like PR is different to prescribing a pill, and is more complex for a patient to “take”. The barriers to uptake of PR have been well documented previously [10] but knowing why patients do not receive this effective treatment has not fixed the problem [11]. In recent years, scientists and clinicians have begun to explore the efficacy of alternative models for delivering PR in clinical trials, to address patient-related barriers such as the inability to travel due to disabling symptoms or geographical gaps in programme availability. Remotely delivered PR models have come into sharp focus during the COVID-19 pandemic, when social distancing and infection control measures resulted in temporary closure of centre-based programmes in much of the world [12]. This Monograph provides a comprehensive overview of best practice and new science in PR. Our aim is to provide HCPs and healthcare providers with the necessary tools to establish new PR programmes, to continually improve existing programmes, and to adopt and evaluate future innovations. The Monograph begins by describing the rationale for PR, with a focus on the extrapulmonary consequences of chronic lung disease, such as skeletal muscle dysfunction, physical inactivity and psychosocial burdens, and how these may be addressed by a person-centred, individualised and multidisciplinary PR programme (chapter 1 [13]). A key feature of this Monograph is a chapter on patient perspectives on PR, including suggestions for ways in which HCPs can enhance the patient experience to optimise uptake, engagement, enjoyment and outcomes (chapter 2 [14]). A thorough patient assessment is a critical component of PR. Chapter 3 includes an overview of assessment and outcome measurement, starting with the essential domains of exercise capacity, symptoms and HRQoL. Assessment tools for other important domains are also discussed, including limb and respiratory muscle function, mood, frailty, cognitive impairment and social support [15]. The principles of exercise training for patients with COPD are addressed in chapter 4, including the core components of aerobic and resistance training, with practical methods for exercise prescription and progression [16]. The Monograph then details novel and emerging exercise training strategies, including whole-body vibration training, respiratory muscle training, eccentric training and neuromuscular electrical stimulation (chapter 5 [17]). Achieving optimal outcomes from PR requires a comprehensive intervention package delivered by a multidisciplinary team. The importance of occupational therapy, nutritional modulation and psychological support is detailed in chapter 6, including specific assessments and interventions that may be offered [18]. Education and self-management training are essential for PR participants to acquire knowledge, skills and strategies and facilitate sustained behaviour change. This Monograph describes approaches to the delivery of education that emphasise patient engagement and align with adult learning, and highlights factors that may influence patient engagement, including health literacy, psychological symptoms, cognitive impairment and social support (chapter 7 [19]). Participants in PR have a range of coexisting medical conditions and a wide spectrum of disease severity. Modifications to PR programmes may be necessary to optimise uptake, adherence and benefits of PR for individual patients. In chapter 8, special considerations for patients with multimorbidity undergoing PR are presented [20]. Opportunities to optimise symptom control and address palliative care needs in PR are also discussed x
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