{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T22:45:13Z","timestamp":1791240313045,"version":"4.1.0"},"reference-count":138,"publisher":"BMJ","license":[{"start":{"date-parts":[[2019,6,17]],"date-time":"2019-06-17T00:00:00Z","timestamp":1560729600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Much of the burden on healthcare systems is related to the management of chronic conditions such as cardiovascular disease and chronic obstructive pulmonary disease. Although conventional outpatient cardiopulmonary rehabilitation programs significantly decrease morbidity and mortality and improve function and health related quality of life for people with chronic diseases, rehabilitation programs are underused. Barriers to enrollment are multifactorial and include failure to recommend and refer patients to these services; poor communication with patients about potential benefits; and patient factors including logistical and financial barriers, comorbidities, and competing demands that make participation in facility based programs difficult. Recent advances in rehabilitation programs that involve remotely delivered technology could help deliver services to more people who might benefit. Problems with intensity, adherence, and safety of home based programs have been investigated in recent clinical trials, and larger dissemination and implementation trials are under way. This review summarizes the evidence for benefit of in-person cardiac and pulmonary rehabilitation programs. It also reviews the literature on newer developments, such as home based remotely mediated exercise programs developed to decrease cost and improve accessibility, high intensity interval training in cardiac rehabilitation, and alternative therapies such as tai chi and yoga for people with chronic obstructive pulmonary disease.<\/jats:p>","DOI":"10.1136\/bmj.l2191","type":"journal-article","created":{"date-parts":[[2019,6,17]],"date-time":"2019-06-17T10:55:42Z","timestamp":1560768942000},"page":"l2191","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":71,"title":["Advances in rehabilitation for chronic diseases: improving health outcomes and function"],"prefix":"10.1136","author":[{"given":"Caroline R","family":"Richardson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barry","family":"Franklin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilyn L","family":"Moy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A","family":"Jackson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,6,17]]},"reference":[{"key":"key20190618000404_ref1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002571"},{"key":"key20190618000404_ref2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.16885"},{"key":"key20190618000404_ref3","doi-asserted-by":"publisher","DOI":"10.1023\/B:QURE.0000018472.46236.05"},{"key":"key20190618000404_ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.dhjo.2013.06.007"},{"key":"key20190618000404_ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2008.04.030"},{"key":"key20190618000404_ref6","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(15)00179-5"},{"key":"key20190618000404_ref7","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.738732"},{"key":"key20190618000404_ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2017.12.039"},{"key":"key20190618000404_ref9","doi-asserted-by":"publisher","DOI":"10.1016\/j.pupt.2018.03.004"},{"key":"key20190618000404_ref10","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1615664"},{"key":"key20190618000404_ref11","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201510-1966ST"},{"key":"key20190618000404_ref12","doi-asserted-by":"publisher","DOI":"10.1097\/HCR.0b013e318207d2fa"},{"key":"key20190618000404_ref13","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2018.03.18"},{"key":"key20190618000404_ref14","doi-asserted-by":"publisher","DOI":"10.1097\/HJR.0b013e328334f42d"},{"key":"key20190618000404_ref15","unstructured":"World Health Organization. The top 10 causes of death. 2018. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/the-top-10-causes-of-death."