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KIN 435 > Pulmonary Rehabilitation > Flashcards

Pulmonary Rehabilitation Flashcards

1
Q

What is the Background on the article on the key concepts and advances in pulmonary rehabilitation?

A
  • Pulmonary rehabilitation core component of management of Chronic Respiratory Disease
  • Considerable growth in our knowledge of COPD since 2006
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2
Q

What is the conclusion of the article on the key concepts and advances in pulmonary rehabilitation?

A
  • 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
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3
Q

What is Pulmonary Rehabilitation?

A
  • comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies
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4
Q

What is involved in Pulmonary Rehabilitation?

A
  • exercise training
  • education
  • behavioral changes
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5
Q

What has Pulmonary Rehabilitation demonstrated for patients with COPD?

A
  • reduce dyspnea
  • increase exercise capacity
  • improve quality of life
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6
Q

What are the variety of forms of exercise training used in Pulmonary Rehabilitation?

A
  • Interval Training
  • Strength Training
  • Upper Limb Training
  • Transcutaneous neuromuscular electrical stimulation
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7
Q

What do COPD patients with a lesser degree of airflow limitation experience when they participate in Pulmonary Rehabilitation?

A

improvements
- symptoms
- exercise tolerance
- quality of life

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8
Q

What does the commencement of exercise rehabilitation during acute or critical COPD do?

A
  • Reduce extent of functional decline
  • Hastens Recovery
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9
Q

What may impact the effectiveness of pulmonary rehabilitation?

A
  • symptoms of anxiety
  • Depression
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10
Q

What are the goals of Pulmonary Rehabilitation?

A
  • 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
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11
Q

What are the multifactorial origins of Exertional Dyspnea?

A
  • Peripheral Muscle Dysfunction
  • Consequence of Dynamic Hyperinflation
  • Increased Respiratory Load
  • Defective Gas Exchange
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12
Q

What are exercise limitations in COPD patients aggravated by?

A
  • age-related decline
  • physical deconditioning
  • presence of comorbid conditions
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13
Q

How does Improvement in Skeletal Muscle Function after exercise training lead to gains in exercise capacity despite absence of changes in lung function?

A
  • Improved oxidative capacity
  • Improved Efficiency of the skeletal muscles lead to reduced ventilatory requirement for submaximal work rate
  • Reduce dynamic hyperinflation, lowers dyspnea
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14
Q

What does exercise intolerance in individuals with Chronic respiratory disease result from?

A
  • Ventilatory constraints
  • Pulmonary gas exchange abnormalities
  • Peripheral Muscle Dysfunction
  • Cardiac Dysfunction
  • Combination of above
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15
Q

What might anxiety, depression, and poor motivation lead to?

A
  • Exercise Intolerance
  • Direct association has not been established
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16
Q

In COPD, the ventilatory requirements are higher than expected. Why?

A
  • Increased work of breathing
  • Increased Dead Space Ventilation
  • Impaired Gas Exchange
  • Increase Ventilatory Demand as a Consequence of deconditioning and peripheral muscle dysfunction
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17
Q

What adds to the limitation to maximal ventilation during exercise in people with COPD?

A
  • Expiratory airflow obstruction
  • dynamic hyperinflation
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18
Q

What intensifies the sense of dyspnea?

A

Increased
- work of breathing
- load
-mechanical constraints on respiratory muscle

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19
Q

How does Hypoxia directly/indirectly increase pulmonary ventilation?

A

Directly
- augmenting peripheral chemoreceptor output indirectly
- through stimulation of lactic acid production

20
Q

How does the buffering of Lactate create a gas exchange limitation?

A
  • increase in CO2 production and acidosis stimulates the carotid bodies
21
Q

What does supplemental O2 therapy during exercise do for people with COPD? How? Leads to?

A

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

22
Q

What is the main way the cardiovascular system is affected by chronic respiratory disease?

