Does pulmonary rehabilitation reduce anxiety and depression in chronic obstructive pulmonary disease?

Abstract

Symptoms of anxiety and depression are prevalent in at least 20-40% of patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) and are known to affect prognosis and worsen quality of life. This review examines whether pulmonary rehabilitation can effectively improve psychological status in COPD patients. Over the last decade, evidence has accumulated to show that comprehensive pulmonary rehabilitation, which includes exercise training and disease education or psychosocial support or both, can effectively improve anxiety and depression in COPD. The quality of supporting data varies but indicates a consistent and homogeneous effect in favour of pulmonary rehabilitation for anxiety and depression when compared with conventional community care. Pulmonary rehabilitation also appears to improve anxiety and depression in rehabilitating COPD patients with less favourable psychosocial health, but its efficacy for treating more severe and enduring anxiety and depression is largely unproven. Additionally, it is not certain which components of pulmonary rehabilitation lead to improved anxiety and depression, and further research is needed to ensure that psychological benefits accrued during rehabilitation are sustained. Anxiety and depression afflict a significant proportion of COPD patients and lead to worse patient-centred outcomes. Evidence supports the use of pulmonary rehabilitation to effectively manage psychological morbidity in COPD.