The document discusses pulmonary system function and exercise limitations caused by pulmonary diseases. It covers topics like pulmonary ventilation, diffusion, and different types of pulmonary diseases including chronic obstructive pulmonary disease (COPD), asthma, bronchitis, and emphysema. It provides guidelines for exercise for those with pulmonary impairment, focusing on intensity, duration, monitoring symptoms, and addressing complications of pulmonary diseases.

1. Pulmonary System and Exercise

2. Cough Wheeze Sputum Shortness of Breath History of exposure to smoking, pollution, etc Spirometry impairment

3. INSPIRATION AND EXPIRATION

6. Pulmonary Diffusion

7. Respiration INTERNAL Respiration — Gas exchange between the blood and tissues Pulmonary diffusion — exchange of oxygen and carbon dioxide between the lungs and the blood Pulmonary ventilation — inflow and outflow of air between the lugs and atmosphere EXTERNAL Respiration

8. Any disease or disorder where lung function is impaired. Obstructive Lung Disease -- a narrowing or blockage of the airways  a decrease exhaled air flow - asthma, emphysema, and chronic bronchitis. Restrictive lung disease -- a loss of lung compliance / elasticity of the lungs themselves or problem expanding  decrease in the total lungs volume - Pneumonia, Cancer Vascular Defect – decrease ability lung tissue to move oxygen to blood

9. C hronic O bstructive P ulmonary D isease (COPD) Disease Cause Asthma Constriction airways Bronchitis secretion Excess mucus Emphysema Destruction of alveoli

10. Causes of COPD NOXIOUS AGENT (tobacco smoke, pollutants, occupational agent) Inflammation Airway inflammation Airway remodeling COPD Genetic factors Respiratory infection Other

11. Asthma Airway narrowing due to inflammation (bronchial hyperresponsiveness)  airflow obstruction “ bronchoconstriction” Less Constricted More constricted

12. Bronchitis Inflammation or thickened bronchial walls within the lungs due to secretion of fluids acute: infection Chronic: +3 months to year

13. EMPHYSEMA Loss of elasticity in the aveoli Associated with exposure to toxic chemicals & long-term exposure to tobacco smoke.

14. RESTRICTIVE DISEASE Disease Cause Scoliosis Skeletal Origins Pulmonary Edema Plural Paralysis Neuromuscular Pneumonia Alveolar blockage Cancer or Fibrotic Lung Scarring or loss of tissue function

15. Reversible Accumulation of inflammatory cells, mucus, in bronchi Smooth muscle contraction in airways Increase functioning with dynamic hyperinflation during exercise Irreversible Fibrosis and narrowing of the airways Loss of elastic recoil due to alveolar destruction Destruction of alveolar support that maintains patency of small airways

16. PULMONARY DISEASE Obstructive  Flow Restrictive  Volume

17. PULMONARY FUNCTIONS

18. PULMONARY FUNCTIONS

19. Diagnosis Restrictive Disease (  Vol) Normal > 80% of predicted VC Mild 60 to 75% of predicted VC Moderate 50 to 60% of predicted VC Severe < 50% of predicted VC Diagnosis Obstructive Disease (  Flow) Normal > 80% of predicted FEV1 Mild 60 to 70% of predicted FEV1 Moderate 40 to 59% of predicted FEV1 Severe < 40% of predicted FEV1

20. % of oxygen bound to hemoglobin Measures for Hypoxia (decreased O2) Hypoxic – not enough supply of 02 Anemic Hypoxia – not enough HGB Diagnosis SaO2 Average 95-100% Normal 96 – 98 % Low <92% Dysfunction < 88 %--need supplemental O2

21. Men VC = 0.1626*Height(inches) - 0.031*Age(years) - 5.335 Women VC = 0.1321*Height(inches) - 0.018*Age(years) - 4.360 http://www.hopkinsmedicine.org/pftlab/predeqns.html

22. White males 15-79 years (Cherniack, 1972) = (0.09107 * (height in inches)) - (0.0232 * (age in years)) - 1.50723 White females 15-79 years (Cherniack, 1972) = (0.06029 * (height in inches)) - (0.01936 * (age in years)) - 0.18693 Black males 20-92 years years (Stinson, 1981) = (0.096 * (height in inches)) - (0.021 * (age in years)) - 2.51 Black females 20-92 years (Stinson, 1981) = (0.062 * (height in inches)) - (0.017 * (age in years)) - 0.951 http://www.medal.org/visitor/www%5CActive%5Cch8%5Cch8.01%5Cch8.01.01.aspx

23. Ventilation (L/min) VO 2 (ml/min kg) Max Max Ventilatory Adaptations to Graded Exercise Normal Pulmonary Impairment

24. THE VENTILATORY RESPONSE TO EXERCISE

25. COPD complications include: Weight loss fat free mass (FFM) Osteoporosis Further reduces exercise capacity, quality of life and survival Loss excess energy Increased energy cost of breathing Reduced tissue oxygen levels Metabolic responses that enhance breakdown of body proteins

26. Identify and eliminate sources of bronchopulmonary inflammation cigarette smoking, inhaled irritants Inhale or oral bronchodilators and corticosteroids Establish individualized rehabilitation programs for stable patients

27. Rehabilitation programs generally similar to moderate physical and breathing exercises Respiratory muscle training may improve exercise performance Cardiovascular or selective respiratory muscle training May improve oxygen delivery and endurance performance at submaximal exercise Chronic home oxygen therapy for patients whose PaO 2 remains below 55 mmHg (the goal is to alleviate hypoxemia)

28. Smoking Exposure to pollution or other noxious agents Genetics Age History of childhood respiratory infections

29. Pay special attention to environmental conditions Follow GENERAL FIT recommended by ACSM Walking most similar to daily living activities Minimal goals for frequency is 3-5 d/wk— reduced function more frequent exercise training NO CONCENSUS AS TO THE OPTIMAL INTENSITY tolerated OR 50% of Max Start at few minutes…progress as able Pulmonary effect the lungs as well as muscles Follow older adults guidelines Shoulder girdle exercises

30. Monitor for signs and symptoms Use dyspnea scale for 2-3 on 4 point scale May exhibit arterial desaturation w/ exercise May measure blood oxygenation Oximetry May need O2 for patients with reduced PaO2

31. Complete extensive pulmonary function tests prior Only stable patients should exercise in a nonmedical setting RXEX Suggested that patients exercise at 50% VO 2 peak Emphasize progression over intensity To exercise Must be fully be symptom free from bronchitis Have a bronchodilating inhaler with them at all times Perform breathing exercises to help strengthen respiratory muscles

32. Avoid upper-body exercises initially because of the increased strain on the pulmonary system. Some COPD individuals may require supplemental oxygen during exercise. Generally, supplemental oxygen is recommended for patients with a PaO 2 < 55 mmHg or SaO 2 < 88%, while breathing room air COPD clients should not smoke The type and dose of medications should be reviewed with the clients physician, based on the clients response to exercise If a COPD clients exercise performance in a nonmedical supervised program worsens, they should be encouraged to participate in a pulmonary rehabilitation program, until signs and symptoms have improved