Terapi komplementer non invasif pada peningkatan status kesehatan sistem pernapasan penderita PPOK: Sebuah literature review

Senja Paramita, I Made Kariasa, Sri Yona


Non-invasive complementary therapies in improving the health status of the respiratory system in patients with COPD: A literature review 

Background: Patients with COPD need an individual treatment plan that aims to cope with symptoms and requires a different and individualized treatment plan. The medication and surgery cause several complications, accompanied by negative side effects, the “one size fits all as a universal approach" is inappropriate in the treatment of COPD. Therefore, non-pharmacological therapy needed to complement and must be part of comprehensive COPD management as rehabilitation in patients with COPD.

Purpose: A literature study was explore non-invasive complementary therapies in improving the health status of the respiratory system in patients with COPD

Method: Analysis based on articles from online databases Proquest, EBSCO, Cochrane, PubMed, and Google scholar. The criteria for the articles used are Randomized Controlled Trial (RCT), published in 2015-2020, in English, full text, accessible. The initial search found 875 articles, after going through the screening process, nine articles were found that were suitable and analyzed.

Results: Five types of interventions were found in nine publications, namely physical exercise, breathing exercises, chest physiotherapy, hypnosis, and transcutaneous electrical nerve stimulation providing various benefits on status. Globally there are three million deaths every year. The prevalence of COPD is expected to increase over the next 40 years and by 2060 it is estimated that there will be more than 5.4 million deaths each year due to COPD.

Keywords: Non-invasive; Complementary therapies; Health status; Respiratory system; COPD

Pendahuluan: Penderita PPOK membutuhkan rencana pengobatan individual yang bertujuan untuk menanggulangi gejala dan membutuhkan rencana penanganan yang berbeda dan bersifat individual. Mengingat penggunaan obat-obatan dan pembedahan menimbulkan banyak komplikasi dan disertai efek samping negative maka pendekatan “one size fits all” tidak cukup dalam pengobatan PPOK. Oleh karena itu, diperlukan terapi nonfarmakologis untuk melengkapi dan harus menjadi bagian dari manajemen PPOK yang komprehensif sebagai rehabilitasi pada penderita PPOK.

Tujuan: Sebuah studi literatur untuk mengeksplorasi terapi komplementer non-invasif dalam meningkatkan status kesehatan sistem pernapasan pada pasien PPOK

Metode: Analisa berdasarkan artikel yang berasal dari database online Proquest, EBSCO, Cochrane, PubMed, dan Google scholar. Kriteria artikel yang digunakan ialah Randomized Controlled Trial (RCT), diterbitkan pada tahun 2015-2020, berbahasa Inggris, teks lengkap, dapat diakses. Perncarian awal didapatkan 875 artikel setelah melalui proses penyaringan didapatkan sembilan artikel yang sesuai dan diananlisis.

Hasil: Didapatkan lima macam intervensi dalam sembilan publikasi yang ditemukan yaitu physical exercise, latihan pernapasan, fisioterapi dada,  hipnosis, dan trancutaneus electrical nerve stimulation memberikan manfaat yang beragam pada status. Secara global terdapat tiga juta kematian setiap tahunnya. Prevalensi PPOK diperkirakan akan meningkat selama 40 tahun ke depan dan pada tahun 2060 diperkirakan akan ada lebih dari 5,4 juta kematian setiap tahun disebabkan oleh PPOK.


Terapi; Komplementer Noninvasif; Sistem pernapasan; Penderita PPOK


Angelis, N., Porpodis, K., Zarogoulidis, P., Spyratos, D., Kioumis, I., Papaiwannou, A., & Zarogoulidis, K. (2014). Airway inflammation in chronic obstructive pulmonary disease. Journal of Thoracic Disease, 6(SUPPL1), 4–9. https://doi.org/10.3978/j.issn.2072-1439.2014.03.07

Anlló, H., Herer, B., Delignières, A., Bocahu, Y., Segundo, I., Mach Alingrin, V., & Larue, F. (2020). Hypnosis for the management of anxiety and dyspnea in COPD: A randomized, sham-controlled crossover trial. International Journal of COPD, 15, 2609–2620. https://doi.org/10.2147/COPD.S267019

Basri, R., Tahir, M., & Naseem, M. (2017). Short-term effects of chest physiotherapy in acute exacerbation of chronic obstructive pulmonary disease. Journal of Medical Sciences (Peshawar), 25(3), 323–327.

