Pulmonary rehabilitation: effect of new patient-centered methodologies and technologies in patients with chronic pulmonary diseases

Abstract

Pulmonary Rehabilitation (PR) is the most effective physical therapy intervention for clinical, psychosocial and functional improvement for patients with chronic respiratory diseases. Despite this,there is still a need for new strategies to increase patients' physical activity level as well as new methodologies and technologies to diversify treatment and improve clinical control. Objectives: The present study has 3 main objectives: i) to evaluate the effect of a new intervention in patients with moderate to severe Asthma; ii) evaluate the use of new technologies to improve thoracoabdominalmechanics, Dyspnea and physical activity level in patients with Chronic Obstructive Pulmonary Disease (COPD); iii) evaluate the role of behavioral change in patients with different chronic respiratory diseases. Methods: This thematic project is divided into three subprojects. Subproject 1 will involve the use an innovative methodology in individual with moderate to severe Asthma (association of breathing and aerobic exercise). For this, a Randomized Controlled Trial (RCT) will be performed including 54 patients with moderate to severe Asthma. The intervention will last 12 weeks, twice a week. Patients will be followed for 26 weeks for long term effect evaluation. Subproject 2 will involve an intervention performed with an elastic band placed on the chest wall of patients with severe and very severe COPD. A randomized cross-over assay will test the acute effect of the band on thoracoabdominal asynchrony via optoelectronic plethysmography and electrical impedance tomography simultaneously. Another RCTwill analyze the effect of tape for 2 weeks on Dyspnea, quality of life and level of physical activity. Subproject 3 will involve 2 RCTs and 1 bicentric study. 128 patients with 3 different diseases will be included: Asthma, COPD and bronchiectasis. Behavior change will be accomplished using cognitive behavioral therapy. Interventions aim to modify behavior to increase physical activity and/or reducephysical inactivity. Three distinct interventions will be performed considering the clinical and functional condition of the patients and the pathophysiology of each disease. The sample size calculation was performed for all RCTs. (AU)