Individuals who present with a compromised pulmonary system, are acutely ill, or hospitalized for extended periods may become deconditioned or develop hospital-acquired muscle weakness, among other deleterious effects. Even healthy individuals may become deconditioned and frail if they decrease their activity level due to social distancing and limiting time outside their room or home.

• The effects of short-term physical inactivity (with step reduction) are reversible on resumption of habitual physical activity in younger people, but less so in older adults. (Bowden Davies et al., 2019)
• Frailty and pre-frailty are significant predictors of nursing home placement among community-dwelling older adults. (Gotaro, 2018)

As a result, rehab professionals should continue to emphasize activity and participation in therapy. Clinicians should use all available tools including electrical stimulation, cycling, virtual reality (VR), and balance trainers to maximize clinical outcomes. Vital signs such as heart rate (HR), blood pressure (BP), O2 saturation, respiratory rate (RR), and rate of perceived exertion (RPE) should be assessed before, during, and after exercise to assist the therapist in determining the appropriate exercise dose or the need for rest. Standardized outcome measures should also be used at baseline and throughout treatment to demonstrate and document progress.

Research supports the use of advanced technology and electrical stimulation in rehabilitation of deconditioned individuals.

• High intensity interval training (HIIT) increases cardiorespiratory fitness and exercise capacity with COPD. (Sawyer et al., 2020)
• A pulmonary rehab program with VR training is beneficial to improve physical fitness with COPD. (Rutkowski et al., 2020)
• Patterned electrical neuromuscular stimulation (PENS) applied to the quadriceps and hamstring muscles of patients
  with COPD results in 30% increased strength and 34% increased walking distance. (Bourjeily-Habr et al., 2002)

Electrical Stimulation: The use of patterned electrical neuromuscular stimulation (PENS) using OmniVersa^® prior to or during exercise can help re-establish normal recruitment and firing of muscles and facilitate higher level of participation.

References:
Bourjeily-Habr, G., Rochester, C. L., Palermo, F., Synder, P., Mohsenin, V. (2002). Randomized controlled trial of transcutaneous electrical nerve stimulation of the lower extremities in patients with chronic obstructive pulmonary disease. Thorax, 57(2), 1045-1049.
Bowden Davies, K. A., Pickles, S., Sprung, V. S., Kemp, G. J., Alam, U., Moore, D. R., Tahrani, A. A., Cuthbertson, D. J. (2019). Reduced physical activity in young and older adults: metabolic and musculoskeletal implications. Therapeutic Advances in Endocrinology and Metabolism. 10, 1-15.
Gotaro, K. (2018). Frailty as a Predictor of Nursing Home Placement Among Community-Dwelling Older Adults: A Systematic Review and Meta-analysis. Journal of Geriatric Physical Therapy. 41(1), 42-48.
Rutkowski, S., Rutkowska, A., Kiper, P., Jastrzebski, D., Racheniuk, H., Turolla, A., Szczegielniak, J., Casaburi, R. (2020). Virtual Reality Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. International Journal of Chronic Obstructive Pulmonary Disease. 15, 117-124.
Sawyer, A. Cavalheri, V., Hill, K. (2020). Effects of high intensity interval training on exercise capacity in people with chronic pulmonary conditions: a narrative review. BMC Sports Medicine and Rehabilitation. 12:22.
https://doi.org/10.1186/s13102-020-00167-y