},{"key":"key20190618000404_ref16","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1206230"},{"key":"key20190618000404_ref17","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa073350"},{"key":"key20190618000404_ref18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.10.059"},{"key":"key20190618000404_ref19","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD003793.pub3"},{"key":"key20190618000404_ref20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.10.044"},{"key":"key20190618000404_ref21","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2011.11.019"},{"key":"key20190618000404_ref22","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD005305.pub4"},{"key":"key20190618000404_ref23","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2014.02.008"},{"key":"key20190618000404_ref24","doi-asserted-by":"publisher","DOI":"10.2147\/COPD.S143101"},{"key":"key20190618000404_ref25","doi-asserted-by":"publisher","DOI":"10.1177\/2047487314548815"},{"key":"key20190618000404_ref26","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1992.00400170113021"},{"key":"key20190618000404_ref27","doi-asserted-by":"publisher","DOI":"10.1177\/0269215506070783"},{"key":"key20190618000404_ref28","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.113.000568"},{"key":"key20190618000404_ref29","doi-asserted-by":"publisher","DOI":"10.1177\/2047487316657669"},{"key":"key20190618000404_ref30","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2017.07.019"},{"key":"key20190618000404_ref31","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2017-312809"},{"key":"key20190618000404_ref32","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2017-312832"},{"key":"key20190618000404_ref33","doi-asserted-by":"publisher","DOI":"10.1177\/2047487312460484"},{"key":"key20190618000404_ref34","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.675041"},{"key":"key20190618000404_ref35","doi-asserted-by":"publisher","DOI":"10.1177\/2047487317734051"},{"key":"key20190618000404_ref36","doi-asserted-by":"publisher","DOI":"10.1123\/jsep.2015-0286"},{"key":"key20190618000404_ref37","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2019.03.019"},{"key":"key20190618000404_ref38","doi-asserted-by":"publisher","DOI":"10.1177\/2047487317739978"},{"key":"key20190618000404_ref39","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.117.007664"},{"key":"key20190618000404_ref40","doi-asserted-by":"publisher","DOI":"10.1161\/HCQ.0000000000000037"},{"key":"key20190618000404_ref41","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2010.501"},{"key":"key20190618000404_ref42","doi-asserted-by":"publisher","DOI":"10.1016\/S0828-282X(09)70096-0"},{"key":"key20190618000404_ref43","doi-asserted-by":"publisher","DOI":"10.1080\/09638288.2017.1397776"},{"key":"key20190618000404_ref44","unstructured":"Smith A. Smartphone ownership 2013. Pew Research Center: internet and technology. 2013. https:\/\/pewinternet.org\/Reports\/2013\/Smartphone-Ownership-2013.aspx"},{"key":"key20190618000404_ref45","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2014.12.026"},{"key":"key20190618000404_ref46","doi-asserted-by":"publisher","DOI":"10.1177\/1741826711422988"},{"key":"key20190618000404_ref47","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2014-305783"},{"key":"key20190618000404_ref48","doi-asserted-by":"publisher","DOI":"10.1177\/2047487314535076"},{"key":"key20190618000404_ref49","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.08.006"},{"key":"key20190618000404_ref50","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.10.020"},{"key":"key20190618000404_ref51","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000001250"},{"key":"key20190618000404_ref52","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.01.053"},{"key":"key20190618000404_ref53","doi-asserted-by":"publisher","DOI":"10.1177\/0269215513516475"},{"key":"key20190618000404_ref54","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.021348"},{"key":"key20190618000404_ref55","doi-asserted-by":"publisher","DOI":"10.1177\/2047487317752373"},{"key":"key20190618000404_ref56","unstructured":"World Health Organization. Global health estimates 2016: deaths by cause, age, sex, by country and by region, 2000-2016. 2018. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/the-top-10-causes-of-death."},{"key":"key20190618000404_ref57","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(17)30293-X"},{"key":"key20190618000404_ref58","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1164\/rccm.201606-1162PP","article-title":"The projected epidemic of chronic obstructive pulmonary disease hospitalizations over the next 15 years. A population-based perspective","volume":"195","author":"Khakban","year":"2017","journal-title":"Am J Respir Crit Care Med"},{"key":"key20190618000404_ref59","first-page":"938","article-title":"Chronic obstructive pulmonary disease among adults\u2014United States, 2011","volume":"61","author":"Centers for Disease Control and Prevention (CDC)","year":"2012","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"key20190618000404_ref60","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2018.01.038"},{"key":"key20190618000404_ref61","doi-asserted-by":"publisher","DOI":"10.1111\/resp.13012"},{"key":"key20190618000404_ref62","first-page":"1662","article-title":"Standardised questionnaire on respiratory symptoms: a statement prepared and approved by the MRC Committee on the Aetiology of Chronic Bronchitis (MRC breathlessness score).","volume":"2","author":"Fletcher","year":"1960","journal-title":"BMJ"},{"key":"key20190618000404_ref63","doi-asserted-by":"publisher","DOI":"10.7326\/M15-2023"},{"key":"key20190618000404_ref64","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2010.05.002"},{"key":"key20190618000404_ref65","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201707-582OC"},{"key":"key20190618000404_ref66","doi-asserted-by":"publisher","DOI":"10.1007\/s00408-015-9838-z"},{"key":"key20190618000404_ref67","first-page":"E418","article-title":"Muscle dysfunction in chronic obstructive pulmonary disease: update on causes and biological findings","volume":"7","author":"Gea","year":"2015","journal-title":"J Thorac Dis"},{"key":"key20190618000404_ref68","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00079-2018"},{"key":"key20190618000404_ref69","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00024608"},{"key":"key20190618000404_ref70","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2013-203534"},{"key":"key20190618000404_ref71","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.02110-2017"},{"key":"key20190618000404_ref72","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201201-0034OC"},{"key":"key20190618000404_ref73","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00046814"},{"key":"key20190618000404_ref74","doi-asserted-by":"publisher","DOI":"10.1378\/chest.10-2521"},{"key":"key20190618000404_ref75","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00023214"},{"key":"key20190618000404_ref76","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00062-2015"},{"key":"key20190618000404_ref77","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0060400"},{"key":"key20190618000404_ref78","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2014.12.004"},{"key":"key20190618000404_ref79","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2006.060145"},{"key":"key20190618000404_ref80","doi-asserted-by":"publisher","DOI":"10.1378\/chest.13-1052"},{"key":"key20190618000404_ref81","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201309-1634ST"},{"key":"key20190618000404_ref82","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d6615"},{"key":"key20190618000404_ref83","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2013-203808"},{"key":"key20190618000404_ref84","doi-asserted-by":"publisher","DOI":"10.2147\/COPD.S54925"},{"key":"key20190618000404_ref85","doi-asserted-by":"publisher","DOI":"10.1111\/resp.12200"},{"key":"key20190618000404_ref86","doi-asserted-by":"publisher","DOI":"10.2147\/COPD.S120555"},{"key":"key20190618000404_ref87","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2016.05.038"},{"key":"key20190618000404_ref88","doi-asserted-by":"publisher","DOI":"10.1183\/1393003.congress-2017.PA3714"},{"key":"key20190618000404_ref89","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2018.02.021"},{"key":"key20190618000404_ref90","doi-asserted-by":"publisher","DOI":"10.1097\/HCR.0000000000000194"},{"key":"key20190618000404_ref91","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-018-0718-1"},{"key":"key20190618000404_ref92","doi-asserted-by":"publisher","DOI":"10.1111\/resp.13224"},{"key":"key20190618000404_ref93","doi-asserted-by":"publisher","DOI":"10.2147\/COPD.S150650"},{"key":"key20190618000404_ref94","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2007.11.003"},{"key":"key20190618000404_ref95","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00073609"},{"key":"key20190618000404_ref96","doi-asserted-by":"publisher","DOI":"10.1097\/HCR.0b013e3181c9c985"},{"key":"key20190618000404_ref97","doi-asserted-by":"publisher","DOI":"10.1177\/1479972311430335"},{"key":"key20190618000404_ref98","doi-asserted-by":"publisher","DOI":"10.1097\/00008483-200601000-00010"},{"key":"key20190618000404_ref99","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200204-318OC"},{"key":"key20190618000404_ref100","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2016-208506"},{"key":"key20190618000404_ref101","doi-asserted-by":"publisher","DOI":"10.1513\/pats.201101-001RM"},{"key":"key20190618000404_ref102","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2012.09.018"},{"key":"key20190618000404_ref103","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200407-855OC"},{"key":"key20190618000404_ref104","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2012.08.016"},{"key":"key20190618000404_ref105","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-010106"},{"key":"key20190618000404_ref106","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-149-12-200812160-00006"},{"key":"key20190618000404_ref107","doi-asserted-by":"publisher","DOI":"10.1378\/chest.109.2.366"},{"key":"key20190618000404_ref108","first-page":"335","article-title":"Home