principalmente a prover recomendações terapêuticas práticas que auxiliem o fisioterapeuta a oferecer o melhor tratamento possível para pacientes com DPOC, consideradas as evidências científicas disponíveis na atualidade.

DPOC; guia prático; fisioterapia baseada em evidências

REVIEW ARTICLE

Clinical Practice Guideline for physical therapy in patients with Chronic Obstructive Pulmonary Disease (COPD) - Portuguese version

Langer D^{I, II}; Probst VS^III; Pitta F^IV; Burtin C^{I, II}; Hendriks E^V; Schans CPVD^VI; Paterson WJ^VII; Verhoef-Dewijk MCE^VIII; Straver RVM^IX; Klaassen M^X; Troosters T^{I, II}; Decramer M^{I, II}; Ninane V^XI; Delguste P^XII; Muris J^XIII; Gosselink R^{I, II}

^IFaculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Bélgica

^IIRespiratory Division, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Bélgica

^IIIDepartamento de Fisioterapia, Universidade Norte do Paraná (UNOPAR), Londrina (PR), Brasil

^IVDepartamento de Fisioterapia, Universidade Estadual de Londrina (UEL), Londrina (PR), Brasil

^VCentre for Evidence Based Phyisotherapy en Vakgroep Epidemiologie Universiteit Maastricht, Holanda

^VIAcademie voor Gezondheidsstudies, Academie voor Verpleegkunde, Hanzehogeschool Groningen, Holanda

^VIIErasmus MC, Rotterdam, Holanda

^VIIIPraktijk Verhoef Utrecht, Holanda

^IXVUMC Amsterdam, Hogeschool van Leiden, Holanda

^XAfdeling Longrevalidatie, Universitair Longcentrum Dekkerswald, Universitair Medisch Centrum Nijmegen, Holanda

^XIChest Service, Saint-Pierre Hospital, Bruxelas, Bélgica

^XIICliniques Universitaires St Luc, Université Catholique de Louvain, Bélgica

^XIIICapaciteitsgroep Huisartsgeneeskunde, Onderzoeksinstituut CAPHRI, Universiteit Maastricht, Holanda

Correspondence to

ABSTRACT

INTRODUCTION: In the context of international collaboration for the development of practice guidelines, the Royal Dutch Society for Physical Therapy (Koninklijk Nederlands Genootschap voor Fysiotherapie, KNGF) has developed guidelines for the clinical practice of physical therapy in patients with Chronic Obstructive Pulmonary Disease (COPD). It has also stimulated its translation into other languages to make it accessible to international audiences.

OBJECTIVES: The present document brings the Portuguese version of the KNGF Clinical Practice Guidelines for physical therapy in COPD patients. Its purpose was to describe evidence-based physical therapy for COPD patients with impairments in pulmonary function, peripheral and respiratory muscle function, exercise capacity, mucus clearance and quality of life, in addition to limitations in physical activity in daily life due to dyspnea and/or exercise intolerance.

CONCLUSION: The guideline provides practical and therapeutic recommendations based on currently available scientific evidence to help the physical therapist provide the best possible treatment to COPD patients.

Keywords: COPD; practice guidelines; evidence-based physical therapy.

NOTE TO READERS

As any guidelines for clinical practice, this document was motivated by the potential benefits of providing practical therapy recommendations to help the physical therapist offer the best possible treatment for patients with chronic obstructive pulmonary disease (COPD), taking into account the available scientific evidence. The Brazilian Journal of Physical Therapy (BJPT) has published the Portuguese version of the Clinical Practice Guidelines for Physical Therapy in patients with COPD, originally published in 2008 in Dutch by the Dutch Royal Society for Physical Therapy (Koninklijk Nederlands Genootschap voor Fysiotherapie, KNGF) and more recently translated into other languages. The original version in Dutch is substantially more detailed than the version published by the BJPT and can be found at http://www.fysionet.nl/dossier_files/uploadFiles/RL_COPD_PRL_281108.pdf. A complementary document published by KNGF, also in Dutch and composed of an extensive literature review on the topic, is available at https://www.cebp.nl. Because the BJPT does not have permission to publish the English version, it will not be translated or available for free access.

COPYRIGHT

The Dutch Royal Society for Physical Therapy (KNGF) has authorized the Brazilian Journal of Physical Therapy (BJPT) to publish solely the Portuguese version of the guidelines for clinical practice. However, KNGF owns the copyright to all content published internationally. No part of the practical guidelines in Portuguese may be copied or republished in any form without written consent of KNGF (Internet: www.kngf.nl; Post Code: KNGF P.O. Box 248, 3800 A E A mersfoort, the Netherlands) and the Brazilian Journal of Physical Therapy.

