Pulmonary Rehab Flashcards
What is Pulmonary Rehabilitation (PR)?
Pulmonary Rehabilitation (PR) is a comprehensive intervention for patients with chronic respiratory diseases aimed at improving exercise tolerance, reducing symptoms, and enhancing quality of life.
Define COPD.
Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease characterized by chronic airflow limitation, typically caused by smoking or long-term exposure to irritants.
What is the 6-Minute Walk Test (6MWT)?
The 6-Minute Walk Test (6MWT) is a standardized test to assess functional exercise capacity by measuring the distance a patient can walk on a flat surface in six minutes.
What does Dyspnea mean?
Dyspnea refers to the sensation of shortness of breath or difficulty breathing, commonly experienced by patients with pulmonary diseases.
- Working up to 3-5/10
- Not past 5/10
Define Hypercapnia.
Hypercapnia is an elevated level of carbon dioxide (CO2) in the blood.
- Resulting from inadequate ventilation in patients with pulmonary conditions.
What is the purpose of airway clearance techniques?
Airway clearance techniques aim to remove mucus and other secretions from the airways, improving lung function and reducing infection risk in pulmonary patients.
What is a contraindication for pulmonary exercise?
Contraindications include
- chest pain
- severe dyspnea (Dyspnea score of 5 or more)
- dizziness
- muscle pain that does not improve with rest
Define Energy Conservation in pulmonary rehab.
Energy conservation involves techniques that minimize fatigue by planning activities and using proper body mechanics to reduce energy expenditure.
What are accessory muscles in breathing?
Accessory muscles in breathing (sternocleidomastoid and intercostal muscles) assist respiration when primary muscles (e.g., diaphragm) are insufficient.
Define Valsalva Maneuver and why it should be avoided.
The Valsalva Maneuver is a forceful exhalation against a closed airway, which can cause a dangerous spike in blood pressure and should be avoided during exertion.
What are the main objectives of pulmonary rehabilitation?
- improve exercise tolerance
- reduce symptoms (e.g., dyspnea)
- enhance quality of life
- increase functional mobility
What are the common clinical indications for pulmonary rehabilitation?
Indications include
- COPD
- respiratory impairment with dyspnea (at rest or exertion)
- hypoxemia = low blood oxygen levels
- hypercapnia = high blood CO2
- reduced exercise tolerance
- decreased ability to perform ADLs
What does a typical patient assessment in pulmonary rehab involve?
- reviewing medical history
- assessing cardiopulmonary function (e.g., vitals, breathing patterns)
- ROM
- MMT
- edema
What are the core components of exercise prescription in pulmonary rehab?
- aerobic exercises (low, moderate, high intensity)
- resistance training
- flexibility exercises
- interval training
All tailored to individual tolerance and goals.
What are the primary roles of physical therapy in pulmonary rehab?
- administering tests like the 6MWT
- creating individualized exercise prescriptions
- teaching airway clearance techniques
- promoting energy conservation strategies
What are the contraindications for exercise in pulmonary rehab?
Symptoms such as:
- chest pain
- severe dyspnea (Dyspnea score ≥ 5)
- dizziness
- non-resolving muscle pain
What is the significance of interval training in pulmonary rehab?
Interval training allows patients who cannot tolerate sustained high-intensity exercise to still gain benefits like increased VO2 max and efficient breathing patterns.
How is self-management education integrated into pulmonary rehab?
It includes teaching patients about their condition, breathing strategies, airway clearance, medication use, energy conservation, and recognizing exacerbation signs.
Why is goal setting important in pulmonary rehab, and what are standard goals?
- Goal setting provides clear targets for progress.
- Standard goals include performing activities for longer durations, achieving 150 minutes of activity per week, and improving oxygen needs through activity.
Exercise prescription - Aerobic exercise:
- Frequency = ?
- Intensity = ?
- Time = ?
- Type = ?
Exercise prescription - Aerobic exercise:
- Frequency:
- 3-5 days/week
- Intensity:
- Target HR is typically not used as individuals tend to stop at low HR due to ventilatory limits
- Base off patient tolerance
- Using dyspnea rating reported at submax exercise level during exercise test
- Maintain O2 sat >90%
- Work up to a RPE of 12-16
- Time:
- Minimum of 30 minutes of accumulated exercise per session
- Interval training may be appropriate for patients who cannot continuously exercise
- Type:
- Walking, running, bucycling, swimming
Exercise Type for Conditioning in Pulmonary Rehab
- Upper body = ?
- Lower body = ?
- Combined = ?
High intensity interval training in pulmonary rehab guidelines
- High Intensity (60-80%) used to gain:
- Increased VO2max
- Decreased HR for any given work rate
- Lower ventilatory requirement for a given task
- More efficient pattern of breathing
- Interval training is a good option for patients who cannot tolerate sustained high-intensity training
- Important to know:
- Lower intensity aerobic exercise in patients with COPD can still lead to significant improvements in exercise endurance
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Resistance Exercise Guidelines
Frequency:
- 2-3 days/week
Intensity:
- Strength: 60-70% of 1-RM for beginners
- Experienced weight trainers >/= 80% 1-RM
- Endurance: < 50% of 1-RM
- Assessment of dyspnea or RPE
Time:
- Strength: 2-4 sets, 8-12 reps
- Endurance: </= 2 sets for 15-20 reps
Type:
- Weight machines, free weight, body weight exercises
How would you differentiate between hypoxemia and hypercapnia?