Beaumont, M., Mialon, P., Le Ber, C., Le Mevel, P., Péran, L., Meurisse, O.,& Couturaud, F. (2018). Effects of inspiratory muscle training on dyspnoea in severe COPD patients during pulmonary rehabilitation: Controlled randomised trial. European Respiratory Journal, 51(1). https://doi.org/10.1183/13993003.01107-2017

Berchtold, N. C., Patrick Kesslak, J., & Cotman, C. W. (2002). Hippocampal brain-derived neurotrophic factor gene regulation by exercise and the medial septum. Journal of Neuroscience Research. https://doi.org/10.1002/jnr.10256

Borge, C. R., Mengshoel, A. M., Omenaas, E., Moum, T., Ekman, I., Lein, M. P., & Wahl, A. K. (2015). Effects of guided deep breathing on breathlessness and the breathing pattern in chronic obstructive pulmonary disease: A double-blind randomized control study. Patient Education and Counseling, 98(2), 182–190. https://doi.org/10.1016/j.pec.2014.10.017

Brito, R. G., Rasmussen, L. A., & Sluka, K. A. (2017). Regular physical activity prevents development of chronic muscle pain through modulation of supraspinal opioid and serotonergic mechanisms. Pain reports, 2(5).

Chan, J. S., Liu, G., Liang, D., Deng, K., Wu, J., & Yan, J. H. (2019). Special issue–therapeutic benefits of physical activity for mood: a systematic review on the effects of exercise intensity, duration, and modality. The Journal of psychology, 153(1), 102-125.

Charususin, N., Dacha, S., Gosselink, R., Decramer, M., Von Leupoldt, A., Reijnders, T., & Langer, D., (2018). Respiratory muscle function and exercise limitation in patients with chronic obstructive pulmonary disease: a review. Expert review of respiratory medicine, 12(1), 67-79.

Chen X.D., Hong W.,& Qian W.( 2009). Psychological intervention in the treatment of essential hypertension with anxiety. Asia-Pac. Tradit. Med;5:139–141.

Chew, J., & Mahadeva, R. (2018). The role of a multidisciplinary severe chronic obstructive pulmonary disease hyperinflation service in patient selection for lung volume reduction. Journal of Thoracic Disease. https://doi.org/10.21037/jtd.2018.07.36

D’Ascola, A., Bruschetta, G., Zanghì, G., Campo, S., Medica, P., Campana, S.,& Ferlazzo, A. M. (2018). Changes in plasma 5-HT levels and equine leukocyte SERT expression in response to treadmill exercise. Research in Veterinary Science. https://doi.org/10.1016/j.rvsc.2018.02.012

Dalal, A. A., Shah, M., D’Souza, A. O., & Rane, P. (2011). Costs of COPD exacerbations in the emergency department and inpatient setting. Respiratory Medicine. https://doi.org/10.1016/j.rmed.2010.09.003

Davison, G. C., Williams, M. E., Nezami, E., Bice, T. L., & DeQuattro, V. L. (1991). Relaxation, reduction in angry articulated thoughts, and improvements in borderline hypertension and heart rate. Journal of Behavioral Medicine. https://doi.org/10.1007/BF00845104

Dong, Y. H., Chang, C. H., Gagne, J. J., Hsu, C. L., & Lai, M. S. (2016). Comparative cardiovascular and cerebrovascular safety of inhaled long‐acting bronchodilators in patients with chronic obstructive pulmonary disease: a population‐based cohort study. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 36(1), 26-37.

Embarak, S., Mansour, W., & Mortada, M. A. (2015). Pulmonary rehabilitation slows the decline in forced expiratory volume in 1 second and improves body mass index in patients with chronic obstructive pulmonary disease. Egyptian Journal of Chest Diseases and Tuberculosis, 64(1), 41-45.

Eren, G., Dogan, Y., Demir, G., Tulubas, E., Hergunsel, O., Tekdos, Y., & Abut, Y. (2015). Hypnosis for sedation in transesophageal echocardiography: A comparison with midazolam. Annals of Saudi Medicine. https://doi.org/10.5144/0256-4947.2015.58

GOLD. (2021). Gold 2021. Global Inititiative For Chronic Obstructive Lung Disease.

Hansen, M. L., Sorensen, R., Clausen, M. T., Fog-Petersen, M. L., Raunso, J., Gadsboll, N., & Torp-Pedersen, C. (2010). Davidson, S. (2014). Davidson’s principles and practise of medicine (22nd ed.). Edinburgh: Churchill Livingstone. Archives of Internal Medicine.