References

1. Cockcroft AE, Saunders MJ, Berry G. Randomised controlled trial of rehabilitation in chronic respiratory disability. Thorax.1981;36(3):200-3.
2. McGavin CR, Gupta SP, Lloyd EL, McHardy GJ. Physical rehabilitation for the chronic bronchitc: results of a controlled trial of exercises in the home. Thorax. 1977;32(3):307-11.
3. Lake FR, Henderson K, Briffa T, Openshaw J, Musk AW. Upper-limb and lower-limb exercise training in patients with chronic airflow obstruction. Chest. 1990;97(5):1077-82.
4. Booker HA. Exercise training and breathing control in patients with chronic airflow limitation. Physiotherapy. 1984;70(7):258-60.
5. Jones DT, Thomson RJ, Sears MR. Physical exercise and resistive breathing training in severe chronic airways obstruction-are they effective? Eur J Respir Dis. 1985;67(3):159-66.
6. Troosters T, Gosselink R, Decramer M. Short and long-term effects of outpatient rehabilitation in patients, with Chronic Obstructive Pulmonary Disease: a randomized trial. Am J Med. 2000;109(3):207-12.
7. Larson JL, Covey MK, Wirtz SE, Berry JK, Alex CG, Langbein WE, et al. Cycle ergometer and inspiratory muscle training in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999;160(2):500-7.
8. Hernandez MT, Rubio TM, Ruiz FO, Riera HS, Gil RS, Romez JC. Results of a home-based training program for patients with COPD. Chest. 2000;118(1):106-14.
9. Gosselink R, Troosters T, Decramer M. Effect of exercise training in COPD patients: interval versus endurance training. Eur Respir J. 1998;12(Suppl 28):2S.
10. Puhan MA, Busching G, Schünemann HJ, VanOort E, Zaugg C, Frey M. Interval versus continuous high-intensity exercise in chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med. 2006;145(11):816-25.
11. Coppoolse R, Schols AM, Baarends EM, Mostert R, Akkermans MA, Janssen PP, et al. Interval versus continuous training in patients with severe COPD: a randomized clinical trial. Eur Respir J. 1999;14(2): 258-63.
12. Vogiatzis I, Nanas S, Roussos C. Interval training as an alternative modality to continuous exercise in patients with COPD. Eur Respir J. 2002;20(1):12-9.
13. Vogiatzis I, Terzis G, Nanas S, Stratakos G, Simoes DC, Georgiadou O, et al. Skeletal muscle adaptations to interval training in patients with advanced COPD. Chest. 2005;128(6):3838-45.
14. Bernard S, Whittom F, Leblanc P, Jobin J, Belleau R, Berube C, et al. Aerobic and strength training in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999;159(3):896-901.
15. Clark CJ, Cochrane LM, Mackay E, Paton B. Skeletal muscle strength and endurance in patients with mild COPD and the effects of weight training. Eur Respir J. 2000;15(1):92-7.
16. Simpson K, Killian K, McCartney N, Stubbing DG, Jones NL. Randomised controlled trial of weightlifting exercise in patients with chronic airflow limitation. Thorax. 1992;47(2):70-5.
17. Casaburi R, Bhasin S, Cosentino L, Porszasz J, Somfay A, Lewis MI, et al. Effects of testosterone and resistance training in men with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004;170(8):870-8.
18. Ries AL, Ellis B, Hawkins RW. Upper extremity exercise training in chronic obstructive pulmonary disease. Chest. 1988;93(4):688-92.
19. Ortega F, Toral J, Cejudo P, Villagomez R, Sanchez H, Castillo J, et al. Comparison of effects of strength and endurance training in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2002;166(5):669-74.
20. Normandin EA, McCusker C, Connors M, Vale F, Gerardi D, ZuWallack RL. An evaluation of two approaches to exercise conditioning in pulmonary rehabilitation. Chest. 2002;121(4):1085-91.
21. Wurtemberger G, Bastian K. [Functional effects of different training in patients with COPD]. Pneumologie. 2001;55(12):553-62.
22. Spruit M, Gosselink R, Troosters T, De Paepe K, Decramer M. Resistance versus endurance training in patients with COPD and peripheral muscle weakness. Eur Respir J. 2002;19(6):1072-8.
23. Mador MJ, Bozkanat E, Aggarwal A, Shaffer M, Kufel TJ. Endurance and strength training in patients with COPD. Chest. 2004;125(6):2036-45.
24. Bourjeily-Habr G, Rochester CL, Palermo F, Snyder P, Mohsenin V. Randomised controlled trial of transcutaneous electrical muscle stimulation of the lower extremities in patients with chronic obstructive pulmonary disease. Thorax. 2002;57(12):1045-9.
25. Neder JA, Sword D, Ward SA, Mackay E, Cochrane LM, Clark CJ. Home based neuromuscular electrical stimulation as a new rehabilitative strategy for severely disabled patients with chronic obstructive pulmonary disease (COPD). Thorax. 2002;57(4):333-7.
26. Zanotti E, Felicetti G, Maini M, Fracchia C. Peripheral muscle strength training in bed-bound patients with COPD receiving mechanical ventilation: effect of electrical stimulation. Chest. 2003;124(1):292-6.
27. Vivodtzev I, Pepin JL, Vottero G, Mayer V, Porsin B, Levy P, et al. Improvement in quadriceps strength and dyspnea in daily tasks after 1 month of electrical stimulation in severely deconditioned and malnourished COPD. Chest. 2006;129(6):1540-8.
28. Bauldoff GS, Hoffman LA, Sciurba F, Zullo TG. Home-based, upper-arm exercise training for patients with chronic obstructive pulmonary disease. Heart Lung. 1996;25(4):288-94.
29. Epstein SK, Celli BR, Martinez FJ, Couser JI, Roa J, Pollock M, et al. Arm training reduces the VO2 and VE cost of unsupported arm exercise and elevation in chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 1997;17(3):171-7.
30. Martinez FJ, Vogel PD, Dupont DN, Stanopoulos I, Gray A, Beamis JF. Supported arm exercise vs unsupported arm exercise in the rehabilitation of patients with severe chronic airflow obstruction. Chest. 1993;103(5):1397-402.
31. Holland AE, Hill CJ, Nehez E, Ntoumenopoulos G. Does unsupported upper limb exercise training improve symptoms and quality of life for patients with chronic obstructive pulmonary disease? J Cardiopulm Rehabil. 2004;24(6):422-7.
32. Casaburi R, Patessio A, Ioli F, Zanaboni S, Donner CF, Wasserman K. Reductions in exercise lactic acidosis and ventilation as a result of exercise training in patients with obstructive lung disease. Am Rev Respir Dis. 1991;143(1):9-18.
33. Puente-Maestu L, Sanz ML, Sanz P, Cubillo JM, Mayol J, Casaburi R. Comparison of effects of supervised versus self-monitored training programmes in patients with chronic obstructive pulmonary disease. Eur Respir J. 2000;15(3):517-25.
