Pulmonary Rehabilitation What is Pulmonary Rehabilitation (PR)? PR is a exercise and education programme for people with long term lung conditions. It involves a combination of physical exercise and discussion and advice on your lung condition. It is designed to enable you to manage your shortness of breath more easily as well as having further understanding of your lung condition. Why would I need Pulmonary Rehabilitation? PR is aimed at people who have breathing difficulties that are affecting their daily life causing a reduced ability to carry out daily tasks. At East Sussex Healthcare NHS Trust (ESHT) we provide this service for patients with Chronic Obstructive Pulmonary Disease (COPD), Idiopathic Pulmonary Fibrosis and Bronchiectasis. Your age or the severity of your symptoms will not stop you participating in the programme. The first step of the process will involve you being seen by one of the members of the team for a one to one appointment. At this appointment you will be asked questions around your lung condition as well as your general health and mobility to decide if the programme is appropriate for you. What are the symptoms that have led to me needing Pulmonary Rehabilitation? Common symptoms of patients with chonic lung conditions include - Increased shortness of breath Increased cough Increased phlegm production Recurrent chest infections As well as having the exercise part of the program to address your shortness of breath and exercise capacity, the education component of the programme will help you manage these other symptoms more effectively. What are the alternatives to Pulmonary Rehabilitation? If assessed as appropriate for the PR programme you are encouraged to participate as it is shown to have positive effects on quality of life and daily function. However should you decide you do not want to take part on the programme this is of course your decision. If a physiotherapist finds that you are unable to participate on the PR course there are other options available such as further one to one appointments with a physiotherapist or respiratory nurse. It may also be that you are unable to attend the exercise component of the program but can attend the education sessions. This will be advised to you on an individual basis. What are the potential risks and side effects? Exercising can come with associated side effects. Some of these such as joint discomfort and general aches and pains are to, on the whole, be expected but this will be monitored. We will be making you short of breath whilst you are exercising on the programme but we will be doing this in a contolled way and will be monitoring you exercising. 0493/01 Sep 2015 Page 1 of 6
If you experience any more serious side effects from exercise such as dizzyness, fainting or chest pain we will be able to assist you with these. Should you experience severe shortness of breath we have a nebulised salbutamol which we can administer after gaining your consent. What are the expected benefits of Pulmonary Rehabilitation? PR will: Help to improve your muscle strength, so your body uses oxygen more efficiently and therefore reduces your shortness of breath on activities. Allow you to carry out more activities before getting short of breath and therefore be more active and independent. Have a better understanding of your lung condition so you feel more confident at managing your symptoms especially with flare ups or exacerbations. PR is going to improve your overall strength, it does not however change your lung condition. It is designed to make your body more able to cope with your lung condition so it is rare we see a change with the blowing test or spirometry. Picture 1 Patients participating in a group warm on a pulmonary rehabilitation programme at Uckfield Leisure Centre. What should I expect before I attend the Pulmonary Rehabilitation program? Initially you will have been referred to the Regional East Sussex Pulmonary Service (RESPS) by another health professional. This is likely to have been your GP, Respiratory consultant or practice nurse although all health professionals can also refer you. Your first appointment will be a one to one assessment with a RESPS team member. This is likely to be a physiotherapist but it could equally be one of the respiratory nurses. This assessment will act as a screening to check that you are the right candidate for the PR program. Once assessed as appropriate you will be asked to attend a further assessment. This assessment allows us to complete some outcome measures. An outcome measure allows us to review the improvements you have made during the programme. These outcome measures involve a walking test and several questionnaires. You will be monitored throughout the walking test and given that you fit the required criteria then you will be suitable for PR. You will then be enrolled onto one of our programmes. What does a typical Pulmonary Rehabilitation session involve? A typical PR group will aim to contain up to 18 people. At the start of the session the physiotherapist or respiratory support worker will check you oxygen levels, heart rate and breathlessness. This will be monitored at intervals during each session. The whole group will Page 2 of 6