Grimminger, J., Ghofrani, H. A., Weissmann, N., Klose, H., & Grimminger, F. (2016). COPD-associated pulmonary hypertension: clinical implications and current methods for treatment. Expert review of respiratory medicine, 10(7), 755-766.

Haarmann, H., Mohrlang, C., Tschiesner, U., Rubin, D. B., Bornemann, T., Rüter, K., & Andreas, S. (2015). Inhaled β-agonist does not modify sympathetic activity in patients with COPD. BMC pulmonary medicine, 15(1), 1-10.

Hanania, N. A., & O'Donnell, D. E. (2019). Activity-related dyspnea in chronic obstructive pulmonary disease: physical and psychological consequences, unmet needs, and future directions. International journal of chronic obstructive pulmonary disease, 14, 1127.

Hocker, A. D., Morrison, N. R., Selby, M. L., & Huxtable, A. G. (2021). Maternal Methadone Destabilizes Neonatal Breathing and Desensitizes Neonates to Opioid-Induced Respiratory Frequency Depression. Frontiers in physiology, 12, 208.

Holt-Lunstad, J. (2018). Why social relationships are important for physical health: A systems approach to understanding and modifying risk and protection. Annual review of psychology, 69, 437-458.

Houchen-Wolloff, L., Williams, J. E. A., Green, R. H., Woltmann, G., Steiner, M. C., Sewell, L. &, Singh, S. J. (2018). Survival following pulmonary rehabilitation in patients with COPD: The effect of program completion and change in incremental shuttle walking test distance. International Journal of COPD. https://doi.org/10.2147/COPD.S143101

Hyland, M. E., Halpin, D. M., Blake, S., Seamark, C., Pinnuck, M., Ward, D., & Seamark, D. (2016). Preference for different relaxation techniques by COPD patients: comparison between six techniques. International journal of chronic obstructive pulmonary disease, 11, 2315.

Hynninen, M. J., Pallesen, S., & Nordhus, I. H. (2007). Factors affecting health status in COPD patients with co-morbid anxiety or depression. International Journal of COPD.

Jones, S. E., Barker, R. E., Nolan, C. M., Patel, S., Maddocks, M., & Man, W. D. (2018). Pulmonary rehabilitation in patients with an acute exacerbation of chronic obstructive pulmonary disease. Journal of thoracic disease, 10(Suppl 12), S1390.

Kaminsky, D. A., Guntupalli, K. K., Lippmann, J., Burns, S. M., Brock, M. A., Skelly, J., & Hanania, N. A. (2017). Effect of yoga breathing (pranayama) on exercise tolerance in patients with chronic obstructive pulmonary disease: a randomized, controlled trial. The Journal of Alternative and Complementary Medicine, 23(9), 696-704.

Karki, M. K. (2020). Science Behind Yoga Therapy. Journal of Evolutionary Medicine, 15-15.

Kuwano, K., Araya, J., Hara, H., Minagawa, S., Takasaka, N., Ito, S., & Nakayama, K. (2016). Cellular senescence and autophagy in the pathogenesis of chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF). Respiratory investigation, 54(6), 397-406.

Lahham, A., McDonald, C., & Holland, A. E. (2016). Exercise training alone or with the addition of activity counseling improves physical activity levels in copd: A systematic review and meta-analysis of randomized controlled trials. International Journal of COPD. https://doi.org/10.2147/COPD.S121263

Langer, D., Charususin, N., Jácome, C., Hoffman, M., McConnell, A., Decramer, M., & Gosselink, R. (2015). Efficacy of a novel method for inspiratory muscle training in people with chronic obstructive pulmonary disease. Physical therapy, 95(9), 1264-1273.

Lecheler, L., Richter, M., Franzen, D. P., Rampini, S. K., Cheetham, M., Jenewein, J., & Nowak, A. (2017). The frequent and underrecognised co-occurrence of acute exacerbated COPD and depression warrants screening: A systematic review. European Respiratory Review. https://doi.org/10.1183/16000617.0026-2017

Lenferink, A., van der Palen, J., & Effing, T. (2018). The role of social support in improving chronic obstructive pulmonary disease self-management. Expert review of respiratory medicine, 12(8), 623-626.

