The role of balance training in enhancing pulmonary rehabilitation outcomes in patients with chronic obstructive pulmonary disease (COPD): A narrative review
DOI:
https://doi.org/10.29070/zr7ge756Keywords:
chronic obstructive pulmonary disease, pulmonary rehabilitation, balance training, postural control, falls, health-related quality of lifeAbstract
Background. Chronic obstructive pulmonary disease (COPD) is a common, preventable and treatable condition defined by persistent respiratory symptoms and airflow limitation arising from airway and alveolar abnormalities, usually following prolonged exposure to noxious particles or gases. Its consequences extend beyond the lungs to peripheral muscle dysfunction and impaired postural control, and people with COPD fall considerably more often than would be expected for their age alone.
Objective. This narrative review examines whether adding structured balance training to conventional pulmonary rehabilitation improves balance, fall-related outcomes, exercise capacity and health-related quality of life in adults with COPD, and identifies where the evidence remains unsettled.
Approach. Trials, observational studies and systematic reviews addressing pulmonary rehabilitation and balance in COPD were examined, together with guideline literature on rehabilitation practice.
Findings. Balance impairment in COPD is consistently reported and improves with pulmonary rehabilitation alone. Adding balance training produced further gains in balance measures, balance confidence, fatigue, mood and quality of life in single-centre trials, but the largest multicentre trial found no reduction in fall incidence at twelve months. Marked heterogeneity in the outcomes chosen across rehabilitation trials limits comparison and pooling.
Conclusion. Balance training is a low-burden addition to pulmonary rehabilitation that improves balance and confidence measures, but current evidence does not establish that it reduces falls. Adequately powered trials with falls as the primary endpoint, and agreement on a core outcome set, are the principal needs.
Downloads
References
1. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006;3(11):e442.
2. Ries AL, Bauldoff GS, Carlin B, et al. Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based clinical practice guidelines. Chest. 2007;131(5):4S–42S.
3. Griffiths TL, Burr ML, Campbell IA, et al. Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial. Lancet. 2000;355(9201):362–368.
4. Gimenez M, Pham Q, Uffholtz H, et al. Ten years follow up in patients with chronic obstructive lung disease submitted to a programme of pulmonary rehabilitation. London: SAGE Publications; 1978.
5. Boxall AM, Barclay L, Sayers A, et al. Managing chronic obstructive pulmonary disease in the community. A randomized controlled trial of home-based pulmonary rehabilitation for elderly housebound patients. J Cardiopulm Rehabil. 2005;25(6):378–385.
6. Wootton SL, Ng LW, McKeough ZJ, et al. Ground-based walking training improves quality of life and exercise capacity in COPD. Eur Respir J. 2014;44(4):885–894.
7. Ko FW, Tam W, Siu EHS, et al. Effect of short-course exercise training on the frequency of exacerbations and physical activity in patients with COPD: a randomized controlled trial. Respirology. 2021;26(1):72–79.
8. Cramer H, Haller H, Klose P, et al. The risks and benefits of yoga for patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Clin Rehabil. 2019;33(12):1847–1862.
9. Zhu S, Shi K, Yan J, et al. A modified 6-form Tai Chi for patients with COPD. Complement Ther Med. 2018;39:36–42.
10. Souto-Miranda S, Rodrigues G, Spruit MA, Marques A. Pulmonary rehabilitation outcomes in individuals with chronic obstructive pulmonary disease: a systematic review. Ann Phys Rehabil Med. 2022;65(3):101564.
11. Öztürk M, Ozmen İ, Polat M, Özari Yildirim E, Karakış M. Effect of pulmonary rehabilitation on balance control in patients with COPD. Eur Respir J. 2018;52(Suppl 62):PA838.
12. Mkacher W, Mekki M, Chaieb F, Tabka Z, Trabelsi Y. Balance training in pulmonary rehabilitation. J Cardiopulm Rehabil Prev. 2015;35(4):278–285.
13. Suresh A, Srinivasan N, Anil T, Vinod Babu, Alaparthi GK, Reddy K. The effect of balance training and conventional pulmonary rehabilitation in patients with moderate chronic obstructive pulmonary disease. Int J Res Pharm Sci. 2021;12(1):757–767.
14. Hao Q, Brooks D, Ellerton C, et al. Pulmonary rehabilitation with balance training for fall reduction in chronic obstructive pulmonary disease: a randomized controlled trial. BMC Pulm Med. 2024;24:406.
15. Pierobon A, Bottelli ES, Ranzini L, et al. COPD patients’ self-reported adherence, psychosocial factors and mild cognitive impairment in pulmonary rehabilitation. Int J Chron Obstruct Pulmon Dis. 2017;12:2059–2067.
