Clinical pathway for exercise prescription in patients with chronic obstructive pulmonary disease_Chinese Journal of Evidence-Based Medicine

Authors：

LIU Xiaoxue ¹ , ZHENG Dixin ² , DENG Ying ³ , XU Xinyin ³ , HUANG Guoyue ⁴ , HU Mengjie ¹ , DIJI Zhuoma ¹ , ZHANG ling ¹ , LIU Jianwei ⁵ , SHEN Hai ⁵ , WANG Yanjie ⁵ , DENG Dan ² , ZHOU Dingzi ¹ , SU Qiaoli ⁶ , YAO Yongping ² , CHEN Long ² , FAN Mengyu ¹ ,  LI Jiayuan ¹

1. The West China School of Public Health/West China Fourth Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Sichuan Medical Association, Chengdu 610200, P. R. China;
3. Sichuan Center for Disease Control and Prevention, Chengdu 610041, P. R. China;
4. The Johns Hopkins University Bloomberg School of Public Health, Beijing 100020, P. R. China;
5. Sichuan Province Orthopedic Hospital, Chengdu 610041, P. R. China;
6. West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

LI Jiayuan, Email: lijiayuan@scu.edu.cn

Keywords：

Chronic obstructive pulmonary disease; Exercise prescription; Clinical pathway

DOI：

10.7507/1672-2531.202504055

Video：

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Chronic obstructive pulmonary disease (COPD) is one of the major chronic diseases that seriously endanger the health of residents in our country. Exercise is one of the effective interventions to improve the cardiopulmonary function and quality of life of COPD patients. An exercise prescription specifies the frequency, intensity, duration, mode, total exercise volume, and progression of exercise, forming a clear - purpose and systematic exercise guidance plan. Clinical pathways standardize and proceduralize the patient's diagnosis and treatment process. Developing an exercise prescription for the entire process of issuing and implementing exercise prescriptions for COPD patients helps to promote the application of exercise prescriptions and assist in the implementation of related work in primary - level medical institutions. Therefore, we invited a number of COPD experts and sports medicine experts to develop this clinical pathway in combination with domestic and international guidelines, consensuses, and personal experience. Its aims are to simplify the exercise prescription development process, reduce the required level of expertise, enhance the capacity of primary healthcare institutions, and facilitate the application of exercise prescriptions within these settings.

Citation： LIU Xiaoxue, ZHENG Dixin, DENG Ying, XU Xinyin, HUANG Guoyue, HU Mengjie, DIJI Zhuoma, ZHANG ling, LIU Jianwei, SHEN Hai, WANG Yanjie, DENG Dan, ZHOU Dingzi, SU Qiaoli, YAO Yongping, CHEN Long, FAN Mengyu, LI Jiayuan. Clinical pathway for exercise prescription in patients with chronic obstructive pulmonary disease. Chinese Journal of Evidence-Based Medicine, 2025, 25(10): 1117-1124. doi: 10.7507/1672-2531.202504055 Copy

