Pulmonary Rehab

Question 1

what is pulmonary rehab?

Answer 1

structured supervised phased program for patients with disabling symptoms of dyspnea, such as inability to perform ADLs and decreased ability to perform job responsibilities

Question 2

when is pulmonary rehab utilized more for?

Answer 2

chronic respiratory disease rather than acute

Question 3

what stages is PR recommended for?

Answer 3

COPD stages 2-4
emphysema
bronchiectasis
PAH
ILD
COVID

Question 4

what are components of pulmonary rehab?

Answer 4

education
general exercise training
breathing retraining
outcome assessment
nutritional advice
psychological support

Question 5

what are goals of PR?

Answer 5

symptom management
improving exercise capacity/tolerance
improving diet, stress, QOL –> poor nutritional status is predictor of mortality in chronic respiratory disease
functional goal setting –> end of life, palliative vs. hospice
psychosocial intervention –> anxiety reduction, relaxation strategies

Question 6

how many visits does Medicare part B cover?

Answer 6

72 total lifetime visits
split into 2 episodes of 36 visits

Question 7

how long of sessions does Medicare part B cover?
how much has to include aerobic exercise?

Answer 7

1 hour sessions
at least 33 minutes = aerobic

Question 8

Medicare part B covers PR for what 2 conditions?

Answer 8

COPD stages 2-4 and COVID

Question 9

Phase 1 PR is completed in what setting?

Answer 9

acute care or post acute care (inpatient)

Question 10

what is the goal of phase 1 PR?

Answer 10

get patients to next level of care or home

Question 11

what does phase 1 PR focus on?

Answer 11

functional mobility
ambulation
balance
education
breathing strategies
O2 management

Question 12

what is performed in the examination of phase 2 PR?

Answer 12

baseline strength, ROM, flexibility, posture, functional mobility
current endurance through GXT
chest auscultation, cough assessment, breathing patterns
usual/baseline activity level, usual O2 use
use of tobacco or 2nd hand tobacco
compliance with medications and O2
presence of stress incontinence
support networks
goals for participating in PR program

Question 13

6MWT variations:
– walk (more/less) in hallway vs. treadmill
– walk (more/less) with oxygen
– walk (more/less) with encouragement

Answer 13

– more
– more
– more

Question 14

Phase 2 PR:
Dyspnea and breathing retraining:
– controlled breathing and relaxation techniques ______ energy consumption
– avoid:
– **

Answer 14

– decrease
– breath holding, valsalva, or unnecessary talking during tasks
–

Question 15

Phase 2 PR:
airway clearance:
– goal:
– _____ to loosen secretions
– IMTS:
– _____ has beneficial airway clearance effects

Answer 15

– excess secretion removal, improved cough, decreased infection risk
– percussion/vibration
– diaphragmatic breathing, forced expiration, cough strategies, PEP devices, huffing, ACB
– sustained exercise

Question 16

Phase 2 PR:
Aerobic exercise:
– _____ intensity (_____ VO2Max) needed to gain max physiologic improvements in aerobic capacity
– ______ is an effective option for pts who can’t sustain high intensity or continuous exercise
– focus on:

Answer 16

– high (70-85%)
– interval training
– function and specificity

Question 17

Phase 2 PR:
aerobic exercise frequency:
_____/week
______min/session in early phases
work up to _____ mins/session
______ mins continuous exercise within first few weeks

Answer 17

3-5
30-60
60-120
>/= 30

Question 18

Phase 2 PR:
aerobic exercise intensity:
– use predetermined _____ or ____ levels
– chronic respiratory disease: ____ RPE = _____ METs
– combining UE and LE exercise can produce:

Answer 18

– RPE dyspnea or MET
– 4-6/10 ; 3-5 METs
– higher maximal O2 consumption than either body segment alone

Question 19

Phase 2 PR:
Strength Training:
– begin with ______ resistance, initial goal of _____ reps
– increase _____ before ______
– what will improve tolerance for resistance training?
– monitor:
– utilize:

Answer 19

– low ; 10-20
– reps ; weight
– alternating between upper and lower extremity exercise
– breathing patterns during strength training (inhale at start, exhale during/at end AND avoid valsalva)
– body-weight resistance training

Question 20

Phase 2 PR:
Respiratory muscle exercise:
– exercise increases ____ and ____, requiring muscles of breathing to work harder
– -_____ improves respiratory muscle strength and endurance
– instruction in ___ and coordinated with ______ improve diaphragmatic strength, motor control, and coordination
– use of resisted breathing devices benefits pts with:

Answer 20

– tidal volume and RR
– moderate intensity aerobic exercise of BUE/BLE
– breathing retraining on its own and coordinated with exercise
– decreased inspiratory muscle strength

Question 21

use of IMT devices should be performed _____ _min for ___x/day
– start with ________ then gradually increase from there

Answer 21

15-30 ; 2x
– level of resistance that is comfortable to perform the frequency

Question 22

phase 2 PR:
exercise considerations for patients with mild lung disease:
– when is it acceptable for dyspnea to be present?
– PR recommended for mild lung disease?
– what exercise parameters should be recommended?

Answer 22

– only with relatively heavy exercise
– no
– normal population

Question 23

phase 2 PR:
exercise considerations for patients with moderate lung disease:
– when would dyspnea be present?
– what exercise protocol should be used?
– goal of exercise in these patients:
– this is an opportunity to:

Answer 23

– with normal daily activities
– submax GXT with continuous vital sign monitoring
– increase duration of workload that is sufficient to cause physiologic adaptation to effort
– prevent worsening of disease

Question 24

phase 2 PR:
exercise considerations for patients with severe lung disease:
– when is dyspnea present?
– what kind of exercise testing?
– _______- can be used to determine functional levels and exercise tolerance
– what kind of exercise is best?
– focus may shift to: ______ if pathology is not allowing pt to participate in formal program or progress is not being made

Answer 24

– during most daily activities
– modified approach
– 6MWT/2MWT
– interval training programs, with initially short exercise bouts and rest
– compensatory strategies, adaptive equipment, symptom management, palliative approach

Question 25

what is the goal of phase 3 PR?

Answer 25

self-management and maintenance
– manage own exercise programs, symptoms, and health behaviors, group exercise programs