[IS-01-1] Physical therapy in acute and chronic respiratory conditions：the ‘extra-pulmonary' challenges
Over the last 10 years the body of knowledge and evidence in the area of physical therapy for patients with acute and chronic respiratory conditions. The case for an evidence based treatment is best illustrated in patients with COPD. The contribution of physiotherapy in the treatment has grown tremendously. Recent literature has given more details on the relative contribution of the components of a multidisciplinary rehabilitation program and selection of patients for specific components of a rehabilitation program. The Royal Dutch Society for Physical Therapy（KNGF）Guideline for Physical therapy in patients with COPD provides a guide for physical therapists in the treatment of patients with COPD. Physical therapy consists of assessment（exercise testing, limb and respiratory muscle testing, physical activity monitoring, clinical evaluation, symptoms）and various treatment modalities（exercise training, peripheral and respiratory muscle training, breathing exercises）that are considered cornerstones of the rehabilitation program. In addition, much more emphasis is now placed on the assessment and treatment of physical inactivity in daily life. Physical inactivity in daily life is not only a prominent feature in advanced disease stages, especially after acute exacerbations of the disease, but has also been identified early in the disease process. Furthermore, it has become clear that changing a patient's lifestyle（inactivity in daily life, smoking）requires behavioral change strategies in the early stages of the disease, to improve long-term outcome in terms of health status.
Physical therapists are also involved in the management of patients with acute critical illness. In the Recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for critically ill patients special attention was given to the assessment and treatment of physical deconditioning（muscle weakness, joint stiffness, impaired functional exercise capacity, physical inactivity）in critically ill patients. In addition to the treatment of respiratory conditions（retained airway secretions, atelectasis and respiratory muscle weakness）, early physical activity and mobility are key in the prevention, attenuation or reversion of physical deconditioning related to critical illness. A variety of modalities for exercise training and early mobility are evidence based and are implemented depending on the stage of critical illness, comorbid conditions and level of cooperation of the patient. The physical therapist should be responsible for implementing mobilization plans and exercise prescription and make recommendation for progression of these jointly with medical and nursing staff.
Physical therapists are also involved in the management of patients with acute critical illness. In the Recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for critically ill patients special attention was given to the assessment and treatment of physical deconditioning（muscle weakness, joint stiffness, impaired functional exercise capacity, physical inactivity）in critically ill patients. In addition to the treatment of respiratory conditions（retained airway secretions, atelectasis and respiratory muscle weakness）, early physical activity and mobility are key in the prevention, attenuation or reversion of physical deconditioning related to critical illness. A variety of modalities for exercise training and early mobility are evidence based and are implemented depending on the stage of critical illness, comorbid conditions and level of cooperation of the patient. The physical therapist should be responsible for implementing mobilization plans and exercise prescription and make recommendation for progression of these jointly with medical and nursing staff.