Physiotherapy Intervention During Level I of Pulmonary Rehabilitation on Chronic Obstructive Pulmonary Disease: A Systematic Review

Guilherme Medeiros de Alvarenga1, 2, *, Humberto Remigio Gamba1, Lilian Elisa Hellman2, Vanusa Ganzert Ferrari2, Rafael Michel de Macedo3, 4
1 Graduate Program in Electrical and Computer Engineering from Universidade Tecnológica Federal do Paraná, Curitiba, PR, Brazil
2 Specialization Program in Physiotherapy on Gerontology from Universidade Positivo, Curitiba, PR, Brazil
3 Heart Academy, Rehabilitation Service from Hospital Cardiológico Costantini, Curitiba, PR, Brazil
4 Graduate Program in Health Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil

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© de Alvarenga et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (, which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Aristides Pereira da Cruz, n 21 casa 57 Curitiba, Paraná 80330-290, Brazil; Tel: +55 41 9962-2102; E-mails:,



The progressive and chronic course of COPD, characterized by difficulty in breathing, can be aggravated by periods of increased symptoms (exacerbation). The treatment often involves in-hospital care and among the interventions applied in COPD patients, physical therapy prompts good results. However the most used techniques are not properly pinpointed and there is no consensus in the literature regarding its effectiveness.


A systematic review was performed to identify which physical therapy treatment was applied in these cases. The following bibliographic databases were consulted: PubMed, and Bireme Portal, Periódicos Capes. Controlled randomized clinical trials that is under went physical therapy intervention in patients hospitalized for exacerbated COPD without the use of NIV (non-invasive ventilation) were included in the study. The PEDro scale, which has a score of 0-10, was used to evaluate the quality of studies included in this review.


The electronic search yielded a total of 302 references published in English, of which only 6 met the criteria for inclusion and exclusion.


It is possible to infer that physiotherapy’s techniques used in patients hospitalized for COPD exacerbation, based on this review, were the high frequency chest wall oscillation (HFCWO) on the chest; relaxing massage and active exercises, electrical stimulation via electro-acupuncture; strengthening of the quadriceps; the ELTGOL bronchial drainage technique (expiration with the glottis open in the lateral posture) and an incentive spirometer.

Keywords: COPD, exacerbation, hospitalization, physiotherapy intervention.