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2.	Wang C, Xu J, Yang L, et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China [the China Pulmonary Health (CPH) study]: a national cross-sectional study. Lancet, 2018, 391(10131): 1706-1717.
3.	Neumeier A, Keith R. Clinical guideline highlights for the hospitalist: the GOLD and NICE guidelines for the management of COPD. J Hosp Med, 2020, 15(4): 240-241.
4.	Vogiatzis I, Rochester CL, Spruit MA, et al. Increasing implementation and delivery of pulmonary rehabilitation: key messages from the new ATS/ERS policy statement. Eur Respir J, 2016, 47(5): 1336-1341.
5.	Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med, 2013, 188(8): e13-e64.
6.	Ries AL, Bauldoff GS, Carlin BW, et al. Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based clinical practice guidelines. Chest, 2007, 131(5 Suppl): 4S-42S.
7.	McCarthy B, Casey D, Devane D, et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev, 2015, (2): CD003793.
8.	中國康復醫學會循證康復醫學工作委員會, 中國康復科學所康復信息研究所中國康復研究中心, 蘭州大學循證醫學中心, 等. 慢性阻塞性肺疾病臨床康復循證實踐指南. 中國康復理論與實踐, 2021, 27(1): 15-26.
9.	中華醫學會呼吸病學分會慢性阻塞性肺疾病學組, 中國醫師協會呼吸醫師分會慢性阻塞性肺疾病工作委員會. 慢性阻塞性肺疾病診治指南(2021年修訂版). 中華結核和呼吸雜志, 2021, 44(3): 170-205.
10.	慢性阻塞性肺疾病中西醫結合管理專家共識寫作組. 慢性阻塞性肺疾病中西醫結合管理專家共識(2023版). 中國全科醫學, 2023, 26(35): 4359-4371.
11.	專家組運動處方中國專家共識. 運動處方中國專家共識(2023). 中國運動醫學雜志, 2023, 42(1): 3-13.
12.	馮浩. 臨床路徑的基本概念及其應用. 臨床醫藥文獻電子雜志, 2016, 3(49): 9871-9873.
13.	Holland AE, Cox NS, Houchen-Wolloff L, et al. Defining modern pulmonary rehabilitation. an official American Thoracic Society Workshop report. Ann Am Thorac Soc, 2021, 18(5): e12-e29.
14.	中國老年醫學學會呼吸病學分會慢性阻塞性肺疾病學組. 中國老年慢性阻塞性肺疾病臨床診治實踐指南. 中華結核和呼吸雜志, 2020, 43(2): 100-119.
15.	王正珍, 譯. 美國運動醫學學會. ACSM運動測試與運動處方指南. 北京: 北京體育大學出版社, 2024.
16.	王擁軍, 潘華山. 運動醫學(第2版). 北京: 人民衛生出版社, 2018.
17.	王正珍, 徐峻華. 運動處方(第3版). 北京: 高等教育出版社, 2021.
18.	Global Initiative for Chronic Obstructive Lung Disease (GOLD). GOLD 2023 report: global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease.
19.	朱蕾, 陳榮昌. 成人肺功能診斷規范中國專家共識. 臨床肺科雜志, 2022, 27(7): 973-981.
20.	Riebe D, Franklin BA, Thompson PD, et al. Updating ACSM's recommendations for exercise preparticipation health screening. Med Sci Sports Exerc, 2015, 47(11): 2473-2479.
21.	Salzman SH. The 6-min walk test: clinical and research role, technique, coding, and reimbursement. Chest. 2009, 135(5): 1345-1352.
22.	Maltais F, Decramer M, Casaburi R, et al. An official American Thoracic Society/European Respiratory Society statement: update on limb muscle dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2014, 189(9): e15-e62.
23.	Puente-Maestu L, Palange P, Casaburi R, et al. Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement. Eur Respir J, 2016, 47(2): 429-460.
24.	Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med, 2004, 350(10): 1005-1012.
25.	Palmer T, Obst SJ, Aitken CR, et al. Fixed-intensity exercise tests to measure exertional dyspnoea in chronic heart and lung populations: a systematic review. Eur Respir Rev, 2023, 32(169): 230016.
26.	Horowitz MB, Mahler DA. Dyspnea ratings for prescription of cross-modal exercise in patients with COPD. Chest, 1998, 113(1): 60-64.
27.	Li CL, Lin MH, Chen PS, et al. Using the BODE index and comorbidities to predict health utilization resources in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis, 2020, 15: 389-395.
28.	國家國民體質監測中心國家體育總局. 國民體質測定標準(2023年修訂). 2023.
29.	中國疾病預防控制中心營養與食品安全所, 湖北省疾病預防控制中心, 首都兒科研究所, 等. 人群健康監測人體測量方法. 2015.
30.	中華醫學會心血管病學分會, 中國康復醫學會心肺預防與康復專業委員會, 中華心血管病雜志編輯委員會. 六分鐘步行試驗臨床規范應用中國專家共識. 中華心血管病雜志, 2022, (5): 432-442.
31.	Puhan MA, Mador MJ, Held U, et al. Interpretation of treatment changes in 6-minute walk distance in patients with COPD. Eur Respir J, 2008, 32(3): 637-643.
32.	Lewthwaite H, Jensen D, Ekstr?m M. How to assess breathlessness in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis, 2021, 16: 1581-1598.
33.	Zhang H, Hu D, Xu Y, et al. Effect of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis of randomized controlled trials. Ann Med, 2022, 54(1): 262-273.