Liao, L. Y., Chen, K. M., Chung, W. S., & Chien, J. Y. (2015). Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: A randomized control trial. International Journal of COPD, 10(1), 1703–1709. https://doi.org/10.2147/COPD.S90673

Liao, W. H., Chen, J. W., Chen, X., Lin, L., Yan, H. Y., Zhou, Y. Q., & Chen, R. (2015). Impact of resistance training in subjects with COPD: A systematic review and meta-analysis. Respiratory Care. https://doi.org/10.4187/respcare.03598

Li, C., Liu, Y., Ji, Y., Xie, L., & Hou, Z. (2018). Efficacy of yoga training in chronic obstructive pulmonary disease patients: a systematic review and meta-analysis. Complementary therapies in clinical practice, 30, 33-37.

Li, G., Li, S., Sun, L., Lin, F., & Wang, B. (2015). A comparison study of immune-inflammatory response in electroacupuncture and transcutaneous electrical nerve stimulation for patients undergoing supratentorial craniotomy. International journal of clinical and experimental medicine, 8(2), 2662.

Li, Z. (2011). Clinical effect of Taijiquan on relieving depression and anxiety of chronic obstructive pulmonary disease. Chin J Aesthetic Med, 20(s6), 129-30.

Li, Z., Liu, S., Wang, L., & Smith, L. (2020). Mind–body exercise for anxiety and depression in copd patients: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health. https://doi.org/10.3390/ijerph17010022

Lindquist, R., Snyder, M., & Tracy, M. F. (2014). Complementary and Alternative Therapies in Nursing (7th editio). New York: Springer.

Mammen, M. J., & Sethi, S. (2016). COPD and the microbiome. Respirology, 21(4), 590-599.

McCarthy, B., Casey, D., Devane, D., Murphy, K., Murphy, E., & Lacasse, Y. (2015). Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane database of systematic reviews, (2).

Mokhtari, T., Ren, Q., Li, N., Wang, F., Bi, Y., & Hu, L. (2020). Transcutaneous electrical nerve stimulation in relieving neuropathic pain: basic mechanisms and clinical applications. Current pain and headache reports, 24(4), 1-14.

Moore, E., Palmer, T., Newson, R., Majeed, A., Quint, J. K., & Soljak, M. A. (2016). Pulmonary Rehabilitation as a Mechanism to Reduce Hospitalizations for Acute Exacerbations of COPD: A Systematic Review and Meta-Analysis. Chest. https://doi.org/10.1016/j.chest.2016.05.038

Naghavi, M., Wang, H., Lozano, R., Davis, A., Liang, X., Zhou, M., Temesgen, A. M. (2015). Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013. The Lancet. https://doi.org/10.1016/S0140-6736(14)61682-2

Neuman, Å., Gunnbjörnsdottir, M., Tunsäter, A., Nyström, L., Franklin, K. A., Norrman, E., & Janson, C. (2006). Dyspnea in relation to symptoms of anxiety and depression: A prospective population study. Respiratory Medicine. https://doi.org/10.1016/j.rmed.2006.01.016

Ngai, S. P. C., Jones, A. Y. M., Hui-Chan, C. W. Y., Yu, H. P. M., & He, C. Q. (2011). Acute effects of Acu-TENS on FEV1 and Blood β-endorphin Level in Chronic Obstructive Pulmonary Disease. Alternative Therapies in Health and Medicine.

Ngai, S. P. C., Spencer, L. M., Jones, A. Y. M., Alison, J. A., & Vemulpad, S. (2017). Acu-TENS reduces breathlessness during exercise in people with chronic obstructive pulmonary disease. Evidence-Based Complementary and Alternative Medicine, 2017. https://doi.org/10.1155/2017/3649257

NICE. (2017). Guideline scope Chronic obstructive pulmonary disease in over 16s : diagnosis and management ( update ), (February), 1–17.

Nishi, S. P., Zhang, W., Kuo, Y. F., & Sharma, G. (2016). Pulmonary rehabilitation use in older adults with chronic obstructive pulmonary disease, 2003-2012. Journal of cardiopulmonary rehabilitation and prevention, 36(5), 375.

O’Donnell, D. E., Milne, K. M., James, M. D., de Torres, J. P., & Neder, J. A. (2020). Dyspnea in COPD: New Mechanistic Insights and Management Implications. Advances in Therapy. https://doi.org/10.1007/s12325-019-01128-9

Oshvandi, K., Bostanbakhsh, A., Salavati, M., Bakhsai, M., Moghimbeighi, A., & Maghsoudi, Z. (2020). Effect of Respiratory Exercises on the Prevalence of Atelectasis in Patients Undergoing Coronary Artery Bypass Surgery. Avicenna Journal of Nursing and Midwifery Care, 27(6), 432-440.

