TY - JOUR
T1 - Rehabilitation for People with Respiratory Disease and Frailty An Official American Thoracic Society Workshop Report
AU - Maddocks, Matthew
AU - Brighton, Lisa J.
AU - Alison, Jennifer A.
AU - ter Beek, Lies
AU - Bhatt, Surya P.
AU - Brummel, Nathan E.
AU - Burtin, Chris
AU - Cesari, Matteo
AU - Evans, Rachael A.
AU - Ferrante, Lauren E.
AU - Flores-Flores, Oscar
AU - Franssen, Frits M.E.
AU - Garvey, Chris
AU - Harrison, Samantha L.
AU - Iyer, Anand S.
AU - Lahouse, Lies
AU - Lareau, Suzanne
AU - Lee, Annemarie L.
AU - Man, William D.C.
AU - Marengoni, Alessandra
AU - McAuley, Hamish J.C.
AU - Rozenberg, Dmitry
AU - Singer, Jonathan P.
AU - Spruit, Martijn A.
AU - Osadnik, Christian R.
AU - American Thoracic Society Assembly on Pulmonary Rehabilitation
N1 - Funding Information:
This document was funded by the American Thoracic Society.
Funding Information:
support from the National Institute for Health and Care Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. L.J.B. received research support from NIHR, Economic and Social Research Council. J.A.A. received research support from National Health and Medical Research Council Australia, Medical Research Futures Fund. S.P.B. served on an advisory committee for Boehringer Ingelheim, GlaxoSmithKline, Sanofi/Regeneron, Sunovion; served as a consultant for Boehringer Ingelheim, Sanofi/Regeneron; served as a speaker for Boehringer Ingelheim, IntegrityCE; received research support from NIH, Nuvaira, Sanofi/Regeneron. N.E.B. received research support from NIH. R.A.E. served as a consultant for AstraZeneca, British Medical Journal; served as a speaker for Boehringer Ingelheim, Chiesi, GlaxoSmithKline. L.E.F. received research support from NIH/NIA. O.F.F. received research support from Fogarty International Center and NIMH/NIH. F.M.F. served on an advisory committee for Chiesi, Novartis; served as a consultant for GlaxoSmithKline, Merck Sharp and Dohme; served as a speaker for AstraZeneca, Boehringer Ingelheim, Chiesi, Novartis; received research support from AstraZeneca. C.G. served as a speaker for Boehringer Ingelheim. S.L.H. received research support from NIHR. A.S.I. served as a consultant for AstraZeneca; served as a speaker for Ascension; received research support from NIH, National Institute on Aging. L.L. served as a consultant for AstraZeneca; served as a speaker for Chiesi, ISPA vzw; received research support from Funds for Scientific Research Flanders. A.L.L. received research support from NHMRC, Australian Physiotherapy Association and Physiotherapy Research Foundation. W.D.C.M. received research support from NIHR. D.R. received research support from Sandra Faire and Ivan Fecan Professorship in Rehabilitation Medicine. J.P.S. served on an advisory committee for Altavant, Mallinckrodt, Onspira; served as a consultant for 4C Medical received research support from NIH. M.A.S. served on an advisory committee for GlaxoSmithKline; served as a consultant for AstraZeneca, Boehringer Ingelheim; received research support from AstraZeneca, Boehringer Ingelheim, Chiesi, Netherlands Lung Foundation, Stichting Astma Bestrijding, Teva. C.R.O. served as a speaker for Novartis Australia; received research support from Australian Physiotherapy Association Physiotherapy Research Foundation, European Respiratory Society, GlaxoSmithKline, Rebecca L Cooper Medical Research Foundation, Royal Australian College of General Practitioners. J.A.A., L.T.B., C.B., M.C., S.L., A.M., H.J.C.M. reported no commercial or relevant non-commercial interests from ineligible companies.
Publisher Copyright:
Copyright © 2023 by the American Thoracic Society.
PY - 2023/6/1
Y1 - 2023/6/1
N2 - People with respiratory disease have increased risk of developing frailty, which is associated with worse health outcomes. There is growing evidence of the role of rehabilitation in managing frailty in people with respiratory disease. However, several challenges remain regarding optimal methods of identifying frailty and delivering rehabilitation for this population. The aims of this American Thoracic Society workshop were to outline key definitions and concepts around rehabilitation for people with respiratory disease and frailty, synthesize available evidence, and explore how programs may be adapted to align to the needs and experiences of this population. Across two half-day virtual workshops, 20 professionals from diverse disciplines, professions, and countries discussed key developments and identified opportunities for future research, with additional input via online correspondence. Participants highlighted a “frailty rehabilitation paradox” whereby pulmonary rehabilitation can effectively reduce frailty, but programs are challenging for some individuals with frailty to complete. Frailty should not limit access to rehabilitation; instead, the identification of frailty should prompt comprehensive assessment and tailored support, including onward referral for additional specialist input. Exercise prescriptions that explicitly consider symptom burden and comorbidities, integration of additional geriatric or palliative care expertise, and/or preemptive planning for disruptions to participation may support engagement and outcomes. To identify and measure frailty in people with respiratory disease, tools should be selected on the basis of sensitivity, specificity, responsiveness, and feasibility for their intended purpose. Research is required to expand understanding beyond the physical dimensions of frailty and to explore the merits and limitations of telerehabilitation or home-based pulmonary rehabilitation for people with chronic respiratory disease and frailty.
AB - People with respiratory disease have increased risk of developing frailty, which is associated with worse health outcomes. There is growing evidence of the role of rehabilitation in managing frailty in people with respiratory disease. However, several challenges remain regarding optimal methods of identifying frailty and delivering rehabilitation for this population. The aims of this American Thoracic Society workshop were to outline key definitions and concepts around rehabilitation for people with respiratory disease and frailty, synthesize available evidence, and explore how programs may be adapted to align to the needs and experiences of this population. Across two half-day virtual workshops, 20 professionals from diverse disciplines, professions, and countries discussed key developments and identified opportunities for future research, with additional input via online correspondence. Participants highlighted a “frailty rehabilitation paradox” whereby pulmonary rehabilitation can effectively reduce frailty, but programs are challenging for some individuals with frailty to complete. Frailty should not limit access to rehabilitation; instead, the identification of frailty should prompt comprehensive assessment and tailored support, including onward referral for additional specialist input. Exercise prescriptions that explicitly consider symptom burden and comorbidities, integration of additional geriatric or palliative care expertise, and/or preemptive planning for disruptions to participation may support engagement and outcomes. To identify and measure frailty in people with respiratory disease, tools should be selected on the basis of sensitivity, specificity, responsiveness, and feasibility for their intended purpose. Research is required to expand understanding beyond the physical dimensions of frailty and to explore the merits and limitations of telerehabilitation or home-based pulmonary rehabilitation for people with chronic respiratory disease and frailty.
KW - frailty
KW - pulmonary rehabilitation
KW - respiratory disease
KW - transplantation
U2 - 10.1513/AnnalsATS.202302-129ST
DO - 10.1513/AnnalsATS.202302-129ST
M3 - Article
C2 - 37261787
SN - 2325-6621
VL - 20
SP - 767
EP - 780
JO - Annals of the American Thoracic Society
JF - Annals of the American Thoracic Society
IS - 6
ER -