1. 中華醫學會, 中華醫學會雜志社, 中華醫學會全科醫學分會, 等. 中國慢性阻塞性肺疾病基層診療與管理指南(2024年). 中華全科醫師雜志, 2024, 23(6): 578-602.
2. Wang C, Xu J, Yang L, et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China [the China Pulmonary Health (CPH) study]: a national cross-sectional study. Lancet, 2018, 391(10131): 1706-1717.
3. Neumeier A, Keith R. Clinical guideline highlights for the hospitalist: the GOLD and NICE guidelines for the management of COPD. J Hosp Med, 2020, 15(4): 240-241.
4. Vogiatzis I, Rochester CL, Spruit MA, et al. Increasing implementation and delivery of pulmonary rehabilitation: key messages from the new ATS/ERS policy statement. Eur Respir J, 2016, 47(5): 1336-1341.
5. Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med, 2013, 188(8): e13-e64.
6. Ries AL, Bauldoff GS, Carlin BW, et al. Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based clinical practice guidelines. Chest, 2007, 131(5 Suppl): 4S-42S.
7. McCarthy B, Casey D, Devane D, et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev, 2015, (2): CD003793.
8. 中國康復醫學會循證康復醫學工作委員會, 中國康復科學所康復信息研究所中國康復研究中心, 蘭州大學循證醫學中心, 等. 慢性阻塞性肺疾病臨床康復循證實踐指南. 中國康復理論與實踐, 2021, 27(1): 15-26.
9. 中華醫學會呼吸病學分會慢性阻塞性肺疾病學組, 中國醫師協會呼吸醫師分會慢性阻塞性肺疾病工作委員會. 慢性阻塞性肺疾病診治指南(2021年修訂版). 中華結核和呼吸雜志, 2021, 44(3): 170-205.
10. 慢性阻塞性肺疾病中西醫結合管理專家共識寫作組. 慢性阻塞性肺疾病中西醫結合管理專家共識(2023版). 中國全科醫學, 2023, 26(35): 4359-4371.
11. 專家組運動處方中國專家共識. 運動處方中國專家共識(2023). 中國運動醫學雜志, 2023, 42(1): 3-13.
12. 馮浩. 臨床路徑的基本概念及其應用. 臨床醫藥文獻電子雜志, 2016, 3(49): 9871-9873.
13. Holland AE, Cox NS, Houchen-Wolloff L, et al. Defining modern pulmonary rehabilitation. an official American Thoracic Society Workshop report. Ann Am Thorac Soc, 2021, 18(5): e12-e29.
14. 中國老年醫學學會呼吸病學分會慢性阻塞性肺疾病學組. 中國老年慢性阻塞性肺疾病臨床診治實踐指南. 中華結核和呼吸雜志, 2020, 43(2): 100-119.
15. 王正珍, 譯. 美國運動醫學學會. ACSM運動測試與運動處方指南. 北京: 北京體育大學出版社, 2024.
16. 王擁軍, 潘華山. 運動醫學(第2版). 北京: 人民衛生出版社, 2018.
17. 王正珍, 徐峻華. 運動處方(第3版). 北京: 高等教育出版社, 2021.
18. Global Initiative for Chronic Obstructive Lung Disease (GOLD). GOLD 2023 report: global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease.
19. 朱蕾, 陳榮昌. 成人肺功能診斷規范中國專家共識. 臨床肺科雜志, 2022, 27(7): 973-981.
20. Riebe D, Franklin BA, Thompson PD, et al. Updating ACSM's recommendations for exercise preparticipation health screening. Med Sci Sports Exerc, 2015, 47(11): 2473-2479.
21. Salzman SH. The 6-min walk test: clinical and research role, technique, coding, and reimbursement. Chest. 2009, 135(5): 1345-1352.
22. Maltais F, Decramer M, Casaburi R, et al. An official American Thoracic Society/European Respiratory Society statement: update on limb muscle dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2014, 189(9): e15-e62.
23. Puente-Maestu L, Palange P, Casaburi R, et al. Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement. Eur Respir J, 2016, 47(2): 429-460.
24. Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med, 2004, 350(10): 1005-1012.
25. Palmer T, Obst SJ, Aitken CR, et al. Fixed-intensity exercise tests to measure exertional dyspnoea in chronic heart and lung populations: a systematic review. Eur Respir Rev, 2023, 32(169): 230016.
26. Horowitz MB, Mahler DA. Dyspnea ratings for prescription of cross-modal exercise in patients with COPD. Chest, 1998, 113(1): 60-64.
27. Li CL, Lin MH, Chen PS, et al. Using the BODE index and comorbidities to predict health utilization resources in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis, 2020, 15: 389-395.
28. 國家國民體質監測中心國家體育總局. 國民體質測定標準(2023年修訂). 2023.
29. 中國疾病預防控制中心營養與食品安全所, 湖北省疾病預防控制中心, 首都兒科研究所, 等. 人群健康監測人體測量方法. 2015.
30. 中華醫學會心血管病學分會, 中國康復醫學會心肺預防與康復專業委員會, 中華心血管病雜志編輯委員會. 六分鐘步行試驗臨床規范應用中國專家共識. 中華心血管病雜志, 2022, (5): 432-442.
31. Puhan MA, Mador MJ, Held U, et al. Interpretation of treatment changes in 6-minute walk distance in patients with COPD. Eur Respir J, 2008, 32(3): 637-643.
32. Lewthwaite H, Jensen D, Ekstr?m M. How to assess breathlessness in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis, 2021, 16: 1581-1598.
33. Zhang H, Hu D, Xu Y, et al. Effect of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis of randomized controlled trials. Ann Med, 2022, 54(1): 262-273.

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