Nonpharmacologic adjuncts to training during pulmonary rehabilitation: the role of supplemental oxygen and noninvasive ventilation.

Exercise training is the cornerstone of pulmonary rehabilitation. However, patients may not be able to exercise at a level that produces a training effect because of limitations related to their underlying lung disease. Adjuncts during exercise training may increase their exercise capacity and increase the benefit of pulmonary rehabilitation. The pathophysiology of exercise associated limitation is reviewed, as well as the role of supplemental oxygen and noninvasive ventilatory support as nonpharmacologic adjuncts to training. While most studies demonstrate benefit during exercise, the evidence of an added benefit during pulmonary rehabilitation is mixed. Work is needed to better define the benefits and appropriate patient populations. The subgroups that may derive the most benefit from these adjuncts are those with oxygen desaturation during exercise and those with severe chronic obstructive pulmonary disease (defined as a forced expiratory volume in 1 s (FEV1) < 1.0 L). Nocturnal noninvasive ventilation during pulmonary rehabilitation seems to be an effective adjunct and merits further study.