From the Guidelines
The optimal number of rehabilitation sessions per week for maximum results is at least three times per week.
Key Points
- A minimum of 20 sessions should be given at least three times per week to achieve physiologic benefits 1.
- Twice-weekly supervised plus one unsupervised home session may also be acceptable 1.
- Patients should perform exercise at least three times per week, and regular supervision of exercise sessions is necessary to achieve optimal physiologic benefits 1.
- The combination of endurance and strength training generally has multiple beneficial effects and is well tolerated 1.
Details
Some studies suggest that high-intensity exercise produces greater physiologic benefit and should be encouraged 1. However, low-intensity training is also effective for those patients who cannot achieve this level of intensity 1. Interval training may be useful in promoting higher levels of exercise training in the more symptomatic patients 1. Both upper and lower extremity training should be utilized 1. The American College of Sports Medicine recommends that, to enhance muscle strength in adults, 1 to 3 sets of 8 to 12 repetitions should be undertaken on 2 to 3 days each week 1. Initial loads equivalent to either 60 to 70% of the one repetition maximum or one that evokes fatigue after 8 to 12 repetitions are appropriate 1. Resistance training has greater potential to improve muscle mass and strength than endurance training 1. The optimal resistance training prescription for patients with chronic respiratory disease is not determined 1. Some work has shown that the skeletal muscles of patients with COPD are, in general, dysfunctional 1. In patients with COPD, there is a strong scientific basis for implementing endurance-training programs in regard to both design and benefits 1. Well-designed strength-training programs increase muscle strength and mass in patients with moderate-to-severe COPD 1. Strength training, when delivered as an isolated intervention may improve disease-specific quality of life but does not seem to produce additional gains when added to a program of endurance training 1. No serious adverse effects of strength training have been reported 1. Little information is available on the long-term benefits of strength training in the pulmonary rehabilitation patient 1. Larger, longer term trials are required to resolve these issues 1.
From the Research
Optimal Number of Rehabilitation Sessions per Week
The optimal number of rehabilitation sessions per week for maximum results varies depending on the type of rehabilitation and the individual's condition.
- For patients with coronary artery disease (CAD), a study found that 3 sessions per week of high-intensity interval training (HIIT) or moderate-intensity continuous training (MICT) for 4 weeks, followed by 3 home-based sessions per week for 48 weeks, improved cardiorespiratory fitness 2.
- For knee osteoarthritis, a systematic review and meta-regression analysis found that supervised exercise programs with a frequency of at least 3 times a week were more effective in reducing pain and improving function than programs with a lower frequency 3.
- For stroke rehabilitation, a systematic review found that increasing the time spent in rehabilitation resulted in little to no difference in activities of daily living and upper and lower limb activities, but a small benefit in measures of motor impairment 4.
- For arthroscopic rotator cuff repair, a quasi-randomized study found that a supervised, controlled rehabilitation program with low-frequency visits (once every 2 weeks for the first 6 weeks and once a week for the following 6 weeks) was sufficient to achieve optimal clinical results and reduce rehabilitation-related costs 5.
- For inpatient stroke rehabilitation, a retrospective chart review found that patients received an average of 1.5 to 1.7 therapy sessions per day, 5 to 6 days per week, with a mean duration of 29-30 minutes per session 6.
Key Findings
- The frequency and duration of rehabilitation sessions can vary depending on the individual's condition and the type of rehabilitation.
- Supervised exercise programs with a frequency of at least 3 times a week may be more effective in reducing pain and improving function for certain conditions, such as knee osteoarthritis.
- Increasing the time spent in rehabilitation may result in a small benefit in measures of motor impairment, but may not significantly improve activities of daily living and upper and lower limb activities.
- A supervised, controlled rehabilitation program with low-frequency visits may be sufficient to achieve optimal clinical results and reduce rehabilitation-related costs for certain conditions, such as arthroscopic rotator cuff repair.