34. Casaburi R, Porszasz J, Burns MR, Carithers ER, Chang RS, Cooper CB. Physiologic benefits of exercise training in rehabilitation of patients with severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1997;155(5):1541-51.
35. Maltais F, Leblanc P, Jobin J, Berube C, Bruneau J, Carrier L, et al. Intensity of training and physiologic adaptation in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1997;155(2):555 61.
36. Zacarias EC, Neder JA, Cendom SP, Nery LE, Jardim JR. Heart rate at the estimated lactate threshold in patients with chronic obstructive pulmonary disease: effects on the target intensity for dynamic exercise training. J Cardiopulm Rehabil. 2000;20(6):369-76.
37. Griffiths TL, Burr ML, Campbell IA, Lewis-Jenkins V, Mullins J, Shiels K, et al. Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial. Lancet. 2000;355(9201):362-8.
38. Ries AL, Kaplan RM, Limberg TM, Prewitt LM. Effects of pulmonary rehabilitation on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease. Ann Intern Med. 1995;122(11):823-32.
39. Lacasse Y, Goldstein R, Lasserson TJ, Martin S. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2006;(4):CD003793.
40. Salman GF, Mosier MC, Beasley BW, Calkins DR. Rehabilitation for patients with chronic obstructive pulmonary disease: metaanalysis of randomized controlled trials. J Gen Intern Med. 2003;18(3):213-21.
41. Berry MJ, Rejeski WJ, Adair NE, Ettinger WH Jr, Zaccaro DJ, Sevick MA. A randomized, controlled trial comparing long-term and short-term exercise in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2003;23(1):60-8.
42. Güell R, Casan P, Belda J, Sangenis M, Morante F, Guyatt GH, et al. Long-term effects of outpatient rehabilitation of COPD: a randomized trial. Chest. 2000;117(4):976-83.
43. Green RH, Singh SJ, Williams J, Morgan MD. A randomised controlled trial of four weeks versus seven weeks of pulmonary rehabilitation in chronic obstructive pulmonary disease. Thorax. 2001;56(2):143-5.
44. Lötters F, van Tol B, Kwakkel G, Gosselink R. Effects of controlled inspiratory muscle training in patients with COPD: a meta-analysis. Eur Respir J. 2002;20(3):570-6.
45. Geddes EL, Reid WD, Crowe J, O'Brien K, Brooks D. Inspiratory muscle training in adults with chronic obstructive pulmonary disease: a systematic review. Respir Med. 2005;99(11):1440-58.
46. Hill K, Jenkins SC, Philippe DL, Cecins N, Shepherd KL, Green DJ, et al. High-intensity inspiratory muscle training in COPD. Eur Respir J. 2006;27(6):1119-28.
47. Scherer TA, Spengler C, Owassapian D, Imhof E, Boutellier U. Respiratory muscle endurance training in chronic obstructive pulmonary disease: impact on exercise capacity, dyspnea, and quality of life. Am J Respir Crit Care Med. 2000;162(5):1709-14.
48. Weiner P, Magadle R, Beckerman M, Weiner M, Berar-Yanay N. Specific expiratory muscle training in COPD. Chest. 2003;124(2):468-73.
49. Weiner P, Magadle R, Beckerman M, Weiner M, Berar-Yanay N. Comparison of specific expiratory, inspiratory, and combined muscle training programs in COPD. Chest. 2003;124(4):1357-64.
50. Sharp JT, Druz WS, Moisan T, Foster J, Machnach W. Postural relief of dyspnea in severe chronic obstructive pulmonary disease. Am Rev Respir Dis. 1980;122(2):201-11.
51. Druz WS, Sharp JT. Electrical and mechanical activity of the diaphragm accompanying body position in severe chronic obstructive pulmonary disease. Am Rev Respir Dis. 1982;125(3):275-80.
52. O'Neill S, McCarthy DS. Postural relief of dyspnoea in severe chronic airflow limitation: relationship to respiratory muscle strength. Thorax. 1983;38(8):595-600.
53. Banzett RB, Topulos GP, Leith DE, Nations CS. Bracing arms increases the capacity for sustained hyperpnea. Am Rev Respir Dis. 1983;138(1):106-9.
54. Probst VS, Troosters T, Coosemans I, Spruit MA, Pitta FdeO, Decramer M, et al. Mechanisms of improvement in exercise capacity using a rollator in patients with COPD. Chest. 2004;126(4):1102-7.
55. Tiep BL, Burns M, Kao D, Madison R, Herrera J. Pursed lips breathing training using ear oximetry. Chest. 1986;90(2):218-21.
56. Spahija J, de Marchie M, Grassino A. Effects of imposed pursed-lips breathing on respiratory mechanics and dyspnea at rest and during exercise in COPD. Chest. 2005;128(2):640-50.
57. Breslin EH. The pattern of respiratory muscle recruitment during pursed-lips breathing in COPD. Chest. 1992;101(1):75-8.
58. Ingram RH, Schilder DP. Effect of pursed lips breathing on the pulmonary pressure-flow relationship in obstructive lung disease. Am Rev Respir Dis. 1967;96(3):381-8.
59. Mueller RE, Petty TL, Filley GF. Ventilation and arterial blood gas changes induced by pursed lips breathing. J Appl Physiol. 1970;28(6):784-9.
60. Thoman RL, Stoker GL, Ross JC. The efficacy of pursed-lips breathing in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis. 1966;93(1):100-6.
61. Petty TL, Guthrie A. The effects of augmented breathing maneuvers on ventilation in severe chronic airway obstruction. Respir Care. 1971;16:104-11.
62. Bianchi R, Gigliotti F, Romagnoli I, Lanini B, Castellani C, Grazzini M, et al. Chest wall kinematics and breathlessness during pursed-lip breathing in patients with COPD. Chest. 2004;125(2):459-65.
63. Bellemare F, Grassino A. Force reserve of the diaphragm in patients with chronic obstructive pulmonary disease. J Appl Physiol. 1983;55 (1 Pt 1):8-15.
64. Reybrouck T, Wertelaers A, Bertrand P, Demedts M. Myofeedback training of the respiratory muscles in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 1987;7:18-22.
65. Erpicum B, Willeput R, Sergysels R, De Coster A. Does abdominal breathing below FRC give a mechanical support for inspiration? Clin Respir Physiol. 1984;20:117.
66. Gosselink RA, Wagenaar RC, Rijswijk H, Sargeant AJ, Decramer ML. Diaphragmatic breathing reduces efficiency of breathing in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1995;151(4):1136-42.
67. Sackner MA, Gonzalez HF, Jenouri G, Rodriguez M. Effects of abdominal and thoracic breathing on breathing pattern components in normal subjects and in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis. 1984;130(4):584-7.
68. Grimby G, Oxhoj H, Bake B. Effects of abdominal breathing on distribution of ventilation in obstructive lung disease. Clin Sci Mol Med. 1975;48(3):193-9.
69. Willeput R, Vachaudez JP, Lenders D, Nys A, Knoops T, Sergysels R. Thoracoabdominal motion during chest physiotherapy in patients affected by chronic obstructive lung disease. Respiration. 1983;44(3):204-14.