based rehabilitation for patients with COPD. Is it equally effective as compared to outpatient rehabilitation?","volume":"59","author":"Wijkstra","year":"2003","journal-title":"Monaldi Arch Chest Dis"},{"key":"key20190618000404_ref109","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2016-209026"},{"key":"key20190618000404_ref110","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00083-2016"},{"key":"key20190618000404_ref111","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00084514"},{"key":"key20190618000404_ref112","doi-asserted-by":"publisher","DOI":"10.1378\/chest.14-1466"},{"key":"key20190618000404_ref113","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.5622"},{"key":"key20190618000404_ref114","doi-asserted-by":"crossref","first-page":"447","DOI":"10.23736\/S1973-9087.16.04374-4","article-title":"Effects of yogic exercises on functional capacity, lung function and quality of life in participants with obstructive pulmonary disease: a randomized controlled study","volume":"53","author":"Papp","year":"2017","journal-title":"Eur J Phys Rehabil Med"},{"key":"key20190618000404_ref115","doi-asserted-by":"publisher","DOI":"10.1177\/1479972317724570"},{"key":"key20190618000404_ref116","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2016-208514"},{"key":"key20190618000404_ref117","doi-asserted-by":"publisher","DOI":"10.1111\/resp.12966"},{"key":"key20190618000404_ref118","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.02129-2016"},{"key":"key20190618000404_ref119","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctcp.2017.11.006"},{"key":"key20190618000404_ref120","doi-asserted-by":"publisher","DOI":"10.1089\/acm.2013.0087"},{"key":"key20190618000404_ref121","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00036912"},{"key":"key20190618000404_ref122","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD009953.pub2"},{"key":"key20190618000404_ref123","doi-asserted-by":"publisher","DOI":"10.2147\/COPD.S70862"},{"key":"key20190618000404_ref124","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0061806"},{"key":"key20190618000404_ref125","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/502131"},{"key":"key20190618000404_ref126","doi-asserted-by":"publisher","DOI":"10.1159\/000134225"},{"key":"key20190618000404_ref127","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2014.05.005"},{"key":"key20190618000404_ref128","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2018.01.053"},{"key":"key20190618000404_ref129","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2015.09.004"},{"key":"key20190618000404_ref130","doi-asserted-by":"publisher","DOI":"10.1186\/1745-6215-15-337"},{"key":"key20190618000404_ref131","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2016.12.012"},{"key":"key20190618000404_ref132","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2016.12.019"},{"key":"key20190618000404_ref133","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2017.12.009"},{"key":"key20190618000404_ref134","doi-asserted-by":"publisher","DOI":"10.5603\/CJ.a2018.01"},{"key":"key20190618000404_ref135","doi-asserted-by":"publisher","DOI":"10.1177\/2047487312449597"},{"key":"key20190618000404_ref136","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.06.006"},{"key":"key20190618000404_ref137","doi-asserted-by":"publisher","DOI":"10.1097\/HJR.0b013e3283313592"},{"key":"key20190618000404_ref138","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e31823b21e2"}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj.l2191","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj.l2191","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,20]],"date-time":"2022-09-20T19:27:06Z","timestamp":1663702026000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj.l2191"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6,17]]},"references-count":138,"alternative-id":["10.1136\/bmj.l2191"],"URL":"https:\/\/doi.org\/10.1136\/bmj.l2191","relation":{},"ISSN":["0959-8138","1756-1833"],"issn-type":[{"value":"0959-8138","type":"print"},{"value":"1756-1833","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,6,17]]}}}