Pulmonary Rehab

Question 1

Describe pulmonary limitations to UL exercise in terms of pathophysiology

Answer 1

Acc mm of breathing have to stabilise UL, which increases the work of breathing
Increased HR, RR, BP
Unsupported UL ex improves respiratory endurance

Question 2

Outline benefits of pulmonary rehabilitation

Answer 2

1A - improve QOL
1A - improve exercise capacity
1A - decreased dyspnoea
2B - reduced hospital stay
2B - psychosocial benefits

Question 3

Describe tests that may be used to assess exercise capacity in a patient with a pulmonary disorder

Answer 3

LL ENDURANCE - 6MWT, incremental shuttle walk test (12x 1min)

UL ENDURANCE - incremental unsupported upper limb exercise test (bar in front), grocery shelving test (20 items, 15cm shelf)

Question 4

Describe how to perform a 6MWT

Answer 4

Two trials, best distance recorded
Record distance, breaks, dyspnoea, BP, HR, SpO2
Standard track and instructions

The aim of this test is to walk as far as possible in six minutes. I will let you know as each minute goes past and then at six minutes I will stop you where you are. Six minutes is a long time to walk, so you will be exerting yourself. You are permitted to slow down to rest as necessary but please resume walking as soon as you are able. Do you have any questions?

Question 5

List the precautions and contraindications to exercise testing in patients with a pulmonary disorder

Answer 5

Resting HR >125 or 4 at rest

SpO2

Question 6

Interpret the findings of an exercise test for a patient with a pulmonary disorder

Answer 6

Look at SpO2
Whether they are on oxygen therapy
Dyspnoea (4=somewhat breathless, 5=severe breathlessness)
Distance covered
What stopped them

Question 7

Prescribe exercise for patients with pulmonary disorders (strength, endurance, flexibility)

Answer 7

F - 2-3x week work up to 5/7
I - 60-80% max, 4-5 BORG
T - LL endurance eg walking
T - 20-30 min (or intervals if 20min walk distance 4% to

Question 8

Describe how exercise training improves exercise capacity in patients with COPD

Answer 8

Improved aerobic fitness
Improved oxygen utilisation by skeletal mm -> decreased lactic acid production -> decreased dyspnoea
Reduced anxiety and desensitisation to dyspnoea
Improve QOL

Question 9

Discuss how the benefits of a pulmonary rehab program may be evaluated

Answer 9

6MWD - >54metres
ISWT - 47-78metres
QOL (dyspnoea - St George respiratory questionnaire (more than 4 units), chronic respiratory disease questionnaire (0.5 in each question)

Question 10

Describe pulmonary limitations to LL exercise in term of pathophysiology

Answer 10

PULMONARY (EDIG) - Expiratory flow limitation, dynamic hyperinflation, inspiratory mm abnormality, gas exchange abnormality

CARDIAC - decreased venous return, increased pulmonary vasculature resistance

PERIPHERAL - decreased type 1 fibres, atrophy type 2 fibres, decreased strength