70. Vitacca M, Clini E, Bianchi L, Ambrosino N. Acute effects of deep diaphragmatic breathing in COPD patients with chronic respiratory insufficiency. Eur Respir J. 1998;11(2):408-15.
71. Renfroe KL. Effect of progressive relaxation on dyspnea and state of anxiety in patients with chronic obstructive pulmonary disease. Heart Lung. 1988;17(4):408-13.
72. Gift AG, Moore T, Soeken K. Relaxation to reduce dyspnea and anxiety in COPD patients. Nurs Res. 1992;41(4):242-6.
73. Kolaczkowski W, Taylor R, Hoffstein V. Improvement in oxygen saturation after chest physiotherapy in patients with emphysema. Physioth Canada. 1989;41:18-23.
74. Ambrosino N, Giannini D, D'Amico I. How good is the evidence for ambulatory oxygen in chronic obstructive pulmonary disease. Chron Respir Dis. 2004;1(3):125-6.
75. Troosters T, Casaburi R, Gosselink R, Decramer M. Pulmonary rehabilitation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005;172(1):19-38.
76. Puhan MA, Schunemann HJ, Frey M, Bachmann LM. Value of supplemental interventions to enhance the effectiveness of physical exercise during respiratory rehabilitation in COPD patients. A systematic review. Respir Res. 2004;5:25.
77. Bradley JM, Lasserson T, Elborn S, Macmahon J, O'neill B. A systematic review of randomized controlled trials examining the short-term benefit of ambulatory oxygen in COPD. Chest. 2007;131(1):278-85.
78. Emtner M, Porszasz J, Burns M, Somfay A, Casaburi R. Benefits of supplemental oxygen in exercise training in nonhypoxemic chronic obstructive pulmonary disease patients. Am J Respir Crit Care Med. 2003;168(9):1034-42.
79. Rooyackers JM, Dekhuijzen PN, Van Herwaarden CL, Folgering HT. Training with supplemental oxygen in patients with COPD and hypoxaemia at peak exercise. Eur Respir J. 1997;10(6):1278-84.
80. Garrod R, Paul EA, Wedzicha JA. Supplemental oxygen during pulmonary rehabilitation in patients with COPD with exercise hypoxaemia. Thorax. 2000;55(7):539-43.
81. Wadell K, Henriksson-Larsén K, Lundgren R. Physical training with and without oxygen in patients with chronic obstructive disease and exercise-induced hypoxaemia. J Rehab Med. 2001;33(5):200-5.
82. Johnson JE, Gavin DJ, Adams-Dramiga S. Effects of training with heliox and noninvasive positive pressure ventilation on exercise ability in patients with severe COPD. Chest. 2002;122(2):464-72.
83. van 't Hul A, Gosselink R, Hollander P, Postmus P, Kwakkel G. Training with inspiratory pressure support in patients with severe COPD. Eur Respir J. 2006;27(1):65-72.
84. Costes F, Agresti A, Court-Fortune I, Roche F, Vergnon JM, Barthelemy JC. Noninvasive ventilation during exercise training improves exercise tolerance in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2003;23(4):307-13.
85. Hawkins P, Johnson LC, Nikoletou D, Hamnegård CH, Sherwood R, Polkey MI, et al. Proportional assist ventilation as an aid to exercise training in severe chronic obstructive pulmonary disease. Thorax. 2002;57(10):853-9.
86. Bianchi L, Foglio K, Pagani M, Vitacca M, Rossi A, Ambrosino N. Effects of proportional assist ventilation on exercise tolerance in COPD patients with chronic hypercapnia. Eur Respir J. 1998;11(2):422-7.
87. Puhan MA, Scharplatz M, Troosters T, Steurer J. Respiratory rehabilitation after acute exacerbation of COPD may reduce risk for readmission and mortality - a systematic review. Respir Res. 2005;6:54.
88. Jones A, Rowe BH. Bronchopulmonary hygiene physical therapy in bronchiectasis and chronic obstructive pulmonary disease: a systematic review. Heart Lung. 2000;29(2):125-35.
89. Van der Schans CP, Van der Mark TW, Rubin BK, Postma DS, Koëter GH. Chest physical therapy: mucus mobilizing techniques. In: Bach JR, editor. Pulmonary rehabilitation. Philadelphia, PA: Hanley & Belfus; 1996. p. 229-46.
90. Savci S, Ince DI, Arikan H. A comparison of autogenic drainage and the active cycle of breathing techniques in patients with chronic obstructive pulmonary diseases. J Cardiopulm Rehabil. 2000;20(1):37-43.
91. Sivasothy P, Brown L, Smith IE, Shneerson JM. Effect of manually assisted cough and mechanical insufflation on cough flow of normal subjects, patients with chronic obstructive pulmonary disease (COPD), and patients with respiratory muscle weakness. Thorax. 2001;56(6):438-44.
92. Fink JB. Positioning versus postural drainage. Respir Care. 2002;47(7):769-77.
93. Sutton PP, Parker RA, Webber BA, Newman SP, Garland N, Lopez-Vidriero MT, et al. Assessment of the forced expiration technique, postural drainage and directed coughing in chest physiotherapy. Eur J Respir Dis. 1983;64(1):62-8.
94. Oldenburg FAJr, Dolovich MB, Montgomery JM, Newhouse MT. Effects of postural drainage, exercise and cough on mucus clearance in chronic bronchitis. Am Rev Respir Dis. 1979;120(4):739-45.
95. Christensen EF, Nedergaard T, Dahl R. Long-term treatment of chronic bronchitis with positive expiratory pressure and chest physiotherapy. Chest. 1990;97(3):645-50.
96. Bellone A, Spagnolatti L, Massobrio M, Bellei E, Vinciguerra R, Barbieri A, et al. Short-term effects of expiration under positive pressure in patients with acute exacerbation of chronic obstructive pulmonary disease and mild acidosis requiring non-invasive positive pressure ventilation. Intensive Care Med. 2002;28(5):581-5.
97. Bellone A, Lascioli R, Raschi S, Guzzi L, Adone R. Chest physical therapy in patients with acute exacerbation of chronic bronchitis: effectiveness of three methods. Arch Phys Med Rehabil. 2000;81(5):558-60.
98. Ries AL, Kaplan RM, Myers R, Prewitt LM. Maintenance after pulmonary rehabilitation in chronic lung disease: a randomized trial. Am J Respir Crit Care Med. 2003;167(6):880-8.
99. Heppner PS, Morgan C, Kaplan RM, Ries AL. Regular walking and long-term maintenance of outcomes after pulmonary rehabilitation. J Cardiopulm Rehabil. 2006;26(1):44-53.
100. Atkins CJ, Kaplan RM, Timms RM, Reinsch S, Lofback K. Behavioral exercise programs in the management of chronic obstructive pulmonary-disease. J Consult Clin Psychol. 1984;52(4):591-603.
101. de Blok BM, de Greef MH, ten Hacken NH, Sprenger SR, Postema K, Wempe JB. The effects of a lifestyle physical activity counseling program with feedback of a pedometer during pulmonary rehabilitation in patients with COPD: a pilot study. Patient Educ Couns. 2006;61(1):48-55.