Perkins-Porras, L., Riaz, M., Okekunle, A., Zhelezna, S., Chakravorty, I., & Ussher, M. (2018). Feasibility study to assess the effect of a brief mindfulness intervention for patients with chronic obstructive pulmonary disease: A randomized controlled trial. Chronic Respiratory Disease, 15(4), 400–410. https://doi.org/10.1177/1479972318766140

Pomidori, L., Campigotto, F., Amatya, T. M., Bernardi, L., & Cogo, A. (2009). Efficacy and tolerability of yoga breathing in patients with chronic obstructive pulmonary disease: A pilot study. Journal of Cardiopulmonary Rehabilitation and Prevention. https://doi.org/10.1097/HCR.0b013e31819a0227

Ramlakhan, S., Mason, S., O'Keeffe, C., Ramtahal, A., & Ablard, S. (2016). Primary care services located with EDs: a review of effectiveness. Emergency Medicine Journal, 33(7), 495-503.

Ranjita, R., Hankey, A., Nagendra, H. R., & Mohanty, S. (2016). Yoga-based pulmonary rehabilitation for the management of dyspnea in coal miners with chronic obstructive pulmonary disease: a randomized controlled trial. Journal of Ayurveda and integrative medicine, 7(3), 158-166.

Reel, J., & Campbell, H. (2016). Complementary Therapies for Chronic Obstructive Pulmonary Disease. Journal of Community Medicine & Health Education, 06(01), 6–8. https://doi.org/10.4172/2161-0711.1000e125

Roberts, N. J., Mph, I. Y., Kidd, L., & Frcp, M. R. P. (2016). Barriers to the implementation of self management support in long term lung conditions Barriers to the implementation of self management support in long term lung conditions, 1472(March). https://doi.org/10.1080/17571472.2013.11493370

Rong, X. ., Li, C. ., & Liang, D. (2018). The Effect of Tai Chi on Cardiopulmonary Function of Middle-Aged and Elderly People. Traditional Chinese Medicine, 07(05), 302–306. https://doi.org/10.12677/tcm.2018.75052

Rostami, S., Haghparast, A., & Fayazmilani, R. (2021). The role of pre-pubertal training history on hippocampal neurotrophic factors and glucocorticoid receptor protein levels in adult male rats. Neuroscience Letters, 752, 135834.

Santana, M. J., S-Parrilla, J., Mirus, J., Loadman, M. A., Lien, D. C., & Feeny, D. (2013). An assessment of the effects of Iyengar yoga practice on the health-related quality of life of patients with chronic respiratory diseases: A pilot study. Canadian Respiratory Journal. https://doi.org/10.1155/2013/265406

Satake, M., Shioya, T., Uemura, S., Takahashi, H., Sugawara, K., Kasai, C., & Kawagoshi, A. (2015). Dynamic hyperinflation and dyspnea during the 6-minute walk test in stable chronic obstructive pulmonary disease patients. International journal of chronic obstructive pulmonary disease, 10, 153.

Selman, L., McDermott, K., Donesky, D., Citron, T., & Howie-Esquivel, J. (2015). Appropriateness and acceptability of a Tele-Yoga intervention for people with heart failure and chronic obstructive pulmonary disease: qualitative findings from a controlled pilot study. BMC complementary and alternative medicine, 15(1), 1-13.

Šileikienė, V., Urbonas, M., Matačiūnas, M., & Norkūnienė, J. (2017). Relationships between pulmonary function test parameters and quantitative computed tomography measurements of emphysema in subjects with chronic obstructive pulmonary disease. Acta medica Lituanica, 24(4), 209.

Song, W. J., Chang, Y. S., Faruqi, S., Kim, J. Y., Kang, M. G., Kim, S., & Morice, A. H. (2015). The global epidemiology of chronic cough in adults: a systematic review and meta-analysis. European Respiratory Journal, 45(5), 1479-1481.