- Hypoxemia refers to low oxygen levels in the blood
- Hypercapnia is an elevated level of carbon dioxide (CO2) in the blood, often due to inadequate ventilation.
Flexibility Exercise Guidelines
Frequency:
- 2-3 days/week
- Daily is the most effective
Intensity:
- Stretch to the point of feeling tightnes or slight discomfort
Time:
- 10-30 seconds for static stretching, 2-4 reps of each exercise
Type:
- Staticc, dynamic, or PNF
When would you decide to stop exercise in a pulmonary rehab session?
Exercise should be stopped if the patient experiences
- severe dyspnea (score ≥ 5)
- chest pain
- dizziness
- fainting
- muscle pain that does not resolve
- unusual sweating
How do airway clearance techniques improve pulmonary function?
- helps remove mucus and secretions
- improving ventilation
- reducing infection risk
- enhancing overall lung function.
Differentiate between aerobic and resistance exercises in pulmonary rehab.
- Aerobic exercises improve cardiovascular endurance and VO2 max
- Resistance exercises target muscle strength and support functional tasks.
Exercise Condsiderations
Aerobic Activity
Aerobic Activity:
- Patients will start with poor activity tolerance
- Start low, goal is to walk for longer periods of time
- Manage SpO2 and dyspnea levels throughout
- Walking may be most beneficial in improving functional mobility
- LE training results in most dramatic increase in exercise tolerance
Exercise Condsiderations
Strengthening & Flexibility
Strengthening & Flexibility:
- Controlled breathing with each repetition
- Resistive exercise are beneficial in improving QoL
- Flexibility is important in improve posture, ROM
How would you tailor a pulmonary rehab program for a patient with severe COPD?
- focus on lower-intensity aerobic exercises
- interval training
- breathing techniques
- gradually increase activity tolerance with close monitoring of symptoms
Explain the relationship between oxygen titration and activity in pulmonary rehab.
Oxygen titration ensures adequate oxygen delivery during activity, helping to maintain saturation levels and reduce dyspnea as tolerance improves.
What are the components of a cardiopulmonary assessment for pulmonary patients?
Vitals, breathing patterns, use of accessory muscles, chest examination (palpation, percussion, symmetry), and cardiac function (rate, rhythm).
What factors determine the intensity of an aerobic exercise prescription?
- patient tolerance
- baseline functional capacity
- symptom management (e.g., dyspnea)
- target heart rate zones
Differentiate between the Valsalva maneuver and normal exhalation during exercise.
- The Valsalva maneuver involves forceful exhalation against a closed airway, risking blood pressure spikes
- Normal exhalation allows steady airflow and oxygen exchange.
How would you modify exercise prescription for a patient experiencing significant fatigue?
- lower the intensity
- incorporate interval training
- include frequent rest breaks to manage fatigue while maintaining engagement
Why is patient goal-setting critical in pulmonary rehab?
It motivates patients by providing measurable milestones and ensures interventions align with individual needs and functional goals.
How would you assess the effectiveness of a pulmonary rehab program?
By tracking outcomes such as improvements in 6MWT distance, reduced dyspnea scores, enhanced quality of life metrics, and patient-reported activity levels.
A patient with COPD reports increased dyspnea during low-intensity exercise.
- What steps should you take?
- Stop the exercise, monitor vitals, assess oxygen saturation, and provide breathing techniques to reduce dyspnea.
- Consider adjusting the exercise intensity or incorporating more rest periods.
You observe a patient using accessory muscles during breathing during a 6MWT.
- What does this indicate?
- This indicates increased respiratory effort and potential ventilatory limitation.
- Adjust exercise intensity and teach diaphragmatic breathing techniques.
During a pulmonary rehab session, a patient complains of chest tightness and dizziness.
- What is your immediate response?
Stop the session immediately, assess vitals, monitor for signs of cardiac distress, and seek medical assistance if symptoms persist.
A patient with severe COPD struggles to complete the 6MWT due to fatigue.
- How would you modify their exercise program?
Incorporate interval training with frequent rest periods, lower exercise intensity, and introduce light resistance training to build endurance gradually.
A patient with pulmonary fibrosis demonstrates poor oxygen saturation (< 88%) during exercise.
- What adjustments would you make?
- Titrate supplemental oxygen as needed, lower exercise intensity, and prioritize endurance exercises within a safe oxygen saturation range.
How would you educate a patient on energy conservation techniques for ADLs?
Teach them to plan activities, use assistive devices, take frequent rest breaks, and avoid overexertion to manage fatigue effectively.
A patient with COPD reports difficulty using their inhaler.
- What would you do?
- Assess their technique, provide a demonstration, and educate them on proper inhaler use.
- Consider alternative devices if challenges persist.
During a group pulmonary rehab class, a patient experiences leg cramping and sweating.
- How should you proceed?
- Pause the exercise, assess hydration status, monitor vitals, and provide rest.
- Adjust the exercise program to prevent recurrence.
A patient has difficulty performing diaphragmatic breathing.
- What strategies can you use to help them improve?
Provide visual and tactile feedback, practice in a supported position (e.g., semi-reclined), and use verbal cues to guide breathing patterns.
A patient’s dyspnea score increases to 5 during moderate exercise.
- What is your next step?
Stop the exercise, implement recovery techniques like pursed-lip breathing, and reassess before resuming activity at a lower intensity.