Correspondência para:

Rik Gosselink

Professor of Rehabilitation Sciences, Respiratory Rehabilitation and Respiratory Division, University Hospitals KU Leuven

Herestraat 49

B3000 Leuven, Belgium

e-mail:

Rik.Gosselink@faber.kuleuven.be

*

Nota dos editores: A tradução desse guia está sendo publicada, na íntegra, em caráter excepcional, pela grande relevância e contribuição científica à área de Fisioterapia Respiratória.

Publication Dates

Publication in this collection
19 June 2009
Date of issue
June 2009

History

Accepted
02 Apr 2009
Reviewed
11 Mar 2009
Received
04 Mar 2009

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Cockcroft AE, Saunders MJ, Berry G. Randomised controlled trial of rehabilitation in chronic respiratory disability. Thorax.1981;36(3):200-3.

[2] 2. McGavin CR, Gupta SP, Lloyd EL, McHardy GJ. Physical rehabilitation for the chronic bronchitc: results of a controlled trial of exercises in the home. Thorax. 1977;32(3):307-11.

[3] 3. Lake FR, Henderson K, Briffa T, Openshaw J, Musk AW. Upper-limb and lower-limb exercise training in patients with chronic airflow obstruction. Chest. 1990;97(5):1077-82.

[4] 4. Booker HA. Exercise training and breathing control in patients with chronic airflow limitation. Physiotherapy. 1984;70(7):258-60.

[5] 5. Jones DT, Thomson RJ, Sears MR. Physical exercise and resistive breathing training in severe chronic airways obstruction-are they effective? Eur J Respir Dis. 1985;67(3):159-66.

[6] 6. Troosters T, Gosselink R, Decramer M. Short and long-term effects of outpatient rehabilitation in patients, with Chronic Obstructive Pulmonary Disease: a randomized trial. Am J Med. 2000;109(3):207-12.

[7] 7. Larson JL, Covey MK, Wirtz SE, Berry JK, Alex CG, Langbein WE, et al. Cycle ergometer and inspiratory muscle training in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999;160(2):500-7.

[8] 8. Hernandez MT, Rubio TM, Ruiz FO, Riera HS, Gil RS, Romez JC. Results of a home-based training program for patients with COPD. Chest. 2000;118(1):106-14.

[9] 9. Gosselink R, Troosters T, Decramer M. Effect of exercise training in COPD patients: interval versus endurance training. Eur Respir J. 1998;12(Suppl 28):2S.

[10] 10. Puhan MA, Busching G, Schünemann HJ, VanOort E, Zaugg C, Frey M. Interval versus continuous high-intensity exercise in chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med. 2006;145(11):816-25.

[11] 11. Coppoolse R, Schols AM, Baarends EM, Mostert R, Akkermans MA, Janssen PP, et al. Interval versus continuous training in patients with severe COPD: a randomized clinical trial. Eur Respir J. 1999;14(2): 258-63.

[12] 12. Vogiatzis I, Nanas S, Roussos C. Interval training as an alternative modality to continuous exercise in patients with COPD. Eur Respir J. 2002;20(1):12-9.

[13] 13. Vogiatzis I, Terzis G, Nanas S, Stratakos G, Simoes DC, Georgiadou O, et al. Skeletal muscle adaptations to interval training in patients with advanced COPD. Chest. 2005;128(6):3838-45.

[14] 14. Bernard S, Whittom F, Leblanc P, Jobin J, Belleau R, Berube C, et al. Aerobic and strength training in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999;159(3):896-901.

[15] 15. Clark CJ, Cochrane LM, Mackay E, Paton B. Skeletal muscle strength and endurance in patients with mild COPD and the effects of weight training. Eur Respir J. 2000;15(1):92-7.

[16] 16. Simpson K, Killian K, McCartney N, Stubbing DG, Jones NL. Randomised controlled trial of weightlifting exercise in patients with chronic airflow limitation. Thorax. 1992;47(2):70-5.

[17] 17. Casaburi R, Bhasin S, Cosentino L, Porszasz J, Somfay A, Lewis MI, et al. Effects of testosterone and resistance training in men with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004;170(8):870-8.

[18] 18. Ries AL, Ellis B, Hawkins RW. Upper extremity exercise training in chronic obstructive pulmonary disease. Chest. 1988;93(4):688-92.

[19] 19. Ortega F, Toral J, Cejudo P, Villagomez R, Sanchez H, Castillo J, et al. Comparison of effects of strength and endurance training in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2002;166(5):669-74.

[20] 20. Normandin EA, McCusker C, Connors M, Vale F, Gerardi D, ZuWallack RL. An evaluation of two approaches to exercise conditioning in pulmonary rehabilitation. Chest. 2002;121(4):1085-91.

