Week 12 (Pulmonary Rehab) Flashcards
What is pulmonary rehab
An effective intervention for those with COPD as those with COPD decrease their levels of PA due to dyspnoea leading to a disability spiral. PR can’t change the disease process but aims to break the disability spiral.
Groups that benefit from pulmonary rehab
COPD, chronic asthma, bronchiectasis, interstitial lung disease, pre/post lung surgery, pulmonary arterial hypertension, lung cancer
Groups that don’t benefit from pulmonary rehab
MSK or neurological disorders that prevent exercise, unstable CVD e.g. unstable angina, aortic valve disease, severe cognitive impairment, severe psychotic disturbance, relevant infectious disease
Benefits of pulmonary rehab
Improve: exercise capacity, health-related QOL, muscle strength, health behaviours
Reduce: dyspnoea, health costs, reduction in hospital admission/length of stay
The 3 systems that limit pulmonary rehab
- Cardiovascular system
- Peripheral system
- Pulmonary system
- Impaired ventilation: normal response to exercise
Vt increases by increasing in lung capacity and ERV decreases
- Impaired ventilation: COPD response to exercise
ERV increases. As we blow out air, airways collapse and air doesn’t come out so each breath becomes deeper.
Pathophysiology of dynamic hyperinflation
Increased RR and ERV > not enough time for lung emptying > gas trapping leading to dynamic hyperinflation and increased EELV > flattened/shortened diaphragm means decreased inspiratory reserve > impaired respiratory mechanics and WOB > reach max ventilation and/or dyspnoea tolerated
- Impaired gas exchange: due to
Decreased ventilation, diffusion and perfusion leading to desaturation with exercise
Pulmonary limitation: when will it be seen in measurement at peak exercise?
- Abnormally high RR
- Severe dyspnoea
- Decreased Spo2
- Abnormal POB
- Lower Vt
- VE/MVV > 70%
- Increased EELV
Max HR not achieved
Peripheral limitation to exercise in COPD
COPD > progressive decrease in PA + systemic inflammation > skeletal muscle atrophy and decreased oxidative capacity of SKM > decreased mm strength and endurance > early onset of muscle fatigue
Cardiovascular limitation to exercise in COPD
Late stage COPD > RHF common > decreased SV > decreased CO > decreased PA
What system benefits from COPD
Peripheral system
Benefits of pulmonary rehab on the peripheral system
Improve muscle endurance and strength and decrease fatigue. Increase muscle endurance through reversed muscle fibre distribution, increased capillary density in muscles and oxidative enzymes
How does improving the pulmonary system help with dyspnoea
- Better oxygen extraction
- Reduced dyspnoea
- Delay dynamic hyperinflation
How does exercise help maintain aerobic metabolism longer
Delay onset of lactic acidosis (metabolic acidosis) by producing a respiratory acidosis through hyperventilation and increases exercise capacity
Benefits for PR other than the pulmonary, cardiovascular and peripheral
Psychological benefits: improve emotional function, self-confidence, coping strategies and reduces depression, social impediments and mood disturbance
Improves adherence with medications
Common components of PR
- Initial assessment
- Exercise training
- Nutrition advice
- Education
- Psychosocial support
- Final assessment and strategies for ongoing exercise
Endurance exercise testing for PR: lower limb
- 6MWT x 2 (most common)
- ISWT
- Endurance shuttle walk test
- Lab tests e.g. incremental cycle/treadmill test
Endurance exercise testing for PR: upper limb
Unsupported upper limb exercise test
Strength exercise testing: lower/upper limb
- 8-10RM depending on the condition of the patient. Use hand weight or weight training equipment.
- 5 STS test
Setting of PR include
- Hospital based (inpatient/outpatient)
- Community based
- Home based
- Tele rehabilitation
- Hydrotherapy
Length of PR include
Standard programs 8-12 weeks with at least 20 sessions. Those with severe COPD may need a longer program up to half a year to achieve changes.
Assessment of PR
- Medical history
- Physical exam
- Investigations e.g. spirometry, CXR
- Exercise testing
- QOL measures: disease specific and generic
