Lecture 26: Pulmonary Rehab Flashcards
what is pulmonary rehab
structured/supervised programs for pts with chronic respiratory disease
ATS/AACVPR recommends pulm rehab for COPD stages 2-4, emphysema, bronchiectasis, PAH, ILD, and COVID
components of PR
education
general exercise training
breathing retraining
outcome assessment
nutritional advice
psychological support
goals of PR
symptom management
improving exercise capacity/tolerance
improved diet/stress/QOL
functional goal setting (i.e. palliative vs hospice)
psychological intervention (anxiety reduction/relaxation)
poor nutritional status is a significant predictor of what
mortality in chronic respiratory disease
paying for PR
medicare part B covers 72 total lifetime visits, split int o2 episodes of 36 visits
covers 1 hour sessions, at least 33 min have to include aerobic exercise
only covers COPD stages 2-4 and COVID
provided to <10% of those who qualify by diagnosis
up to 50% of referred pts don’t even complete initial visit
PR is reimbursed 50% less than CR
describe phase 1 PR
acute care or post acute (all in patient)
aim = get pt to next level of care or home
focus:
- functional mobiliy
- ambulation
- balance
- education
- breathing strategies
- O2 management
combo of rehab services and nursing
eval/initial exam for PR stage 2
baseline strength, ROM, flexibility, posture, functional mobility
current endurance level through GXT of some sort
chest auscultation, cough assessment, breathing patterns
usual/baseline activity level, usual O2
use of tobacco or 2nd hand smoke
compliance with meds and O2
presence of stress incontinence
support networks
goals for participating in pulmonary rehab
describe dyspnea and breathing retraining for PR phase 2
controlled breathing/relaxation techniques that decrease energy consumption
avoid breath holding, valsalva, or unnecessary talking during tasks
paced breathing and PLB during exertion as needed
fwd leaning increases intraabdominal pressure and pushes the diaphragm higher in the thorax for better contraction mechanics
tripping with BUE support anchors proximal mm attachments of respiratory mm which allows thoracic attachments to pull the chest into expansion for inhalation
describe airway clearance in phase 2 CR
goal = excess secretion removal, improved cough, decreased infection risk
permission/vibration to loosen secretion
diaphragmatic breathing, forced expiration ,cough strategies, PEP devices, huffing, active cycle of breathing
sustained exercise will have beneficial airway clearance effects
describe aerobic exercise with phase 2 PR
high intensity (70-85% VO2 max) needed to gain max physiological improvement in aerobic capacity
interval training (intensity based on pt capacity) = effective for pts who cant sustain high intensity or continuous exercise
“high intensity” in pts with chronic disease may look very different than typical/normal pts
focus on function and specificity
frequency of aerobic exercise in PR phase 2
3-5x/wk
30-60 min/session in early phases, work up to 60-120 min/sessions
> /= 30 min continuous exercise within first few weeks
intensity of aerobic exercise in phase 2 PR
use predetermined RPE dyspnea or MET levels
for chronic respiratory disease, 4-6/10 RPE recommended which correlates to 3-5 METs depending on the pt situation
combining upper and lower extremity exercise can produce a higher max O2 consumption than either body segment alone
describe strength training with phase 2 CR
begin with low resistance with initial goal of 10-20 reps
increase reps before weight
alternate between UE and LE exercise will improve tolerance for resistance training
monitor breathing patterns during strength training (inhale at start of movement, exhale during/at end of movement)
avoid valsalva
utilize body weight resistance
describe respiratory mm exercise in phase 2 PR
exercise = increase in tidal volume and RR, requiring muscles of breathing to work harder
moderate intensity aerobic exercise of BUE/BLE improves respiratory mm strength and endurance
instruction in breathing retraining on its own and coordinated with exercise improves diaphragmatic strength, motor control, and coordination
use of resisted breathing devices (IMT) benefits pt with decreased inspiratory mm strength
- 15-30 min/day, 2x/day
- start with level of resistance that is comfortable to perform the above frequency then gradually increase
- >30% MIP: sets or intervals performed to fatigue
exercise considerations for those with mild lung disease
dyspnea should be present only with relatively heavy exercise
pulmonary rehab usually not recommended for this stage
exercise can be recommended using testing/training protocols for the normal population
