Pulmonary Rehabilitation Flashcards
What is the Background on the article on the key concepts and advances in pulmonary rehabilitation?
- Pulmonary rehabilitation core component of management of Chronic Respiratory Disease
- Considerable growth in our knowledge of COPD since 2006
What is the conclusion of the article on the key concepts and advances in pulmonary rehabilitation?
- Considerable growth in the science and application of pulmonary rehabilitation since 2006
- Adds support for efficacy in wide range of individuals with chronic respiratory disease
What is Pulmonary Rehabilitation?
- comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies
What is involved in Pulmonary Rehabilitation?
- exercise training
- education
- behavioral changes
What has Pulmonary Rehabilitation demonstrated for patients with COPD?
- reduce dyspnea
- increase exercise capacity
- improve quality of life
What are the variety of forms of exercise training used in Pulmonary Rehabilitation?
- Interval Training
- Strength Training
- Upper Limb Training
- Transcutaneous neuromuscular electrical stimulation
What do COPD patients with a lesser degree of airflow limitation experience when they participate in Pulmonary Rehabilitation?
improvements
- symptoms
- exercise tolerance
- quality of life
What does the commencement of exercise rehabilitation during acute or critical COPD do?
- Reduce extent of functional decline
- Hastens Recovery
What may impact the effectiveness of pulmonary rehabilitation?
- symptoms of anxiety
- Depression
What are the goals of Pulmonary Rehabilitation?
- Minimizing Symptoms Burden
- Maximizing Exercise Performance
- Promoting Autonomy
- Increasing participation in everyday activities
- Enhancing (health-related) quality of life
- Effecting long-term health-enhancing behaviour change
What are the multifactorial origins of Exertional Dyspnea?
- Peripheral Muscle Dysfunction
- Consequence of Dynamic Hyperinflation
- Increased Respiratory Load
- Defective Gas Exchange
What are exercise limitations in COPD patients aggravated by?
- age-related decline
- physical deconditioning
- presence of comorbid conditions
How does Improvement in Skeletal Muscle Function after exercise training lead to gains in exercise capacity despite absence of changes in lung function?
- Improved oxidative capacity
- Improved Efficiency of the skeletal muscles lead to reduced ventilatory requirement for submaximal work rate
- Reduce dynamic hyperinflation, lowers dyspnea
What does exercise intolerance in individuals with Chronic respiratory disease result from?
- Ventilatory constraints
- Pulmonary gas exchange abnormalities
- Peripheral Muscle Dysfunction
- Cardiac Dysfunction
- Combination of above
What might anxiety, depression, and poor motivation lead to?
- Exercise Intolerance
- Direct association has not been established
In COPD, the ventilatory requirements are higher than expected. Why?
- Increased work of breathing
- Increased Dead Space Ventilation
- Impaired Gas Exchange
- Increase Ventilatory Demand as a Consequence of deconditioning and peripheral muscle dysfunction
What adds to the limitation to maximal ventilation during exercise in people with COPD?
- Expiratory airflow obstruction
- dynamic hyperinflation
What intensifies the sense of dyspnea?
Increased
- work of breathing
- load
-mechanical constraints on respiratory muscle
How does Hypoxia directly/indirectly increase pulmonary ventilation?
Directly
- augmenting peripheral chemoreceptor output indirectly
- through stimulation of lactic acid production
How does the buffering of Lactate create a gas exchange limitation?
- increase in CO2 production and acidosis stimulates the carotid bodies
What does supplemental O2 therapy during exercise do for people with COPD? How? Leads to?
Do
- higher intensity training
How
- Decrease in pulmonary artery pressure
- carotid body inhibition
- Decrease in lactate production
Leads to
- Decrease in respiratory rate
- reduction in dynamic hyperinflation
What is the main way the cardiovascular system is affected by chronic respiratory disease?
- increase in right ventricular afterload
What contributes to cardiac limitations in people with Chronic Respiratory Disease?
- Elevated pulmonary vascular resistance from hypoxic vasoconstriction
- Vascular Injury and/or Remodeling
- Increased Effective Pulmonary Vascular Resistance Due to Erythrocytosis
How does Exercise Training improve cardiac limitations in people with COPD?
- improvements in cardiovascular function
What might cause peripheral muscle dysfunction in people with Chronic Respiratory Disease?
Single or Combined Effect of:
- inactivity-induced deconditioning
- systemic inflammation
- oxidative stress
- smoking
- blood-gas distrubances
- nutritional impairments
- low anabolic hormone levels
- aging
- corticosteroid use
What is muscle dysfunction usually reported as?
- Fatigue
What would lactic acidosis and retention of CO2 result in?
- change in pH
What places COPD patients’ respiratory muscles at a mechanical disadvantage?
- Static and Dynamic Hyperinflation
What is compromised in people with COPD? functional inspiratory muscle strength or muscle endurance?
- BOTH
What does respiratory muscle weakness contribute to in COPD?
- Hypercapnia
- Dyspnea
- Nocturnal Oxygen Desaturation
- Reduced Exercise Performance
What is the aim of endurance training for people with COPD?
- Condition muscles of ambulation
- improve cardiorespiratory fitness
- increase physical activity associated with reduction in breathlessness and fatigue
What is the most common form of endurance exercise training?
- cycling
- walking
What is the common prescription of endurance training for individuals with chronic respiratory disease?
3-5 times per week
- >60% maximal work rate
- 20-60 minutes per session
What training intensity is the target for endurance training?
Borg dyspnea or fatigue score
- 4-6
Rating of Perceived Exertion
- 12-14
What does biking exercise do compared to walking? why?
Less Exercise-induced oxygen desaturation
- greater specific load on quadriceps muscles
What is interval training?
- modification of endurance training
- high-intensity exercise regularly interspersed with periods of rest
Why would interval training be used?
- Maintain training effects of endurance exercise in cachectic individuals with severe COPD
Why would you use Resistance / Strength Training for individuals with COPD?
Resistance
- Potential to improve muscle mass and strength
Strength
- less dyspnea during exercise period
both
- can be easier to tolerate than endurance constant-load training
Why is the Pressure-generating capacity of the inspiratory pump muscles reduced in COPD?
- Deleterious effect of pulmonary hyperinflation
- shortens and flattens the diaphragm
What does reduced pressure-generating capacity of inspiratory muscles contribute to in individuals with COPD?
- exercise intolerance
- perception of dyspnea
How does Inspiratory Muscle Training Improve symptoms of COPD?
- Increase Exercise Capacity
- Reduce Dyspnea
How can Bronchodilators help maximize the Effects of exercise Training?
- control symptoms
- reduce exacerbations
- improve exercise intolerance
- improve health status
What can be used to help maximize the effects of exercise training?
- Bronchodilators
- Oxygen and Helium-Hyperoxic Gas Mixtures
- Non-invasive ventilation
Has the use of anabolic hormonal supplementation been proven to improve the effects of exercise training?
- No
- has not received sufficient study to consider as routine inclusion in pulmonary rehabilitation programs
How has breathing Helium-Hyperoxic Gas Mixtures benefited individuals with COPD?
- decreasing airway resistance
- decrease expiratory flow limitation
- reducing ventilatory demand
- reductions in resistive and elastic work
- reduced dyspnea
- greater improvements in exercise tolerance
What effect does breathing Helium-Hyperoxic gas mixtures have on exercise for individuals with COPD?
- increase intensity
- increase duration
- greater improvement in constant-load training
