Pulmonary rehabilitation: an integral part of the long-term management of COPD.

Pulmonary rehabilitation comprises a variety of interventions grouped into three main categories: exercise training, education, and psychological support. Typically, patients participate in a programme of exercise rehabilitation 2-3 times a week for 6-12 weeks, at the same time being encouraged to incorporate breathing and stretching exercises as part of their daily routine. The physiological rationale for pulmonary rehabilitation in COPD is primarily based on its effect on peripheral muscle dysfunction. A recent meta-analysis demonstrated that pulmonary rehabilitation is effective in reducing dyspnoea and fatigue as well as improving patients' sense of control (mastery) over their condition. Without compliance with a maintenance programme these improvements will diminish with time. The value of various components of rehabilitation, programme length, the required degree of supervision, the intensity of training and the best approach to maintaining programme adherence represent issues that remain to be explored.