Pulmonary Rehabilitation in CLD Improves Cognitive, Physical Impairment

Pulmonary rehabilitation for chronic lung diseases (CLDs) improves cognitive function and dyspnea, which affect motor control and daily function in patients with CLD, according to a review published in Chest.

The review reported on evidence presented and conclusions reached during a 2-day virtual meeting discussing motor control in patients with chronic lung diseases, key rehabilitation strategies for cognitive-physical limitations, and future research priorities. The virtual meeting, held in November 2022, was attended by 38 patient partners, clinicians, and researchers in diverse research areas from Belgium, Canada, the Netherlands, and the United States. The review article recently published in Chest also included a literature review of Medline through April 5, 2024, for articles on COPD, ILD, and cognitive function that corroborated conclusions reached at the virtual meeting.

The first part of the meeting focused on evidence of cognitive limitations in patients with chronic lung diseases and the needs of these patients, particularly as related to health management and the cognitive load of dyspnea. Meeting attendees noted that the interference of respiratory muscle loading with associated dyspnea leads to a decrease in cognition and motor control in healthy persons, with emerging evidence for patients with COPD. Assessing dual-task reductions in motor control may help determine rehabilitation strategies to improve daily activities, attendees reported.

The second meeting topic was the evaluation of cognition in chronic lung diseases. Several cognitive assessments are used, including screening questionnaires such as the Montreal Cognitive Assessment and more comprehensive neuropsychologic testing batteries. Meeting attendees agreed that a standardized cognitive battery in chronic lung diseases is needed.

The third topic discussed was approaches for optimizing cognitive processing and motor control during daily activities. Evidence has shown that physical training for patients with chronic lung diseases can increase exercise capacity. Exercise training may modify neuroplasticity with direct effects on brain structure and function, as well as with physiologic adaptations and improvement in psychologic well-being. Research on improving the cognitive and motor control of physical activities in patients with chronic lung diseases are in the early stages. Assessment including performance-based tests and cognition in everyday life may be beneficial in determining how cognitive impairment interferes with essential daily activities, according to the participants.

The fourth topic concerned future research directions. Priorities were identified, focusing on assessment, outcome measures, and standardization of cognitive and physical function measures. Meeting participants noted that consideration should be given to the clinical setting and requiring training regimens to optimize cognitive and physical assessments. Meeting attendees debated whether impairment in the stable state and after an exacerbation may be attributed to cognitive impairment, poor motor control, or cognitive interference from issues such as increased dyspnea.

“Given the increasing age, complexity, and prevalence of frailty in chronic lung diseases, evaluation of cognition and physical function is becoming critically important in these patient populations,” the authors stated. “A better understanding of cognitive-motor mechanistic interactions may help disentangle their impacts on disability and provide a platform for more tailored rehabilitation strategies,” they added.

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Pulmonology Advisor