Pulmonary Rehabilitation. Steve Crogan RRT Pulmonary Rehabilitation, University of Washington Medical Center Seattle, Washington 10/13/07

Transcription

1 Pulmonary Rehabilitation Steve Crogan RRT Pulmonary Rehabilitation, University of Washington Medical Seattle, Washington 10/13/07

2 Pulmonary Rehabilitation Created in the 1970 s Initially intended for COPD patients It is now recognized as appropriate for any patient with chronic lung disease who is disabled to some degree by respiratory symptoms A physician referral is necessary to enter Pulmonary Rehabilitation

3 Pulmonary Rehabilitation The primary goal of Pulmonary Rehabilitation is to restore the patient with chronic lung disease to the highest possible level of independent function This is done by helping people be more physically active, and to learn more about their disease, treatment options, and how to cope

4 Components of Pulmonary Rehabilitation Supervised exercise Endurance Strength Flexibility Consistency is essential to increase exercise capacity

5 Components of Pulmonary Rehabilitation Education, topics include: Structure and function of the lung Lung diseases Coping with stress and depression Respiratory medications Use of oxygen and related equipment Nutrition Energy conservation Dyspnea and breathing techniques Home exercise program planning

6 Components of Pulmonary Rehabilitation Breathing retraining and anxiety control Practice in pacing and energy conservation Strategies for coping during times when breathing is very difficult

7 Components of Pulmonary Rehabilitation Sufficient oxygen delivery during exercise Pacing controlling exertion

8 While Pulmonary Rehab does not alter the underlying lung disease, it does result in: reduced dyspnea increased ability to perform sustained physical activity improved sense of well being, confidence preparation for the stress of surgery (prehabilitation)

9 Who is Pulmonary Rehabilitation for? People with chronic lung disease and often one or more of these issues: Low oximetry values (sats) High supplemental oxygen requirements Lots of coughing Lots of sputum Severe breathlessness An aversion to exertion Other barriers to exercise, such as poor balance and falls risk, weakness, problems ambulating

10 Regardless of diagnosis, things in common Some degree of loss of independence Breathing related anxiety Decreased endurance Shortness of breath (dyspnea)

11 A Vicious Cycle Lung Disease Dyspnea with exertion Physical Conditioning Reluctance to exert Activity

12 Breaking the Cycle Supervised exercise Activity Reluctance to exert Physical Conditioning Dyspnea with exertion

13 Breaking the cycle by helping people to: Exercise safely at an intensity and frequency that will produce a significant gain in fitness Learn to cope with breathlessness during physical activity Become more knowledgeable about their disease Be more actively involved in their own health care Be more independent in performing daily activities

14 Exercise intensity, heart rate, and the Borg Scale Intensity = how hard you re working Exercising at the proper intensity is essential to improve fitness (not too easy, not too hard) Intensity is commonly gauged by heart rate except in lung disease Typically, when the exerciser has lung disease, shortness of breath limits intensity of exertion

15 The Borg Scale 0 Nothing at all 0.5 Very, very slight (just noticeable) 1 Very slight 2 Slight (light) 3 Moderate 4 Somewhat hard 5 Hard 6 7 Very hard Maximal

16 Supervised exercise session routine - UWMC Oxygen, weigh-in, oximetry Warm up Aerobic activity using exercise machine (treadmill, bike, stepper, etc.) Monitor oximetry, make oxygen adjustments Frequent assessment of dyspnea and exertion Resistance exercises Flexibility exercises

17 NuStep

18 Treadmill

19 Airdyne

20 Arm Ergometer

21 Class Schedule UWMC 3 days per week, M-W-F 24 sessions total 75 minutes in gym 60 minutes lecture (9 sessions)

22 Home exercise plan After pulmonary rehab, an effective, achievable exercise plan is essential or fitness gains will be lost Oxygen Frequency Intensity Duration Mode of exercise Variety