cardiac and pulmonary rehabilitation Flashcards
Symptoms of the COPD
symptoms of COPD- SOB, SOBOE, cough- productive and non- productive, depression and fatigue
negative cycle of inactivity
increased breathlessness and fatigue= reduced activity= reconditioning= anxiety/fear= avoidance of activity
what is pulmonary rehabilitation
is an evidence based, multidisciplinary and comprehensive intervention for patients with chronic respiratory disease who are symptomatic and often have decreased daily function.
what is pulmonary rehabilitation designed to do
reduce symptoms, optimise functional status, increased participation and reduce health care cost. advice for any COPD patient who has some form of functional disability, evidence based treatment for patients with COPD, combines exercise and education
stages and content of pulmonary rehabilitation
selection, assessment, rehabilitation, re-assessment, maintenance
content- exercise education, disease education, psychological and social support
evidence for pulmonary rehabilitation
improves dyspnoea/ fatigue/ depression/ self management, reduced hospital admissions, reduce mortality, highly cost effective, reduce number of home visits, cost saving, reduce readmissions, functional and maximal exercise capacity
why do you exercise
increase exercise tolerance, improve muscle strength, reduces breathlessness and fatigue, benefits on QOL, other general benefits- cardiovascular, cholesterol and diabetes
positive cycle of activity
mobility and strength, reconditioning, reduced breathlessness and fatigue, increased confidence and motivation, increased activity
patient selection for pulmonary rehab
majority of COPD but will be extended to all patients with dyspnoea from respiratory disease in some areas, disabled by COPD no selection based on age, impairment, disability or smoking status, consider significant co-morbilities
things to consider with patient selection
poor motivation, and logistical factors such as geography, transport, equipment usage and the group composition
medical research council dyspnoea scale (MRC)
1- only get short of breath with strenuous exercise
2- get SOB when hurting on the level or walking up slight hill
3- I walk slower than people of the same age because of breathlessness or I have to stop when walking at my own pace on the level
4- have to stop for break after 100m walk
5- I am to breathless to leave house, or I am breathless when dressing or undressing
exercise criteria
unstable angina/ diabetes, acute LVF, uncontrolled BP, uncontrolled arrhythmias, history of MI in last 6 weeks, mobility limited by MSK or neurological condition, cognitive problems, compliance issues, aortic aneurysm
structure of programme
minimum of twice a week supervised, 6-12 weeks in length depending on where you live, rolling or cohort programme, include progressive muscle resistance training and aerobic training, should be offered within a month post discharge from hospital if relevant
exercise in pulmonary rehab- main points
individualised, optimise medical management, doesn’t influence lung function- doesn’t reverse disease or improve function- feel less breathless, reconditions, psychosocial impact
exercise in pulmonary rehabilitation
warm up, waking programme, aerobic programme, strength training programme, cool down
exercise prescription
intensity borg scale (working in 4-5 reigion), RPE (13-16)
duration, frequency, specify, type interval or continuous, mode (walking cycling), progression- home programme
measurement and prescription
measure saturations and HR as needed- tends to be for patients who may be desaturated on exercise
assessment in pulmonary rehabilitation
generic measures- SF-36, hospital anxiety and depression scale, Nottingham extended activities of daily living, disease specific/ hearth status, 6 min walk test, incremental shuttle walk test, endurance shuttle walk test
disease specific/ health status
CRQ-SR, SGRQ- 50 questions to measure health status and WOL, BPQ- breathing problem, GAD- anxiety, LINQ- lung inflammation
incremental shuttle walk test
10M course marked by cones, audio signal sets the pace, pace increases each minute, end test when fails to make the cones, result expressed in meters, measure of HR, symptoms, Saturation
topics covered In education
what’s happening inside my lungs? my lung condition, chest clearance, coping with breathlessness, medication in COPD- nurse specialists, diet, anxiety management and relaxation, energy conservation
what is cardiac rehabilitation
the sum activities required to indolence favourably the underling cause of heart disease, as well as physical, mental and social conditions. maximise function and QOL. difference is patients often use reporting systems whilst exercising- pulse oximeters, ECGs
aims of cardiac rehabilitation
reduce individuals risk of subsequent cardiac problems- relieve symptoms and reduce risk factors
promote the individuals return to a full and normal life- increase knowledge and understanding and enhance QOL
concerns raised by patients
lifestyle changes, fear of dying, stress and anxiety, fear of over exertion, fears of intimacy, depression, anger
exercises in CR- main points
a phased process, varies according to phase, still individualised but less than PR, reconditioning, cardiovascular disease, decrease risk factor
measurements cardiac rehab
pulse rate, exercise tolerance- treatment test- picks up angina, increased BP problems, bruce protocool- exercise test looks at maximum exercise test
