pneumonia. Therefore, interventions to minimise such declines are
crucial for these patients.
Mundy et al evaluated the effects of early mobilisation
performed by nurses on 456 patients who were hospitalised for
community-acquired pneumonia and found that hospitalisation
length and costs were reduced, with no adverse events.16 However,
this intervention was poorly described and the control group did
not receive any kind of standard respiratory physiotherapy. The
present study is the first to demonstrate the relative effects of a
physical training program on functional capacity for hospitalised
patients with community-acquired pneumonia. The aerobic and
resistance training provided a more effective recovery of functional
capacity than standard respiratory physiotherapy.
The loss of peripheral muscle strength is a common adverse
change in hospitalised patients, even during short periods of
hospitalisation.34 The interventions performed in the present
study led to a significant increase in peripheral muscle strength of
the exercised muscles, whereas no such increase occurred in the
control group. The training to improve peripheral muscle strength
was performed with elastic bands due to the difficulty in
transporting and storing weights in a hospital setting with limited
space. Elastic bands are a low-cost, highly practical alternative
with no need for more expensive equipment, which hospitals often
cannot provide, and are as effective as other recources.35
The evaluation of dyspnoea using the Medical Research Council
scale revealed a greater reduction in the experimental group than
in the control group, although both groups improved substantially.
However, if a reduction of 0.58 is considered clinically significant
for the Medical Research Council scale,36 this reduction occurred in
both groups. Besides the improvement in the clinical status and the
resolution of the lung disease, it is possible that the 10-minute
walk in the control group as well as the aerobic and resistance
training in the experimental group both led to a lower sensation of
dyspnoea upon discharge from the hospital.
The magnitude of change in CRP was similar in both groups,
suggesting that the common management or natural recovery
(rather than the randomised interventions) determined the
reduction in CRP. The association between CRP and functional
capacity was also investigated in the present study, but was not
significant. This was likely due to the low severity of communityacquired
pneumonia, since previous studies with severe patients
with high levels of CRP found such an association, along with a
worse prognosis. Moreover, a high level of CRP upon admission to
the hospital, the maintenance of this level after treatment and a
small reduction in comparison to the initial level have also been
associated with a worse prognosis as well as greater morbidity and
mortality rates.37,38
A limitation of the present study was that the researchers who
evaluated the Glittre Activities of Daily Living test, ISWT, quality of
life, dyspnoea, peripheral muscle strength and spirometry were the
same as those who performed the therapeutic interventions.
However, the evaluations were standardised with written guidelines
to minimise the potential for bias from unblinded assessors.
Furthermore, the assessors were blinded for some key study
outcomes such as CRP, length of stay and outcome (death or
hospital discharge).
In summary, this study identified significant improvements in
functional capacity, peripheral muscle strength, dyspnoea and
quality of life with inpatient exercise rehabilitation as opposed to
respiratory interventions. It is believed that these benefits, in
conjunction with other evidence about the benefits of inpatient
exercise in this population,16 are sufficient to recommend the use
of an inpatient rehabilitation program – especially where the
current routine treatment for these patients is respiratory
physiotherapy techniques, since the latter lacks robust evidence
to support its routine use in this population. Given the unexpected
effects of inpatient exercise rehabilitation in COPD exacerbations,
14 however, further research should investigate the effects of
the intervention of people with community-acquired pneumonia