Pulmonary Rehabilitaion Flashcards
Pulmonary Rehabilitation - Definition
Thorough patient assessment followed by patient-tailored therapies, which include, exercise trianing, education and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease an to promote long-term adherence of health-enhancing behaviors.
Goals of Pulmonary Rehabilitation
↓ symptom burden
↑ exercise capacity (ventilatory limitation)
↑ QoL!!!!
↑ Autonomy
↑ Participation in daily life activities
↑ Health behavior change
Not improving lung function variables.
Improve oxygenation and capnea
Contraindications for Pulmonary Rehab (8)
Significant ischemia on ECG
Recent myocardial infarction
Unstable angina
Uncontrolled cardiac arrythmia
Acute embolus or pulmonary infarction
Acute myocarditis or pericarditis
Dissected aneurysm
Acute infection
Indications for Pulmonary Rehabilitation
Obstructive disease (COPD, asthma, bronchiectasis)
Restrictive diseases (interstitial fibrosis, lung cancer, pulmonary hypertension, cystic fibrosis, before/after lung surgery)
Timing of Pulmonary Rehab
When patient is stable!
Exacerbation free for > 8 weeks
Safety In Pulmonary Rehab
At the start of each session:
Screen patient for outcomes related to the disease.
BP
SpO2
HR
Peak expiratory flow
Symptoms
Medication use
Contraindications for Exercise - Stop (12)
Generally unwell
Fever and acute systemic illness
Resting SBP >200mmHg
Resting DBP >110mmHg
Failure to ↑ BP during exercise
Unexplained drop in BP
Dizziness, angina, nausea, headache
Resting/uncontrolled tachycardia >100bpm
Uncontrolled atrial or ventricular arrhythmias
New/recurrent symptoms of lethargy, palpitation
Unstable angina
Unstable heart failure
Unstable diabetes
Underweight vs Overweight
Underweight: prevalent in advanced resp. disease (COPD).
Overweight: prevalent in mild COPD/cardiovascular disease
How does exercise training reduce VE?
Less VO2 required for a given work rate.
Less lactate production for a given task.
Continuous Endurance vs Interval training
Endurance (20-30min): Majority of ADLs of COPD patients require aerobic activity. ↑ aerobic capacity, ↑QoL, ↓ dyspnea sensation, ↓ limitations ADLs.
Interval (20-30min): Able to do more intensity while feeling less dyspnea.
Length of Rehabilitation Program
8 weeks to 6 months.
Other Training Modalities
Water-based programs
Tai-chi
Nordic walking
Neuromuscular electrical stimulation
Resp. muscle training
Balance training
Whole body vibration
Oxygen therapy
Desaturation
More than 4% difference
