Pulmonary Rehabilitation in Chronic Respiratory Disease

Question 1

Aims of pulmonary rehab

Answer 1

> ↓ dyspnoea
↑ muscle endurance and strength (peripheral and respiratory)
↑ exercise capacity
Improve daily functioning and ensure long-term commitment to exercise
Help allay fear and anxiety and improve health-related QoL
↑ knowledge of lung condition and promote self-management

Question 2

Duration and frequency of training programme

Answer 2

> Evidence suggests longer programmes yield larger and more endurable effects.

> 2-3 sessions/week (at least)

Question 3

Training intensity

Answer 3

> Determine the initial exercise prescription at 70-80% of the derived VO2 max and then use breathlessness scores to monitor the training and adjust accordingly.

> Higher intensity and shorter time showed to be more effective than lower intensity and longer time. Recommended intensity 60-80% of peak work rate or VO2max

Question 4

Physiological Training Responses

Answer 4

> Improved mechanical efficiency
Cardiovascular adaptations
Muscle changes

Question 5

Practical aspects of training

Answer 5

> Location: most appropiate should be determined by the needs of the patient.
Timing: start as soon as possible.
Equipment: depend primarily on the type of training to be performed and the financial resources (swimming, riding, golfing, bowling, walking, multigym, dumbells, mat)
Changing attitudes towards exercise and dyspnoea: replace negative perception of dyspnoea for positive.
Supplemental O2 during exercise training: only if desaturation and a clear benefit comes with the use of O2.
Safety issues in rehab: field walking test with HR monitoring and pulse oximetry will identify O2 needs and intensity.

Question 6

Evidence

Answer 6

> Breathing techniques: evidence for pursed lips and forward lean position. Not for diaphragmatic breathing.
Specific training of ADLs: general exercise is as effective as ADL-targeted training.
Walking aids: acute benefits of the use of a rollator.
Non-invasive positive pressure ventilation (NIPPV): only for pt severely disabled by dyspnoea.
Pharmacological agents: use of inhaled corticosteroids prevents exacerbations and oral reduce duration and impact of exacerbations.
Nutrition: insufficient evidence.
Neuromuscular electrical stimulation: may provide an additional stimulus for changes in muscle physiology.
Smoking cessation: clinically, positive influence.
Acupressure: not enough evidence.