Introduction [edit | edit source]Pulmonary rehabilitation has been defined by the American Thoracic Society and European Respiratory Society in 2013 Show
Pulmonary rehabilitation (PR) is a “comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies that include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors”[1] PR is tailored to the individual who has recently had an exacerbation, with the aim of optimizing their respiratory function and therefore their quality of life (QOL) and participation in their everyday lives. PR has been proven to significantly improve health related QOL and exercise capacity in individuals with Chronic Respiratory Pulmonary Disorder (COPD) compared to usual care[2]. Studies suggest PR is useful in patients with moderate-to-severe COPD[3]. Individuals with COPD who undergo PR are likely to have better utilisation of healthcare service for the next 12 months, although it is unclear whether these benefits last beyond this.[4] What is PR [edit | edit source]PR programmes vary from person to person and from centre to centre, depending on available resources, but in general will include[5]:
Structure [edit | edit source]PR programmes can vary in length, anywhere from 6-8 weeks to a year[2]. The British Thoracic Society’s guideline[6] recommends 6-12 weeks with twice weekly supervised exercise sessions (with a third unsupervised session), at a minimum of 12 supervised sessions. PR can be based in hospital, in the community or in both. Research suggests that better outcomes are observed in inpatient-based PR compared to community-based PR as measured by the Chronic Respiratory Questionnaire which measures dyspnoea, fatigue, emotional function and mastery[2]. Guidelines recommend that individuals be offered some sort of exercise program after finishing PR (see below). Adherence [edit | edit source]NICE guidelines recommend emphasizing the importance of adherence to PR to individuals in order to achieve improvements in QOL and respiratory function[5]. Specific ways to improve adherence include optimising access to PR, this includes: suitable times for classes, appropriate physical access to facilities, good public transport links and timely referrals to PR[5]. Maintenance [edit | edit source]Guidelines recommend maintenance of exercise after PR[6] to maintain gains made in respiratory function, exercise tolerance and QOL. A recent study has shown that gains made after an eight-week outpatient PR programme can be maintained at two years follow up in people with moderate-to-severe COPD with a maintenance programme[7]. Individuals in this study showed better maintenance in scores for 6-minute-walk distance and body mass index, airflow obstruction, dyspnea score and exercise capacity. The maintenance programme was focused on exercise and included cycle ergometers in homes and hospital-based supervised exercise sessions every other week. Adherence to this maintenance programme was 66%. Contraindications [edit | edit source]According to the NICE guideline[5], the following people should not undergo PR:
Considerations [edit | edit source]Other factors worth considering include[6]:
Intervention [edit | edit source]Physiotherapists play an important role in prescribing, supervising, and measuring outcomes in exercise. Research shows there has been an increase in the use of guideline-based exercise prescription methodology (using FITT methodology - Frequency, Intensity, Time, Type)[8]. Participants engaging in both functional and maximal exercise show statistically significant improvements after PR, compared with usual care[2]. Pulmonary care: Positioning, exercises, bronchiodialator, etc Functional training: Important in end-stage disease or extreme weakness or fatigue
Specific Exercise Intervention[edit | edit source]Exercise prescription should include supervised aerobic exercise and progressive resistance exercise[6]. Exercise should be individually prescribed according to the initial assessment and goals should be identified and agreed[6]. Participants' exertion should be regularly monitored, paying particular attention to chest pain, discomfort or breathlessness. For the latter, the BORG scale can be used. For exercise prescription ideas see here. For mild lung disease[edit | edit source]•Have symptoms with extreme effort (cough, sputum) •Spirometry: Show the predicted Vital Capacity(VC), FEV1(Forced expiratory volume in the 1st second) is 70-80% •ABG: normal, mild hypoxaemia •Exercise testing and training, individual exercises prescribed, formal rehab not required For moderate lung disease[edit | edit source]•Subjects with moderate lung disease typically have shortness of breath on daily activities •Episode of acute pneumonia after major surgery is when the pulmonary disease is identified, demonstrates good results with PR •VC and FEV1 55-70% (indicates shortness of breath at app 3-4 METS) •Exercise testing: start at a low Metabolic equivalent (MET) ie 1.5 MET and progress 0.5 MET at each stage, monitoring ECG, BP, HR or perform a 12-minute walk test Exercise prescription: •Intensity: HR at a point when patient is 2-3 dyspnoeic on the Borgs scale of perceived exertion •Frequency: 5-7 times a week •If symptoms develop use O2 For Severe Lung disease[edit | edit source]•Shortness of breath on most activities of daily living •VC and FEV1 <50% •Needs oxygen at rest •Some show R ventricular dysfunction •Testing: low level intermittent test or exercises set at a steady endurance test of 2-3 METs •Training: interval training, short exercise bouts, frequent rests, once a day, when duration increases to 20 mins, 5 times a week •Intensive monitoring: When monitoring Oxygen, every decrease in SPO2 of 3%, should be noted. If the drop reached <88% SPO2 oxygen therapy is indicated.[9] [10] Resources [edit | edit source]NICE guideline British Thoracic Society guideline Lung Foundation Australia Pulmonary Rehabilitation Toolkit American Thoracic Society Patient Information References [edit | edit source]
What are the goals of pulmonary rehabilitation?Pulmonary Rehabilitation has three main goals:. Help your shortness of breath.. Improve your quality of life.. Improve your ability to do daily living activities, like housework or going out with your family.. What are the three primary goals of pulmonary rehabilitation?The basic goals of pulmonary rehabilitation are to (1) improve symptoms, (2) restore functional capabilities, and (3) enhance overall quality of life.
What are the key components of pulmonary rehab?Components of Pulmonary Rehabilitation. Exercise training.. Inspiratory muscle training.. Neuromuscular electrical stimulation.. Psychosocial counseling.. Nutritional evaluation and counseling.. Education, including on proper use of prescribed drugs.. What are the three components of a cardiopulmonary rehabilitation program quizlet?What is a cardiac rehabilitation program? a multidiscipline program of exercise, education, and lifestyle modification and is a covered service under the Centers for Medicare and Medicaid and outlined in a National coverage Determination, including a description of the patient diagnosis, program components, etc.
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