A
  • increase in right ventricular afterload
23
Q

What contributes to cardiac limitations in people with Chronic Respiratory Disease?

A
  • Elevated pulmonary vascular resistance from hypoxic vasoconstriction
  • Vascular Injury and/or Remodeling
  • Increased Effective Pulmonary Vascular Resistance Due to Erythrocytosis
24
Q

How does Exercise Training improve cardiac limitations in people with COPD?

A
  • improvements in cardiovascular function
25
Q

What might cause peripheral muscle dysfunction in people with Chronic Respiratory Disease?

A

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

26
Q

What is muscle dysfunction usually reported as?

A
  • Fatigue
27
Q

What would lactic acidosis and retention of CO2 result in?

A
  • change in pH
28
Q

What places COPD patients’ respiratory muscles at a mechanical disadvantage?

A
  • Static and Dynamic Hyperinflation
29
Q

What is compromised in people with COPD? functional inspiratory muscle strength or muscle endurance?

A
  • BOTH
30
Q

What does respiratory muscle weakness contribute to in COPD?

A
  • Hypercapnia
  • Dyspnea
  • Nocturnal Oxygen Desaturation
  • Reduced Exercise Performance
31
Q

What is the aim of endurance training for people with COPD?

A
  • Condition muscles of ambulation
  • improve cardiorespiratory fitness
  • increase physical activity associated with reduction in breathlessness and fatigue
32
Q

What is the most common form of endurance exercise training?

A
  • cycling
  • walking
33
Q

What is the common prescription of endurance training for individuals with chronic respiratory disease?

A

3-5 times per week
- >60% maximal work rate
- 20-60 minutes per session

34
Q

What training intensity is the target for endurance training?

A

Borg dyspnea or fatigue score
- 4-6
Rating of Perceived Exertion
- 12-14

35
Q

What does biking exercise do compared to walking? why?

A

Less Exercise-induced oxygen desaturation
- greater specific load on quadriceps muscles

36
Q

What is interval training?

A
  • modification of endurance training
  • high-intensity exercise regularly interspersed with periods of rest
37
Q

Why would interval training be used?

A
  • Maintain training effects of endurance exercise in cachectic individuals with severe COPD
38
Q

Why would you use Resistance / Strength Training for individuals with COPD?

A

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

39
Q

Why is the Pressure-generating capacity of the inspiratory pump muscles reduced in COPD?

A
  • Deleterious effect of pulmonary hyperinflation
  • shortens and flattens the diaphragm
40
Q

What does reduced pressure-generating capacity of inspiratory muscles contribute to in individuals with COPD?

A
  • exercise intolerance
  • perception of dyspnea
41
Q

How does Inspiratory Muscle Training Improve symptoms of COPD?

A
  • Increase Exercise Capacity
  • Reduce Dyspnea
42
Q

How can Bronchodilators help maximize the Effects of exercise Training?

A
  • control symptoms
  • reduce exacerbations
  • improve exercise intolerance
  • improve health status
43
Q

What can be used to help maximize the effects of exercise training?

A
  • Bronchodilators
  • Oxygen and Helium-Hyperoxic Gas Mixtures
  • Non-invasive ventilation
44
Q

Has the use of anabolic hormonal supplementation been proven to improve the effects of exercise training?

A
  • No
  • has not received sufficient study to consider as routine inclusion in pulmonary rehabilitation programs
45
Q

How has breathing Helium-Hyperoxic Gas Mixtures benefited individuals with COPD?

A
  • decreasing airway resistance
  • decrease expiratory flow limitation
  • reducing ventilatory demand
  • reductions in resistive and elastic work
  • reduced dyspnea
  • greater improvements in exercise tolerance
46
Q

What effect does breathing Helium-Hyperoxic gas mixtures have on exercise for individuals with COPD?

A
  • increase intensity
  • increase duration
  • greater improvement in constant-load training

KIN 435 (14 decks)

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