[21] 21. Wurtemberger G, Bastian K. [Functional effects of different training in patients with COPD]. Pneumologie. 2001;55(12):553-62.

[22] 22. Spruit M, Gosselink R, Troosters T, De Paepe K, Decramer M. Resistance versus endurance training in patients with COPD and peripheral muscle weakness. Eur Respir J. 2002;19(6):1072-8.

[23] 23. Mador MJ, Bozkanat E, Aggarwal A, Shaffer M, Kufel TJ. Endurance and strength training in patients with COPD. Chest. 2004;125(6):2036-45.

[24] 24. Bourjeily-Habr G, Rochester CL, Palermo F, Snyder P, Mohsenin V. Randomised controlled trial of transcutaneous electrical muscle stimulation of the lower extremities in patients with chronic obstructive pulmonary disease. Thorax. 2002;57(12):1045-9.

[25] 25. Neder JA, Sword D, Ward SA, Mackay E, Cochrane LM, Clark CJ. Home based neuromuscular electrical stimulation as a new rehabilitative strategy for severely disabled patients with chronic obstructive pulmonary disease (COPD). Thorax. 2002;57(4):333-7.

[26] 26. Zanotti E, Felicetti G, Maini M, Fracchia C. Peripheral muscle strength training in bed-bound patients with COPD receiving mechanical ventilation: effect of electrical stimulation. Chest. 2003;124(1):292-6.

[27] 27. Vivodtzev I, Pepin JL, Vottero G, Mayer V, Porsin B, Levy P, et al. Improvement in quadriceps strength and dyspnea in daily tasks after 1 month of electrical stimulation in severely deconditioned and malnourished COPD. Chest. 2006;129(6):1540-8.

[28] 28. Bauldoff GS, Hoffman LA, Sciurba F, Zullo TG. Home-based, upper-arm exercise training for patients with chronic obstructive pulmonary disease. Heart Lung. 1996;25(4):288-94.

[29] 29. Epstein SK, Celli BR, Martinez FJ, Couser JI, Roa J, Pollock M, et al. Arm training reduces the VO2 and VE cost of unsupported arm exercise and elevation in chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 1997;17(3):171-7.

[30] 30. Martinez FJ, Vogel PD, Dupont DN, Stanopoulos I, Gray A, Beamis JF. Supported arm exercise vs unsupported arm exercise in the rehabilitation of patients with severe chronic airflow obstruction. Chest. 1993;103(5):1397-402.

[31] 31. Holland AE, Hill CJ, Nehez E, Ntoumenopoulos G. Does unsupported upper limb exercise training improve symptoms and quality of life for patients with chronic obstructive pulmonary disease? J Cardiopulm Rehabil. 2004;24(6):422-7.

[32] 32. Casaburi R, Patessio A, Ioli F, Zanaboni S, Donner CF, Wasserman K. Reductions in exercise lactic acidosis and ventilation as a result of exercise training in patients with obstructive lung disease. Am Rev Respir Dis. 1991;143(1):9-18.

[33] 33. Puente-Maestu L, Sanz ML, Sanz P, Cubillo JM, Mayol J, Casaburi R. Comparison of effects of supervised versus self-monitored training programmes in patients with chronic obstructive pulmonary disease. Eur Respir J. 2000;15(3):517-25.

[34] 34. Casaburi R, Porszasz J, Burns MR, Carithers ER, Chang RS, Cooper CB. Physiologic benefits of exercise training in rehabilitation of patients with severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1997;155(5):1541-51.

[35] 35. Maltais F, Leblanc P, Jobin J, Berube C, Bruneau J, Carrier L, et al. Intensity of training and physiologic adaptation in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1997;155(2):555 61.

[36] 36. Zacarias EC, Neder JA, Cendom SP, Nery LE, Jardim JR. Heart rate at the estimated lactate threshold in patients with chronic obstructive pulmonary disease: effects on the target intensity for dynamic exercise training. J Cardiopulm Rehabil. 2000;20(6):369-76.

[37] 37. Griffiths TL, Burr ML, Campbell IA, Lewis-Jenkins V, Mullins J, Shiels K, et al. Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial. Lancet. 2000;355(9201):362-8.

[38] 38. Ries AL, Kaplan RM, Limberg TM, Prewitt LM. Effects of pulmonary rehabilitation on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease. Ann Intern Med. 1995;122(11):823-32.

[39] 39. Lacasse Y, Goldstein R, Lasserson TJ, Martin S. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2006;(4):CD003793.

[40] 40. Salman GF, Mosier MC, Beasley BW, Calkins DR. Rehabilitation for patients with chronic obstructive pulmonary disease: metaanalysis of randomized controlled trials. J Gen Intern Med. 2003;18(3):213-21.

[41] 41. Berry MJ, Rejeski WJ, Adair NE, Ettinger WH Jr, Zaccaro DJ, Sevick MA. A randomized, controlled trial comparing long-term and short-term exercise in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2003;23(1):60-8.

[42] 42. Güell R, Casan P, Belda J, Sangenis M, Morante F, Guyatt GH, et al. Long-term effects of outpatient rehabilitation of COPD: a randomized trial. Chest. 2000;117(4):976-83.

[43] 43. Green RH, Singh SJ, Williams J, Morgan MD. A randomised controlled trial of four weeks versus seven weeks of pulmonary rehabilitation in chronic obstructive pulmonary disease. Thorax. 2001;56(2):143-5.

[44] 44. Lötters F, van Tol B, Kwakkel G, Gosselink R. Effects of controlled inspiratory muscle training in patients with COPD: a meta-analysis. Eur Respir J. 2002;20(3):570-6.

[45] 45. Geddes EL, Reid WD, Crowe J, O'Brien K, Brooks D. Inspiratory muscle training in adults with chronic obstructive pulmonary disease: a systematic review. Respir Med. 2005;99(11):1440-58.

[46] 46. Hill K, Jenkins SC, Philippe DL, Cecins N, Shepherd KL, Green DJ, et al. High-intensity inspiratory muscle training in COPD. Eur Respir J. 2006;27(6):1119-28.

