Exercise training for bronchiectasis

Bronchiectasis is defined as the permanent dilatation of bronchi, clinically characterized by chronic cough, sputum production, and bronchial infection. The global prevalence of bronchiectasis is unclear, and the estimate varies according to the country. In the U.S. between 2010 and 2013, the prevalence was between 139 and 1,106 cases per 100,000, with incidence increasing with age. Patients with bronchiectasis have respiratory muscle weakness, reduced quadriceps strength, dyspnoea, fatigue, and reduced exercise tolerance. Consequently, they have difficulty in carrying out daily activities. In addition, psychological symptoms of anxiety and depression decrease their health-related quality of life (HRQoL). In this scenario, rehabilitation aims to improve the physical and psychological conditions of patients with bronchiectasis. In particular, exercise training can be part of a pulmonary rehabilitation program and includes upper- and lower-limb endurance exercise and strength training. It has been demonstrated that, in people with chronic respiratory conditions, exercise has a relevant role in the recovery of respiratory symptoms, functional ability, exercise tolerance, and HRQoL and in reducing exacerbation frequency. For these reasons, modern rehabilitation guidelines recommend pulmonary rehabilitation for people with bronchiectasis. Moreover, clinicians prescribe exercise training for people with bronchiectasis or refer people to pulmonary rehabilitation programmes.

This review investigated whether, in adults and children with bronchiectasis, exercise training compared to no training improved exercise tolerance, quality of life, or symptoms and whether it reduced the number of exacerbations.

This review is important for

People with bronchiectasis, their loved ones/caregivers, health professionals caring for this population, general practitioners, researchers, and policymakers.

Outcomes of this review

The outcomes analysed were exercise tolerance, quality of life, incidence of exacerbations and hospitalisation, respiratory and mental health symptoms, physical function, mortality, and adverse events in people with stable or acute exacerbation of bronchiectasis. The CSR included six studies with a total of 275 adult participants registered up to October 2020. Results showed that exercise training improved exercise tolerance and quality of life. Moreover, the effects of exercise training on cough-related quality of life and psychological symptoms appear to be minimal. Greater benefits are reached by adults with stable bronchiectasis since there were no improvements for people who undertook exercise training after an acute flare-up. Ultimately, data were insufficient to demonstrate the effects of exercise training on exercise capacity and quality of life in the long term.

These results must be interpreted with caution since trials rarely specified the etiological background of bronchiectasis, with some causes being severely impairing, thus having a more negative impact on the benefits of training. 

Author’s conclusion of the review

Exercise may improve functional exercise capacity and quality of life more than those who did not undergo an exercise program in people with stable bronchiectasis.

Future recommendations 

The authors recommend a higher number of randomised-controlled trial studies with a larger participant number, particularly to (a) study the role of exercise training in isolation or with other treatments on exercise capacity and quality of life, (b) learn the long-term effects of exercise, and (c) reduce the imprecision associated with observed treatment effects.

Comment by Robin Kuruvila Sentinella