Pulmonary Rehabilitation 2

Question 1

Exercise Prescription Components

Answer 1

¬ Mandatory – training of ambulatory muscles (i.e. LL endurance exercise)
¬ Strength training increase muscle strength and mass
¬ Unsupported UL endurance training is beneficial
¬ Routine use of inspiratory muscle training is not supported

Question 2

Guidelines

Answer 2

¬	At least 20 mins
¬	At least 3x/week
¬	At least 6 weeks
¬	Higher intensity:
o	 Physiological benefit
o	60-80% peak work rate
o	Can start at 80% 6MWD
o	Can use interval training if symptomatic
¬	UL & LL, strength & endurance

Question 3

Strength Guidelines

Answer 3

• Specificity – dynamic resistance is best
• Overload - inc. resistance/load
• Dose – 6-12RM; older 10-15RM
• Minimal added gain when > 1 set
• Average 6/12 gain – 25-30%

Question 4

Intensity Guidelines

Answer 4

• 80% peak work rate (vs 50%)
o Lactate threshold & HR/ventilation levels
• > 60% peak exercise capacity elicits a physiological response
o Clinically use % of 6MWD or BORG of 4-6 for dyspnoea or fatigue
o Can also use HR or power output

Question 5

Interval Training

Answer 5

• Similar benefits/ dec. Ventilatory response
o dec. Blood lactate & dyspnoea
o Either for symptom modification – moderate intensity
OR
o High training intensity aimed at inc. adaptations with training

Question 6

Prescribing a Walking Program from 6MWD

Answer 6

• Six-minute walk distance (6MWD) / 6 = distance in one minute
o For distance in 30 minutes = one minute distance x 30
o Note: the patient would not be expected to keep up the same walking pace throughout the walking training session that they achieved in the 6MWT prescribe approximately 80% of the calculated distance
Treadmill speed = 80% 6MWT average speed
6MWT average speed = (6MWT distance x 10) / 1000 km/hr

Question 7

Maintenance

Answer 7

• 6 to 12 weeks pulmonary rehabilitation
o Benefits that decline gradually over 12 to 18 months
o Health related QOL remain above control at 12 to 18 months

Question 8

Physical Activity in COPD

Answer 8

¬ > 2 hours/wk walking or cycling associated with a 30-40% risk reduction

Question 9

Supplemental O2 with Exercise

Answer 9

¬ Severe exercise-induced hypoxaemia
o Safety considerations - work of right heart by hypoxic vasoconstriction of the pulmonary vessels
¬ With high-intensity exercise without exercise-induced hypoxemia
o May gains in exercise endurance