Rehabilitation for People with Respiratory Disease and Frailty An Official American Thoracic Society Workshop Report

Matthew Maddocks*, Lisa J. Brighton, Jennifer A. Alison, Lies ter Beek, Surya P. Bhatt, Nathan E. Brummel, Chris Burtin, Matteo Cesari, Rachael A. Evans, Lauren E. Ferrante, Oscar Flores-Flores, Frits M.E. Franssen, Chris Garvey, Samantha L. Harrison, Anand S. Iyer, Lies Lahouse, Suzanne Lareau, Annemarie L. Lee, William D.C. Man, Alessandra MarengoniHamish J.C. McAuley, Dmitry Rozenberg, Jonathan P. Singer, Martijn A. Spruit, Christian R. Osadnik

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)767-780
Number of pages14
JournalAnnals of the American Thoracic Society
Volume20
Issue number6
DOIs
Publication statusAccepted/In press - 6 Jan 2023

Keywords

  • frailty
  • pulmonary rehabilitation
  • respiratory disease
  • transplantation

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