2. DEFINITION
• PULMONARY REHABILITATION has been defined by the American
Thoracic Society and European Respiratory Society in 2013.
• 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.
4. RESPIRATION
Process of moving oxygen from
the air to alveoli of the lungs by a
mass movement of air and
removing carbon dioxide from
alveoli by the same movement
The circulatory system provide
the transport of oxygen between
lung and the tissue.
5. PHYSIOLOGICAL DISORDERS OF RESPIRATION
• Inadequate transport of oxygen in and carbon dioxide out
Of the lung
• Retention of carbon dioxide
• Lack of oxygen
6. STRUCTURE OF (PR)
• PR programs can vary in length, anywhere from 6-8 weeks
to a year.
• The British Thoracic Society’s guideline 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 dyspnea, fatigue, emotional function and
mastery.
• Guidelines recommend that individuals be offered some
sort of exercise program after finishing PR.
7. CONTRAINDICATIONS
According to the NICE guideline, the following people should not
undergo PR:
• Those who are unable to walk
• Those who have unstable angina
• People who have had a recent myocardial infarction.
8. BENEFITS OF PULMONARY REHABILITATION
• You might have fewer symptoms, like
less cough or less shortness of breath.
• Your quality of life may improve.
• You may be able to walk more or
improve your ability to exercise.
• You may feel better about yourself or
feel less anxious.
• You may feel less tired
9. THE AIM OF CONTROL BREATHING:
A. Help the patients relieve and control breathlessness.
B. Improve ventilator pattern.
C. Prevent dynamic airway compression.
D. Improve gas exchange.
10. PATIENT SELECTION
• Symptomatic lung disease
• Stable on standard therapy
• Function limitation because of disease
• Motivated to be actively involved in and take responsibility
for own health care.
11. (PR) TEAM
• Your rehab: team often includes;
• Doctors
• Nurses
• Physical Therapists
• Respiratory Therapists
• Exercise specialists
• Dietitians, together, these health professionals create a personal
program to meet your specific needs.
12. INTERVENTION
• PHYSIOTHERAPISTS play an important role in prescribing, supervising, and
measuring outcomes in exercise:
• PULMONARY CARE: Positioning, exercises, bronchodilator, etc.
• FUNCTIONAL TRAINING: Important in end-stage disease or extreme
weakness
or fatigue.
• Adapt the environment to improve ease
• Work areas supported in convenient places to avoid bending
• Locate a table to slide heavy objects while working
• Chairs at landings of stairs, besides bathtubs
• Using adaptive equipment and assistive technology
• Using good ventilation to kitchens etc.
13. SPECIFIC EXERCISE INTERVENTION
• Exercise prescription should include supervised aerobic exercise and
progressive resistance exercise. Exercise should be individually
prescribed according to the initial assessment and goals should be
identified and agreed. Participants exertion should be regularly
monitored, paying particular attention to chest pain, discomfort or
breathlessness:
14. FOR MILD LUNG DISEASE
• 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 hypoxemia
• Exercise testing and training, individual exercises prescribed, formal
rehab not required
15. FOR MODERATE LUNG DISEASE
• 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) i.e. 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 dysphonic of perceived
exertion
• Frequency: 5-7 times a week
• If symptoms develop use O2.
16. FOR SEVERE LUNG DISEASE
• 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 mints, 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.
