Fig. 12.1 Percentage improvement in 12-min walking distance in relation to the initial 12-minute walking distance (r =-0.71; P < 0.0001) [19].

aerobic benefit from rehabilitation. This suggests that lung function might be an important predictor of the outcome of rehabilitation. However, a study by Maltais et al. showed contradictory results [20]. In this study, 42 patients with a moderately severe airflow obstruction (mean FEV1 38% of predicted) received a 12-week endurance programme. The effects of training were compared in patients with a FEV1 < 40% of predicted and FEV1 > 40% of predicted. Percent changes in Vo2max, Wmax, and VE were significant and of similar magnitude in both groups. They concluded that a physiological training effect could be achieved even in patients with severe COPD.

Another way to identify ideal candidates is to look at whether some of the underlying basic problems can be improved by rehabilitation. There is growing evidence that COPD patients have muscle weakness and that this is related to exercise tolerance [21,22]. Pure strength training was found to be beneficial in improving quality of life [23] and exercise tolerance [24] in these patients. Therefore, it might be concluded that patients with impaired muscle function are good candidates for rehabilitation, because it is possible to improve their functional status by training their muscles. Finally, there is now also clear evidence that rehabilitation improves quality of life and dyspnoea, suggesting that patients with a poor quality of life and severe dyspnoea complaints are good candidates too [25,26].

Unfortunately, only a few studies have been carried out to investigate patient profiles in order to characterize patients who are suitable for a rehabilitation programme. Based on what we know at present, it seems that patients with an impaired muscle function, decreased exercise tolerance, severe complaints of dyspnoea, and poor quality of life might be good candidates for inclusion. However, all results are derived from groups of patients, and we do not know how to interpret them in an individual patient. Moreover, although we have the impression that motivation is a very important factor in this

Fig. 12.2 Model of the pathways involved in the development of impaired health or quality of life in patients with chronic obstructive pulmonary disease [27].

Lung disease

Muscle wasting

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