title: Pulmonary rehabilitation program including respiratory conditioning for chronic obstructive pulmonary disease (COPD): Improved hyperinflation and expiratory flow during tidal breathing.
abstract: BACKGROUND
  Pulmonary rehabilitation has generally relieved symptoms, strengthened exercise endurance and improved health-related quality of life (QOL) in patients with COPD, but recovery of pulmonary function remains questionable. This analysis of our innovative rehabilitation program is directed at documenting changes in patients' expiratory airflow limitation, pulmonary symptoms and QOL. This program is designed to provide "respiratory conditioning", a physical therapist-assisted intensive flexibility training that focuses on stretching and rib cage mobilization.
  
  
  METHODS
  Thirty-one patients with COPD who attended rehabilitation sessions at Juntendo University Hospital from 1999 to 2006 were analyzed. Pulmonary function, expiratory flow limitation during tidal breathing, six minute walk distance (6MWD), respiratory muscle strength, and St. George Respiratory Questionnaire (SGRQ) were measured before and after pulmonary rehabilitation.
  
  
  RESULTS
  In participants ages 68±7 years, the FEV(1)% predicted was 39.3±15.7%. 6MWD, SGRQ and respiratory muscle strength were significantly improved after pulmonary rehabilitation. Although neither FEV(1)% predicted nor FEV(1)/FVC was affected to a significant extent, indicating little effect on airflow limitation, expiratory flow limitation in supine as well as seated during tidal breathing improved significantly. Moreover, rehabilitation significantly diminished TLC% predicted, FRC% predicted, RV% predicted and RV/TLC values, thus indicating a reduction of hyperinflation of the lungs at rest.
  
  
  CONCLUSIONS
  The present results suggest that our rehabilitation program with respiratory conditioning significantly lowered the hyperinflation of lungs at rest as well as the expiratory flow limitation during tidal breathing. In patients with COPD, overall pulmonary function improved, exercise endurance increased and health-related QOL was enhanced.
authors: Kaku
authors: K
authors: Yoshimi
authors: Jun
authors: J
authors: Ueki
authors: Kuniaki
authors: K
authors: Seyama
authors: Makiko
authors: M
authors: Takizawa
authors: Seiko
authors: S
authors: Yamaguchi
authors: Eriko
authors: E
authors: Kitahara
authors: Shinji
authors: S
authors: Fukazawa
authors: Yukiko
authors: Y
authors: Takahama
authors: Masako
authors: M
authors: Ichikawa
authors: Kazuhisa
authors: K
authors: Takahashi
authors: Yoshinosuke
authors: Y
authors: Fukuchi