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PHTY 800 > Week 12 - Pulmonary Rehab > Flashcards

Week 12 - Pulmonary Rehab Flashcards

1
Q

Aim of pulmonary rehab

A
  • Reduced symptom burden
  • Maximise exercise capacity
  • Promote autonomy
  • Improve participation in ADLs
  • Enhance health-related quality of life
  • Promote health behaviour change
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2
Q

What patient groups are excluded from PR?

A
  • MSK / neuro disorders that prevent exercise
  • Unstable CVD
  • Severe cognitive impairment
  • Severe psychotic disturbance
  • Relevant infectious disease
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3
Q

What patient groups can benefit from PR?

A
  • COPD
  • Chronic asthma
  • Bronchiectasis
  • Interstitial lung disease (ILD)
  • Pre/post lung surgery
  • Pulmonary arterial hypertension
  • Lung cancer
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4
Q

Improved benefits of PR:

A
  • Exercise capacity
  • Health-related QOL
  • Muscle strength
  • Health behaviours
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5
Q

Reduced benefits of PR:

A
  • Dyspnoea
  • Health care costs
  • Reduction in hospital admissions/length of stay
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6
Q

What limits an untrained person w/o disease:

A

Peripheral system

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7
Q

What limits a trained individual?

A

Cardiovascular system

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8
Q

CV limitations to exercise:

A
  • HR
  • Rhythm
  • BP
  • Chest pain
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9
Q

Pulmonary limitation:

A
  • Vt
  • RR
  • VE/MVV (max voluntary ventilation)
  • POB (pattern of breathing)
  • SpO2/Dyspnoea score
  • End expiratory lung volume (EELV)
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10
Q

Pulmonary limitation in COPD:

A
  • 2 main impairments: impaired ventilation (resp. system mechanics & muscle impaired) / Impaired gas exchange
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11
Q

Steps that happen with impaired ventilation due to COPD:

A
  • Increased RR & Vt
  • Insufficient time for lung emptying
  • Gas trapping > dynamic hyperinflation > Increased EELV
  • Flattened / shortened diaphragm
  • Decreased inspiratory reserve
  • Increased WOB
  • Reach MAX VE / DYSPNOEA
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12
Q

Gas exchange can be impaired due to decreased:

A

Ventilation, perfusion, diffusion

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13
Q

Measurements that identify pulmonary limitations in COPD:

A
  • Abnormally high RR
  • Severe dyspnoea
  • Decreased SpO2
  • Abnormal POB
  • Lower Vt than normal
  • VE/MVV > 70%
  • Increased EELV
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14
Q

Peripheral muscle limitations in patients w/ COPD:

A
  • Decreased muscle mass (strength)
  • Decreased oxidative enzymes
  • Change in muscle fibre type (decreased type 1, increased type 2) - (decreased muscle endurance)
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15
Q

What is a consequence of muscle changes in those w/ COPD:

A

Early onset of lactic acidosis > early muscle fatigue

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16
Q

Late stage COPD CV limitations:

A
  • R sided heart failure (RHF) is common
  • Decreased SV / CO
  • Decreased PA
17
Q

Benefits of PR in those w/ COPD:

A
  • As long as lung function doesn’t change, these benefits occur:
  • Improvement of peripheral mm function / exercise endurance :
  • Increase in muscle strength/ decrease in fatigue
  • increase muscle endurance
18
Q

How does PR increase muscle endurance in those w/ COPD?

A
  • It reverses muscle fibre distribution (maintains slow twitch fibres)
  • Increases capillary density in muscles
  • Increases oxidative enzymes
19
Q

How does PR help w/ dyspnoea:

A
  • Increased O2 extraction @ the working muscle.
  • Lower lactate prod. > decrease ventilation > decreased dyspnoea
  • Delays dynamic hyperinflation (DHI)
20
Q

With a metabolic acidosis, how does the resp. system try to compensate?

A
  • By producing a respiratory alkalosis through hyperventilating
21
Q

Psychological benefits of PR in COPD:

A
  • Improves: emotional function/self-confidence/coping strategies
  • Reduces: depression/social impediments/ mood disturbance
22
Q

What can PR include?

A
  • Initial assessment
  • Exercise training
  • Eduction
  • Nutritional intervention
  • Psychosocial support
  • Final assessment/ strategies for ongoing exercise
23
Q

PR assessment:

A
  • Medical Hx
  • Physical Exam
  • Investigation (SpO2/CXR)
  • Exercise testing
  • QoL measure
24
Q

Typical length of programs:

A
  • 4-8 weeks minimum
  • Standard programs: 8-12 weeks
  • At least 20 sessions
  • Those w/ severe COPD need longer (up to 6 months to see changes)
25
Q

Frequency of training:

A
  • MINIMUM 3 x week , 2x-supervised, 1x- @ home
26
Q

Intensity of training:

A
  • High elicits the greatest training response

- Low intensity is also effective (60-65% peak work rate)

27
Q

Walking training intensity based of test:

A
  • 80% of better (out of 2) avg. 6MWT speed
  • 70% of peak walking speed on the ISWT
  • Dysp score of 3-4
28
Q

Intensity of cycle training:

A
  • 60-80% of peak cycle work rate from cycle test
  • Predictive equation from 6MWT
  • OR dysp score of 3
29
Q

What to do if pt desaturates while exercising?

A
  • Regularly monitor SpO2
  • Consider interval training
  • Drops below 88% - assess for supplemental O2
  • Cycling induces less O2 desaturation than walking

PHTY 800 (8 decks)

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