[47] 47. Scherer TA, Spengler C, Owassapian D, Imhof E, Boutellier U. Respiratory muscle endurance training in chronic obstructive pulmonary disease: impact on exercise capacity, dyspnea, and quality of life. Am J Respir Crit Care Med. 2000;162(5):1709-14.

[48] 48. Weiner P, Magadle R, Beckerman M, Weiner M, Berar-Yanay N. Specific expiratory muscle training in COPD. Chest. 2003;124(2):468-73.

[49] 49. Weiner P, Magadle R, Beckerman M, Weiner M, Berar-Yanay N. Comparison of specific expiratory, inspiratory, and combined muscle training programs in COPD. Chest. 2003;124(4):1357-64.

[50] 50. Sharp JT, Druz WS, Moisan T, Foster J, Machnach W. Postural relief of dyspnea in severe chronic obstructive pulmonary disease. Am Rev Respir Dis. 1980;122(2):201-11.

[51] 51. Druz WS, Sharp JT. Electrical and mechanical activity of the diaphragm accompanying body position in severe chronic obstructive pulmonary disease. Am Rev Respir Dis. 1982;125(3):275-80.

[52] 52. O'Neill S, McCarthy DS. Postural relief of dyspnoea in severe chronic airflow limitation: relationship to respiratory muscle strength. Thorax. 1983;38(8):595-600.

[53] 53. Banzett RB, Topulos GP, Leith DE, Nations CS. Bracing arms increases the capacity for sustained hyperpnea. Am Rev Respir Dis. 1983;138(1):106-9.

[54] 54. Probst VS, Troosters T, Coosemans I, Spruit MA, Pitta FdeO, Decramer M, et al. Mechanisms of improvement in exercise capacity using a rollator in patients with COPD. Chest. 2004;126(4):1102-7.

[55] 55. Tiep BL, Burns M, Kao D, Madison R, Herrera J. Pursed lips breathing training using ear oximetry. Chest. 1986;90(2):218-21.

[56] 56. Spahija J, de Marchie M, Grassino A. Effects of imposed pursed-lips breathing on respiratory mechanics and dyspnea at rest and during exercise in COPD. Chest. 2005;128(2):640-50.

[57] 57. Breslin EH. The pattern of respiratory muscle recruitment during pursed-lips breathing in COPD. Chest. 1992;101(1):75-8.

[58] 58. Ingram RH, Schilder DP. Effect of pursed lips breathing on the pulmonary pressure-flow relationship in obstructive lung disease. Am Rev Respir Dis. 1967;96(3):381-8.

[59] 59. Mueller RE, Petty TL, Filley GF. Ventilation and arterial blood gas changes induced by pursed lips breathing. J Appl Physiol. 1970;28(6):784-9.

[60] 60. Thoman RL, Stoker GL, Ross JC. The efficacy of pursed-lips breathing in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis. 1966;93(1):100-6.

[61] 61. Petty TL, Guthrie A. The effects of augmented breathing maneuvers on ventilation in severe chronic airway obstruction. Respir Care. 1971;16:104-11.

[62] 62. Bianchi R, Gigliotti F, Romagnoli I, Lanini B, Castellani C, Grazzini M, et al. Chest wall kinematics and breathlessness during pursed-lip breathing in patients with COPD. Chest. 2004;125(2):459-65.

[63] 63. Bellemare F, Grassino A. Force reserve of the diaphragm in patients with chronic obstructive pulmonary disease. J Appl Physiol. 1983;55 (1 Pt 1):8-15.

[64] 64. Reybrouck T, Wertelaers A, Bertrand P, Demedts M. Myofeedback training of the respiratory muscles in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 1987;7:18-22.

[65] 65. Erpicum B, Willeput R, Sergysels R, De Coster A. Does abdominal breathing below FRC give a mechanical support for inspiration? Clin Respir Physiol. 1984;20:117.

[66] 66. Gosselink RA, Wagenaar RC, Rijswijk H, Sargeant AJ, Decramer ML. Diaphragmatic breathing reduces efficiency of breathing in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1995;151(4):1136-42.

[67] 67. Sackner MA, Gonzalez HF, Jenouri G, Rodriguez M. Effects of abdominal and thoracic breathing on breathing pattern components in normal subjects and in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis. 1984;130(4):584-7.

[68] 68. Grimby G, Oxhoj H, Bake B. Effects of abdominal breathing on distribution of ventilation in obstructive lung disease. Clin Sci Mol Med. 1975;48(3):193-9.

[69] 69. Willeput R, Vachaudez JP, Lenders D, Nys A, Knoops T, Sergysels R. Thoracoabdominal motion during chest physiotherapy in patients affected by chronic obstructive lung disease. Respiration. 1983;44(3):204-14.

[70] 70. Vitacca M, Clini E, Bianchi L, Ambrosino N. Acute effects of deep diaphragmatic breathing in COPD patients with chronic respiratory insufficiency. Eur Respir J. 1998;11(2):408-15.

[71] 71. Renfroe KL. Effect of progressive relaxation on dyspnea and state of anxiety in patients with chronic obstructive pulmonary disease. Heart Lung. 1988;17(4):408-13.

[72] 72. Gift AG, Moore T, Soeken K. Relaxation to reduce dyspnea and anxiety in COPD patients. Nurs Res. 1992;41(4):242-6.

[73] 73. Kolaczkowski W, Taylor R, Hoffstein V. Improvement in oxygen saturation after chest physiotherapy in patients with emphysema. Physioth Canada. 1989;41:18-23.

[74] 74. Ambrosino N, Giannini D, D'Amico I. How good is the evidence for ambulatory oxygen in chronic obstructive pulmonary disease. Chron Respir Dis. 2004;1(3):125-6.

[75] 75. Troosters T, Casaburi R, Gosselink R, Decramer M. Pulmonary rehabilitation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005;172(1):19-38.

[76] 76. Puhan MA, Schunemann HJ, Frey M, Bachmann LM. Value of supplemental interventions to enhance the effectiveness of physical exercise during respiratory rehabilitation in COPD patients. A systematic review. Respir Res. 2004;5:25.

