PRATIGYA DEUJA- PULMO REHAB definition, goals, phases of rehab, breathlessness management, assessment, test and review

1. PRATIGYA DEUJA

2.  Pulmonary rehabilitation is a program of education
and exercise that helps you manage your breathing
problem, increase your stamina(energy) and
decrease breathlessness. (American Thoracic
Society).
 It is an integral part of the clinical management and
health maintenance of those patient with chronic
respiratory disease who remain symptomatic or
continue to have decreased function despite
standard medical treatment.

3. 1) The goals of rehabilitation are to reduce the
symptoms, disability and handicap and to improve
functional independence in people with lung
disease.
2) To increase the muscle strength and
endurance(peripheral and respiratory).
3) To help in managing anxiety and depression.
4) These goals are achieved through patient and family
education, exercise training, psychosocial and
behavioral intervention and outcome assessement.

4. 1) Decrease breathlessness by 65%.
2) Increase capacity and quality of life even for
severely impaired patients.
3) Decrease health care costs.
4) In modified form, increase ability to wean from
mechanical ventilation.
5) Reduced exacerbations post pulmonary
rehabilitation.

5. Respiratory impairment: Decrease lung function.
e.g, FEV₁
Respiratory disability: The effect of this
impairment, e.g. anxiety or decrease exercise
capacity.
Respiratory handicap: social and other
disadvantages.

6. Oximetry
6 minute distance
Stair climbing:- Climbing upstairs, counting the
number of steps that can be climbed up and down in
2 minutes.
Shuttle test
Treadmill walking

8. 1) Check in phase:
 Pre-training vitals are taken.
2) Warm up phase:
 Preparing muscle for exercise which includes
walking, stretching and jogging.
 Done for 5-15 minutes
 Stretching followed in expiration, during inspiration
it might leads to valsalva maneuver.

9. 3) Aerobic exercises:
 All mobility exercises are done.
 It includes walking, cycling, treadmill, postural
drainage, ACBT( active cycle of breathing technique)
 Before the aerobic training session they should
complete a course which includes:
 A course duration of 4-12 weeks
 Training session 2-5 times per week
 A session duration of 20-30 minutes
 A target heart rate corresponding to 60% V0₂
max

10. Strategies to progress exercise:
 setting the duration and increasing the work rate
 setting the intensity and increasing the duration of
exercise
 The training intensity may be set using heart rate,
treadmill speed, shuttle walking speed, or cycle
ergometer load at the given percentage of peak work
rate during the preliminary exercise test.

11. 4) Cool down phase:
 It is done for 5-10 minutes
 The work load are decreased
PATIENT EDUCATION
 Dyspnoea and it’s management
 Nutritional advice
 Anxiety management
 Relaxation
 Oxygen therapy

12.  Prioritize activities
 Organize chores by location to avoid multiple trips.
 Co-ordinate breathing. Example; inhale with pulling
and exhale with pushing.
 Lean on shopping trolleys.
 Organize work space to reduce clutter and minimize
reaching and bending.
 Ensure that work surfaces are at the correct height.
 Keep heavy items on top of the work.
 Develop economic lifting methods using leg power
rather than back and shoulders.

13.  Slide pots and pans along the work top rather than
lifting them.
 Soak washing up.
 Use a stool for kitchen work and ironing (it saves
24% of energy)
 Reduce bending by crossing one leg over other to
put on socks, trousers and shoes.
 Avoid aerosols or strongly scented perfumes.

15. 1) Maximum shortness of breath
2) Fall in partial pressure of O₂ >20 mmhg or partial
pressure of O₂ <55 mmhg
3) Rise in partial pressure of Co₂ >10 mmhg and <65 mmhg
4) Cardiac ischemia
5) Symptoms of fatigue
6) Increased diastolic pressure >20 mmhg, systolic HTN
>250 mmhg
7) Leg pain
8) Total fatigue
9) Signs of insufficient cardiac output
10) Reaching ventilatory maximum

16. 1) K. Liu et al. in their RCT took total 76 patients and divide
them into two groups i.e intervention group (n=38), out
of which 2 abandoned in between and control group
(n=38). The intervention group performed Respiratory
rehab which includes Respiratory muscle training, cough
exercise, diaphragmatic training and stretching. This was
done 2 sessions per week for 6 weeks. The outcome
measures were, Respiratory function exercise,
endurance (6 min walk test),ADL and quality of life,
psychological status assessment (anxiety, depression
scores). The study concluded that 6 week rehab can
improve QoL, Respiratory function and anxiety in elderly
patient’s with COVID-19.

17. 2) Andrew et al. in their RCT took 119 out patients with
COPD and divide them into intervention group
(n=57) and control group (n=62). The intervention
group performed the pulmonary rehab which
includes 30 min walk, treadmill, isokinetic upper
body ergometer whereas the control group were
given education program like coping with stress,
energy conserving technique, oxygen therapy. The
intervention was performed for 4 hour session until
8 week. The study concluded that the pulmonary
rehab significantly improved exercise performance
and symptoms for patients with moderate to severe
COPD.