Advances in rehabilitation for chronic diseases: improving health outcomes and function
BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l2191 (Published 17 June 2019) Cite this as: BMJ 2019;365:l2191
- Caroline R Richardson, professor of family medicine1,
- Barry Franklin, professor of physiology2,
- Marilyn L Moy, associate professor of medicine3,
- Elizabeth A Jackson, professor of medicine4
- 1Department of Family Medicine, University of Michigan, Ann Arbor, MI 48104, USA
- 2Oakland University William Beaumont, School of Medicine, Rochester, MI, USA
- 3Harvard Medical School, Boston, MA, USA
- 4University of Alabama, Birmingham, AL, USA
- Correspondence to: C R Richardson caroli{at}umich.edu
Abstract
Much of the burden on healthcare systems is related to the management of chronic conditions such as cardiovascular disease and chronic obstructive pulmonary disease. Although conventional outpatient cardiopulmonary rehabilitation programs significantly decrease morbidity and mortality and improve function and health related quality of life for people with chronic diseases, rehabilitation programs are underused. Barriers to enrollment are multifactorial and include failure to recommend and refer patients to these services; poor communication with patients about potential benefits; and patient factors including logistical and financial barriers, comorbidities, and competing demands that make participation in facility based programs difficult. Recent advances in rehabilitation programs that involve remotely delivered technology could help deliver services to more people who might benefit. Problems with intensity, adherence, and safety of home based programs have been investigated in recent clinical trials, and larger dissemination and implementation trials are under way. This review summarizes the evidence for benefit of in-person cardiac and pulmonary rehabilitation programs. It also reviews the literature on newer developments, such as home based remotely mediated exercise programs developed to decrease cost and improve accessibility, high intensity interval training in cardiac rehabilitation, and alternative therapies such as tai chi and yoga for people with chronic obstructive pulmonary disease.
Footnotes
Series explanation: State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally. For this reason they are written predominantly by US authors.
Contributors: CRR is the corresponding author and the guarantor and as such accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish. All authors were involved in the initial scoping of the manuscript in collaboration with BMJ editors. CRR conducted the initial literature search with the help of Noa Kim an informationist who supports our research group. CRR also contributed expertise on eHealth and exercise-based rehabilitation. MLM contributed her expertise in COPD and pulmonary rehabilitation. BF and EAJ focused on the cardiology and cardiac rehabilitation sections of the manuscript, helping with literature interpretation as well as extensively revising the initial manuscript sections relevant to their areas of expertise.
Competing interests: The authors have read and understood BMJ policy on declaration of interests and have no competing interests to declare.
Provenance and peer review: Commissioned; externally peer reviewed.
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