Soni, R., Singh, K., Munish, K., & Singh, S. (2012). Study of the effect of yoga training on diffusion capacity in chronic obstructive pulmonary disease patients: A controlled trial. International Journal of Yoga. https://doi.org/10.4103/0973-6131.98230

Spalletta, G., Bossù, P., Ciaramella, A., Bria, P., Caltagirone, C., & Robinson, R. G. (2006). The etiology of poststroke depression: A review of the literature and a new hypothesis involving inflammatory cytokines. Molecular Psychiatry, 11(11), 984–991. https://doi.org/10.1038/sj.mp.4001879

Staub, L. J., Biscaro, R. R. M., Kaszubowski, E., & Maurici, R. (2019). Lung ultrasound for the emergency diagnosis of pneumonia, acute heart failure, and exacerbations of chronic obstructive pulmonary disease/asthma in adults: a systematic review and meta-analysis. The Journal of emergency medicine, 56(1), 53-69.

Stavrou, N. A. M., Debevec, T., Eiken, O., & Mekjavic, I. B. (2018). Hypoxia exacerbates negative emotional state during inactivity: The effect of 21 days hypoxic bed rest and confinement. Frontiers in Physiology. https://doi.org/10.3389/fphys.2018.00026

Sze, M. A., Hogg, J. C., & Sin, D. D. (2014). Bacterial microbiome of lungs in COPD. International Journal of COPD. https://doi.org/10.2147/COPD.S38932

Tricco, A. C., Strifler, L., Veroniki, A. A., Yazdi, F., Khan, P. A., Scott, A.,& Straus, S. E. (2015). Comparative safety and effectiveness of long-acting inhaled agents for treating chronic obstructive pulmonary disease: A systematic review and network meta-analysis. BMJ Open, 5(10), 1–13. https://doi.org/10.1136/bmjopen-2015-009183

Volpato, E., Banfi, P., Nicolini, A., & Pagnini, F. (2018). A quick relaxation exercise for people with chronic obstructive pulmonary disease: Explorative randomized controlled trial. Multidisciplinary Respiratory Medicine. https://doi.org/10.1186/s40248-018-0124-9

Wang, C., Schmid, C., Kalish, R., Yinh, J., Goldenberg, D. L., Rones, R., & McAlindon, T. (2009). Tai Chi is effective in treating fibromyalgia: A randomized controlled trial. Arthritis and Rheumatism.

Wegner, M., Helmich, I., Machado, S., Nardi, A. E., Arias-Carrión, O., & Budde, H. (2014). Send Orders for Reprints to reprints@benthamscience.net Effects of Exercise on Anxiety and Depression Disorders: Review of Meta-Analyses and Neurobiological Mechanisms. CNS & Neurological Disorders-Drug Targets, 13, 1002–1014.

Westerdahl, E., Lindmark, B., Eriksson, T., Friberg, Ö., Hedenstierna, G., & Tenling, A. (2005). Deep-breathing exercises reduce atelectasis and improve pulmonary function after coronary artery bypass surgery. Chest, 128(5), 3482–3488. https://doi.org/10.1378/chest.128.5.3482

William, E. (2018). Cardiovascular and pulmonary physical therapy: an evidence-based approach. McGraw-Hill Medical.

Wu, W., Liu, X., Li, P., Li, N., & Wang, Z. (2018). Effect of Liuzijue Exercise Combined with Elastic Band Resistance Exercise on Patients with COPD: A Randomized Controlled Trial. Evidence-Based Complementary and Alternative Medicine, 2018. https://doi.org/10.1155/2018/2361962

Xu, W., Collet, J. P., Shapiro, S., Lin, Y., Yang, T., Platt, R. W. & Bourbeau, J. (2008). Independent effect of depression and anxiety on chronic obstructive pulmonary disease exacerbations and hospitalizations. American Journal of Respiratory and Critical Care Medicine. https://doi.org/10.1164/rccm.200804-619OC

Yeh, G. Y., Wayne, P. M., Litrownik, D., Roberts, D. H., Davis, R. B., & Moy, M. L. (2014). Tai chi mind-body exercise in patients with COPD: Study protocol for a randomized controlled trial. Trials. https://doi.org/10.1186/1745-6215-15-337

Yu, A. P., Tam, B. T., Lai, C. W., Yu, D. S., Woo, J., Chung, K. F., & Siu, P. M. (2018). Revealing the neural mechanisms underlying the beneficial effects of Tai Chi: a neuroimaging perspective. The American journal of Chinese medicine, 46(02), 231-259.

DOI: https://doi.org/10.33024/hjk.v15i2.4449


  • There are currently no refbacks.

Copyright (c) 2021 Holistik Jurnal Kesehatan

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.