The effects of pulmonary rehabilitation on bone mineral density in patients with known pulmonary conditions : a narrative review

Abstract

Pulmonary Rehabilitation (PR) is a standard treatment for patients diagnosed with Chronic Obstructive Pulmonary Disease (COPD) with exercise training being a key component of this intervention. COPD patients have a high prevalence of osteopenia and osteoporosis, primarily due to corticosteroid use, which significantly increases their risks of falls and fractures. Given the substantial impact of fractures on COPD patients, preventative measures are essential to mitigate bone mineral density loss and reduce fracture risk and associated adverse consequences. Research on the effects of exercise on BMD in COPD patients is notably limited. This review aims to examine the effects of PR on BMD, fall and fracture risks, and functional exercise capacity in patients with COPD. A systematic search was conducted using MEDLINE Complete (via EBSCOhost), AgeLine (via EBSCOhost), Google Scholar and HyDi (Hybrid Discovery) for articles published between 2003 and 2021. The PICO (Population, Intervention, Comparator, Outcomes) framework was used to formulate the research question, define inclusion criteria and report the study characteristics: (P) subjects with stable COPD, (I) PR, (C) no PR during the duration of the study and (O) BMD, risks of falls and fractures, and functional exercise capacity. Critical evaluation, data abstraction and synthesis were conducted by the authors. Evidence suggests that exercise training positively influences BMD outcomes. However, the evidence regarding the effects of PR on BMD in COPD patients, along with its impact on fall and fracture risks, and functional exercise capacity remains insufficient. This highlights the need for further research. Implementing PR may help COPD patients prevent additional BMD loss, reduce fall and fracture risks, and minimise related complications, ultimately improving their health-related quality of life and long term prognosis.