Chronic Obstructive Pulmonary Disease and Overtraining Syndrome: A Narrative Review.

Chronic obstructive pulmonary disease (COPD) is a condition that inevitably leads to airflow limitation. COPD is among the leading causes of increased mortality and morbidity worldwide. A non-invasive and non-pharmacological approach is rehabilitation training, where the patient follows an active program to stimulate the limb and respiratory muscles. Training involves a constant increase in workloads throughout the rehabilitation process. A fundamental concept absent from the literature is that of including training sessions with reduced loads and periods of "unloading" intensity within the rehabilitation program. Without adequate recovery and rest between sessions, the patient may lack the resources necessary to tackle a subsequent demanding rehabilitation session. This situation could lead to the onset of overtraining syndrome (OTS), where the patient experiences an unexplained decline in performance. The article reviews the muscular adaptation of COPD patients and the planned rehabilitation and emphasizes the concept that clinicians should structure the rehabilitation training program not in a linear fashion (constantly increasing loads), but in a wave-like fashion (scheduling some sessions with decreased loads). This organization could benefit the patient's performance, reducing the risk of OTS.