Aerobic exercise: endurance training |
Impaired exercise capacity, limited by dyspnea and/or other respiratory symptoms Restriction in activities of daily living1111 Amaral AF, Coton S, Kato B, Tan WC, Studnicka M, Janson C, et al. Tuberculosis associates with both airflow obstruction and low lung function: BOLD results. Eur Respir J. 2015;46(4):1104-1112. https://doi.org/10.1183/13993003.02325-2014 https://doi.org/10.1183/13993003.02325-2...
,3232 Bongomin F. Post-tuberculosis chronic pulmonary aspergillosis: An emerging public health concern. PLoS Pathog. 2020;16(8):e1008742. https://doi.org/10.1371/journal.ppat.1008742 https://doi.org/10.1371/journal.ppat.100...
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• Treadmill and/or cycle ergometer • 30 min. 2-5 times/week for 4-8 weeks • Intensity set according to maximal oxygen consumption, Luxton equation, or 80% of maximum heart rate adjusted for dyspnea • Inpatients, outpatients, or telemonitoring • Suggest maintenance program |
• Free walking • 30 min. 2-5 times/week for 4-8 weeks • Intensity set according to perceived dyspnea • Outpatients or home setting • Suggest maintenance program |
Strength training: upper and lower extremities (limited evidence for tuberculosis) |
Reduced muscle mass and strength of peripheral muscles; lower muscle weakness with risk for falls Impaired activities of daily living involving the upper extremities (including dressing, bathing, and household tasks)1111 Amaral AF, Coton S, Kato B, Tan WC, Studnicka M, Janson C, et al. Tuberculosis associates with both airflow obstruction and low lung function: BOLD results. Eur Respir J. 2015;46(4):1104-1112. https://doi.org/10.1183/13993003.02325-2014 https://doi.org/10.1183/13993003.02325-2...
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• Free weights (dumbbells and ankle-braces) • 20-30 min. 2-5 times/week for 4-8 weeks • 2-3 sets of 6-12 repetitions • Intensity set to 80% of maximal voluntary contraction and/or adjusted for muscle fatigue • Inpatients, outpatients, or telemonitoring • Suggest maintenance program |
• Free weights (dumbbells and ankle-braces) • 20-30 min. 2-5 times/week for 4-8 weeks • 2-3 sets of 6-12 repetitions • Intensity set according to perceived muscle fatigue • Outpatients or home setting • Suggest maintenance program |
Inspiratory muscle training (limited evidence for tuberculosis) |
Impaired respiratory muscle function, altered respiratory mechanics, decreased chest wall compliance, or pulmonary hyperinflation |
• Load threshold devices, seated and using a nose clip • Interval training: sets of 10 exercise repetitions interspersed with 10-second breaks • 15-20 min. 2-5 times/week for 4-8 weeks • Loads from 30% to 80% of maximal inspiratory pressure |
• Not applicable |
Airway clearance techniques |
Difficult-to-remove secretions or mucous plugs; frequent bronchial exacerbations (≥ 2/year) Concomitant diagnosis of bronchiectasis |
• Choose the suitable technique for the subject among those available, based on respiratory capacity, mucus rheology, patient collaboration, and patient preferences • 15-30 min. one or more times/day • Choose the duration of treatment based on chronic (long-term) or acute (short-term) problem • Suggest maintenance program when needed |
• Choose the suitable technique for the subject among those available, based on respiratory capacity, mucus rheology, patient collaboration, and patient preferences • 15-30 min. one or more times/day • Choose the duration of treatment based on chronic (long-term) or acute (short-term) problem • Suggest maintenance program when needed |
Long-term oxygen therapy (limited evidence for tuberculosis) |
Resting hypoxemia despite stable condition and optimal medical therapy (partial pressure of oxygen < 55 mmHg or ≤ 60 mmHg with evidence of peripheral edema, polycythemia [haematocrit ≥ 55%], or pulmonary hypertension) |
• Titrate oxygen flow to maintain oxygen saturation > 92-93%. • Long-term oxygen therapy should be initiated on a flow rate of 1 L/min and titrated up in 1 L/min increments until oxygen saturation > 90% at rest has been achieved • An arterial blood gas analysis should then be performed to confirm that the target partial pressure of oxygen ≥ 60 mmHg at rest has been achieved • Ambulatory and nocturnal oximetry may be performed to allow more accurate flow rates to be prescribed for exercise and sleep, respectively • Provide formal education to patients referred home • Schedule periodic reassessment at 3 months |
• Titrate oxygen flow to maintain oxygen saturation > 92-93%. • Long-term oxygen therapy should be initiated on a flow rate of 1 L/min and titrated up in 1 L/min increments until oxygen saturation > 90% at rest has been achieved. • Non-hypercapnic patients initiated on long-term oxygen therapy should have their flow rate increased by 1 L/min during sleep in the absence of any contraindications • Ambulatory oximetry may be performed to allow more accurate flow rates to be prescribed for exercise • Provide formal education to patients referred home • Schedule periodic reassessment every 3 months |
Long-term nocturnal noninvasive mechanical ventilation (limited evidence for tuberculosis) |
Chronic stable hypercapnia (partial pressure of carbon dioxide > 45-60 mmHg) despite optimal medical therapy Noninvasive ventilation could be applied during aerobic training in case of severe breathlessness or reduced exercise resistance |
• Not initiating long-term noninvasive ventilation during admission for acute or chronic hypercapnic respiratory failure, favoring reassessment at 2-4 weeks after resolution • Titrate noninvasive ventilation settings • Titrate mask • Plan education • Consider noninvasive ventilation during exercise • Schedule an educational meeting and verify the ability of the subject and/or a caregiver to manage noninvasive ventilation at home |
• Probably not applicable |
Nutritional support |
Malnutrition (BMI < 16 kg/m2 or < 17 kg/m2 in patients with tuberculosis-HIV coinfection, patients with MDR tuberculosis, or in those who are pregnant or are lactating mothers) |
• Nutritional assessment • Tailored treatment: foods and medical supplements • Need for financial incentive and transportation access should be evaluated |
• Nutritional assessment • Tailored treatment: foods and medical supplements • Need for financial incentive and transportation access should be evaluated |
Psychological support |
Social isolation, depression, and/or anxiety Impaired health status and/or quality of life despite optimal pharmacological treatment Low adherence to medical treatment |
• Psychological assessment • Psychological support • Consider self-help group |
• Psychological assessment • Psychological support • Consider self-help group |