[77] 77. Bradley JM, Lasserson T, Elborn S, Macmahon J, O'neill B. A systematic review of randomized controlled trials examining the short-term benefit of ambulatory oxygen in COPD. Chest. 2007;131(1):278-85.

[78] 78. Emtner M, Porszasz J, Burns M, Somfay A, Casaburi R. Benefits of supplemental oxygen in exercise training in nonhypoxemic chronic obstructive pulmonary disease patients. Am J Respir Crit Care Med. 2003;168(9):1034-42.

[79] 79. Rooyackers JM, Dekhuijzen PN, Van Herwaarden CL, Folgering HT. Training with supplemental oxygen in patients with COPD and hypoxaemia at peak exercise. Eur Respir J. 1997;10(6):1278-84.

[80] 80. Garrod R, Paul EA, Wedzicha JA. Supplemental oxygen during pulmonary rehabilitation in patients with COPD with exercise hypoxaemia. Thorax. 2000;55(7):539-43.

[81] 81. Wadell K, Henriksson-Larsén K, Lundgren R. Physical training with and without oxygen in patients with chronic obstructive disease and exercise-induced hypoxaemia. J Rehab Med. 2001;33(5):200-5.

[82] 82. Johnson JE, Gavin DJ, Adams-Dramiga S. Effects of training with heliox and noninvasive positive pressure ventilation on exercise ability in patients with severe COPD. Chest. 2002;122(2):464-72.

[83] 83. van 't Hul A, Gosselink R, Hollander P, Postmus P, Kwakkel G. Training with inspiratory pressure support in patients with severe COPD. Eur Respir J. 2006;27(1):65-72.

[84] 84. Costes F, Agresti A, Court-Fortune I, Roche F, Vergnon JM, Barthelemy JC. Noninvasive ventilation during exercise training improves exercise tolerance in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2003;23(4):307-13.

[85] 85. Hawkins P, Johnson LC, Nikoletou D, Hamnegård CH, Sherwood R, Polkey MI, et al. Proportional assist ventilation as an aid to exercise training in severe chronic obstructive pulmonary disease. Thorax. 2002;57(10):853-9.

[86] 86. Bianchi L, Foglio K, Pagani M, Vitacca M, Rossi A, Ambrosino N. Effects of proportional assist ventilation on exercise tolerance in COPD patients with chronic hypercapnia. Eur Respir J. 1998;11(2):422-7.

[87] 87. Puhan MA, Scharplatz M, Troosters T, Steurer J. Respiratory rehabilitation after acute exacerbation of COPD may reduce risk for readmission and mortality - a systematic review. Respir Res. 2005;6:54.

[88] 88. Jones A, Rowe BH. Bronchopulmonary hygiene physical therapy in bronchiectasis and chronic obstructive pulmonary disease: a systematic review. Heart Lung. 2000;29(2):125-35.

[89] 89. Van der Schans CP, Van der Mark TW, Rubin BK, Postma DS, Koëter GH. Chest physical therapy: mucus mobilizing techniques. In: Bach JR, editor. Pulmonary rehabilitation. Philadelphia, PA: Hanley & Belfus; 1996. p. 229-46.

[90] 90. Savci S, Ince DI, Arikan H. A comparison of autogenic drainage and the active cycle of breathing techniques in patients with chronic obstructive pulmonary diseases. J Cardiopulm Rehabil. 2000;20(1):37-43.

[91] 91. Sivasothy P, Brown L, Smith IE, Shneerson JM. Effect of manually assisted cough and mechanical insufflation on cough flow of normal subjects, patients with chronic obstructive pulmonary disease (COPD), and patients with respiratory muscle weakness. Thorax. 2001;56(6):438-44.

[92] 92. Fink JB. Positioning versus postural drainage. Respir Care. 2002;47(7):769-77.

[93] 93. Sutton PP, Parker RA, Webber BA, Newman SP, Garland N, Lopez-Vidriero MT, et al. Assessment of the forced expiration technique, postural drainage and directed coughing in chest physiotherapy. Eur J Respir Dis. 1983;64(1):62-8.

[94] 94. Oldenburg FAJr, Dolovich MB, Montgomery JM, Newhouse MT. Effects of postural drainage, exercise and cough on mucus clearance in chronic bronchitis. Am Rev Respir Dis. 1979;120(4):739-45.

[95] 95. Christensen EF, Nedergaard T, Dahl R. Long-term treatment of chronic bronchitis with positive expiratory pressure and chest physiotherapy. Chest. 1990;97(3):645-50.

[96] 96. Bellone A, Spagnolatti L, Massobrio M, Bellei E, Vinciguerra R, Barbieri A, et al. Short-term effects of expiration under positive pressure in patients with acute exacerbation of chronic obstructive pulmonary disease and mild acidosis requiring non-invasive positive pressure ventilation. Intensive Care Med. 2002;28(5):581-5.

[97] 97. Bellone A, Lascioli R, Raschi S, Guzzi L, Adone R. Chest physical therapy in patients with acute exacerbation of chronic bronchitis: effectiveness of three methods. Arch Phys Med Rehabil. 2000;81(5):558-60.

[98] 98. Ries AL, Kaplan RM, Myers R, Prewitt LM. Maintenance after pulmonary rehabilitation in chronic lung disease: a randomized trial. Am J Respir Crit Care Med. 2003;167(6):880-8.

[99] 99. Heppner PS, Morgan C, Kaplan RM, Ries AL. Regular walking and long-term maintenance of outcomes after pulmonary rehabilitation. J Cardiopulm Rehabil. 2006;26(1):44-53.

[100] 100. Atkins CJ, Kaplan RM, Timms RM, Reinsch S, Lofback K. Behavioral exercise programs in the management of chronic obstructive pulmonary-disease. J Consult Clin Psychol. 1984;52(4):591-603.

[101] 101. de Blok BM, de Greef MH, ten Hacken NH, Sprenger SR, Postema K, Wempe JB. The effects of a lifestyle physical activity counseling program with feedback of a pedometer during pulmonary rehabilitation in patients with COPD: a pilot study. Patient Educ Couns. 2006;61(1):48-55.