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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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.	中国康复医学会循证康复医学工作委员会, 中国康复科学所康复信息研究所中国康复研究中心, 兰州大学循证医学中心, 等. 慢性阻塞性肺疾病临床康复循证实践指南. 中国康复理论与实践, 2021, 27(1): 15-26.
9.	中华医学会呼吸病学分会慢性阻塞性肺疾病学组, 中国医师协会呼吸医师分会慢性阻塞性肺疾病工作委员会. 慢性阻塞性肺疾病诊治指南(2021年修订版). 中华结核和呼吸杂志, 2021, 44(3): 170-205.
10.	慢性阻塞性肺疾病中西医结合管理专家共识写作组. 慢性阻塞性肺疾病中西医结合管理专家共识(2023版). 中国全科医学, 2023, 26(35): 4359-4371.
11.	专家组运动处方中国专家共识. 运动处方中国专家共识(2023). 中国运动医学杂志, 2023, 42(1): 3-13.
12.	冯浩. 临床路径的基本概念及其应用. 临床医药文献电子杂志, 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.	中国老年医学学会呼吸病学分会慢性阻塞性肺疾病学组. 中国老年慢性阻塞性肺疾病临床诊治实践指南. 中华结核和呼吸杂志, 2020, 43(2): 100-119.
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16.	王拥军, 潘华山. 运动医学(第2版). 北京: 人民卫生出版社, 2018.
17.	王正珍, 徐峻华. 运动处方(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, 陈荣昌. 成人肺功能诊断规范中国专家共识. 临床肺科杂志, 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.	国家国民体质监测中心国家体育总局. 国民体质测定标准(2023年修订). 2023.
29.	中国疾病预防控制中心营养与食品安全所, 湖北省疾病预防控制中心, 首都儿科研究所, 等. 人群健康监测人体测量方法. 2015.
30.	中华医学会心血管病学分会, 中国康复医学会心肺预防与康复专业委员会, 中华心血管病杂志编辑委员会. 六分钟步行试验临床规范应用中国专家共识. 中华心血管病杂志, 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, Ekström 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. 中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 中国慢性阻塞性肺疾病基层诊疗与管理指南(2024年). 中华全科医师杂志, 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. 中国康复医学会循证康复医学工作委员会, 中国康复科学所康复信息研究所中国康复研究中心, 兰州大学循证医学中心, 等. 慢性阻塞性肺疾病临床康复循证实践指南. 中国康复理论与实践, 2021, 27(1): 15-26.
9. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组, 中国医师协会呼吸医师分会慢性阻塞性肺疾病工作委员会. 慢性阻塞性肺疾病诊治指南(2021年修订版). 中华结核和呼吸杂志, 2021, 44(3): 170-205.
10. 慢性阻塞性肺疾病中西医结合管理专家共识写作组. 慢性阻塞性肺疾病中西医结合管理专家共识(2023版). 中国全科医学, 2023, 26(35): 4359-4371.
11. 专家组运动处方中国专家共识. 运动处方中国专家共识(2023). 中国运动医学杂志, 2023, 42(1): 3-13.
12. 冯浩. 临床路径的基本概念及其应用. 临床医药文献电子杂志, 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. 中国老年医学学会呼吸病学分会慢性阻塞性肺疾病学组. 中国老年慢性阻塞性肺疾病临床诊治实践指南. 中华结核和呼吸杂志, 2020, 43(2): 100-119.
15. 王正珍, 译. 美国运动医学学会. ACSM运动测试与运动处方指南. 北京: 北京体育大学出版社, 2024.
16. 王拥军, 潘华山. 运动医学(第2版). 北京: 人民卫生出版社, 2018.
17. 王正珍, 徐峻华. 运动处方(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, 陈荣昌. 成人肺功能诊断规范中国专家共识. 临床肺科杂志, 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. 国家国民体质监测中心国家体育总局. 国民体质测定标准(2023年修订). 2023.
29. 中国疾病预防控制中心营养与食品安全所, 湖北省疾病预防控制中心, 首都儿科研究所, 等. 人群健康监测人体测量方法. 2015.
30. 中华医学会心血管病学分会, 中国康复医学会心肺预防与康复专业委员会, 中华心血管病杂志编辑委员会. 六分钟步行试验临床规范应用中国专家共识. 中华心血管病杂志, 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, Ekström 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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