Ventilatory and nonventilatory muscle exercise in COPD rehabilitation.

For maximum benefit, a rehabilitation program for patients with chronic obstructive pulmonary disease (COPD) should include both ventilatory and nonventilatory muscle exercise. The 12-week, outpatient program at Malden (Mass) Hospital incorporates whole-body exercise (walking), inspiratory resistive loading, and use of supplemental oxygen. Exercise prescription is based on the work level requiring a minute ventilation equal to 50% of each patient's maximum breathing capacity. A cardiopulmonary exercise test, 12-minute walk, and endurance test provide the before and after rehabilitation testing protocol. Such a program can be implemented at a community hospital where most patients with COPD have their greatest access to medical care.