ERS | monograph Introduction: Pulmonary rehabilitation strong foundations, new science and opportunities for innovation Anne E. Holland 1,2,3 , Simone Dal Corso4 and Martijn A. Spruit 5,6 @ERSpublications This edition of the Monograph details advances in the science and practice of #pulmrehab, including the patient groups who will benefit, the breadth of programme content, new methods of delivery and important outcomes. PR is not new. It has long been a key component of best care for patients with COPD and its delivery is strongly encouraged in clinical care standards from around the world [1, 2]. This approach is supported by strong evidence that PR delivers meaningful improvements in exercise capacity, symptoms and QoL [3], as well as reductions in hospitalisations [4] and perhaps even improvements in survival [5]. More recently, PR has become the standard of care for patients with other chronic respiratory diseases, including bronchiectasis, pulmonary hypertension, ILD and lung cancer, underpinned by positive findings from clinical trials [6–9]. Whilst there is no question that PR generally “works”, we are still learning how to optimise its delivery and outcomes. In recent years, there have been substantial advances in the science underpinning PR, including the evaluation of novel exercise training methods, behaviour change approaches and physical activity promotion strategies. Many of these newer approaches are now ready for implementation in clinical practice. There has been increasing recognition of important traits that may influence the content, delivery and outcomes of PR for individual patients, including comorbidities, frailty and falls. We have also learnt much more about patient expectations and experiences of PR, and this is critical to inform patient-centred delivery. For PR to realise its potential, these advances in science must be accompanied by improvements in referral, access and uptake. Prescribing a multicomponent intervention Copyright ©ERS 2021. Print ISBN: 978-1-84984-139-9. Online ISBN: 978-1-84984-140-5. Print ISSN: 2312-508X. Online ISSN: 2312-5098. Correspondence: Anne Holland ( 1 Alfred Health Physiotherapy, Melbourne, Australia. 2 Central Clinical School, Monash University, Melbourne, Australia. 3 Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho, Sao Paulo, Brazil. 4 Ciro, Horn, the Netherlands. 5 Dept of Research and Development, Ciro, Horn, the Netherlands. 6 Dept of Respiratory Medicine, Maastricht University Medical Center, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Science, Maastricht, the Netherlands. ix
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