then be required to participate in a group warm up lead by the physiotherapist or respiratory support worker. You will then be required to exercise. You will be provided with an exercise sheet that will give you approximately eight exercises to complete during each session. These are a variety of leg, arm and cardio exercises designed to increase muscle strength. You will be guided by the physiotherapist as to what intensity to complete these to. After all eight exercises are completed the group will complete a cool down. After the exercise session the physiotherapist and occasionally outside speakers will lead on a discussion regarding your lung condition. These topics include: What to do when you are unwell and a self management plan. Benefits of exercise. Understanding of your lungs and your lung condition. Breathlessness management, relaxation and pacing techniques. Chest clearance techniques. Management of anxiety and panic attacks. Inhalers and medications. Welfare rights and benefits. Nutrition and diet. Stopping smoking. Picture 2 Patients listening to an educational talk on pulmonary rehabilitation programme at Uckfield Leisure centre. Where will Pulmonary Rehabilitation take place? The RESPS team work in Eastbourne and Hastings areas. The PR programmes are held in community venues such as community hospitals, community halls, church halls and leisure centres. The locations we most frequently hold PR include Hastings, Eastbourne, Hailsham, Rye and Bexhill. But this can change at times due to patient need. What will I need to bring along to Pulmonary Rehabilitation? You will be required to bring along your reliever inhaler should you have one. We will also advise you of any other medications we may need you to bring. Also a bottle of water as it is important to stay hydrated while you are exercising. You will need to wear appropriate exercising clothing loose fitting trousers and comfortable shoes preferably trainers. You are welcome to being along a supportive relative; it can often be helpful for them to attend the education part of the program as two sets of ears can be better than one. Page 3 of 6
How will I feel afterwards? As said previously following a session of exercise it can sometimes cause some muscle ache and discomfort. To an extent this is normal following exercise but should be monitored closely. But overall hopefully it will bring you a good sense of achievement. PR has been shown to improve - Your ability to resist and fight infections Your ability to do daily activities The strength of your bones The strength of the muscles that help you breathe The strength of your heart muscles Your energy levels Your well being and confidence Continuing to exercise following the programme will ensure that you continue to get these benefits. We will encourage you to continue to exercise and give you advise on how to do this. The six week programme is designed to be the starting point of getting more active to help your lung condition. How long will I be on the Pulmonary Rehabilitation programme? The PR programme is a six week programme. These programmes require you to attend twice a week for six weeks for two hours at a time. The days and times of the programmes will be explained to you during the assessment process. The time and day of the week will stay the same for the full six weeks. It is important that you attend all sessions as it has been shown to affect the benefit you will gain from the programme if you don t attend more than 75% of the sessions You will only be considered to have completed the programme, if you have attended 75% of the sessions. It is important to attend, even if you have a chest infection as you need to stay active, but it may be you don t push yourself as hard during that session. What should I do when I go home? As part of the PR programme we ask that you complete further exercises when you are at home. As you are exercising twice a week at the PR programme we will ask that you complete up to three further sessions of exercise at home. You will be provided with a work book that will give you the information you need to make this possible. At the end of the programme you will be encouraged to continue exercising. The benefits gained from attending this programme are going to be short lived should you not continue to exercise regularly. We hope that by completing exercise in a controlled way on the programme it will increase your confidence to continue this independently. Patient feedback I have enjoyed meeting others with the same lung condition and seeing the improvements I have made Very Very helpful It s a tye but has been worthwhile I highly recommend this rehab, it was the most worthwhile thing I have ever done Staff are very good, courses are really beneficial to participants Page 4 of 6
I would certainly recommend others to take advantage of attending a similar course Come and learn what you don t know about COPD Who do I contact if I need more information? Regional East Sussex Pulmonary Service (RESPS) 01424 758166 Sources of information British lung foundation www.blf.org.uk BreatheEasy - British lung foundation support group: 03000 030 555 - breathe.easy@blf.org.uk NHS Choices - Pulmonary rehabilitation video - www.nhs.uk/video/pages/pulmonaryrehabilitation.aspx Further information on pulmonary rehabilitation - http://patient.info/doctor/pulmonaryrehabilitation Important information The information in this leaflet is for guidance purposes only and is not provided to replace professional clinical advice from a qualified practitioner. Your comments We are always interested to hear your views about our leaflets. If you have any comments please contact our Patient Advice and Liaison Service (PALS) details below. Hand hygiene The trust is committed to maintaining a clean, safe environment. Hand hygiene is very important in controlling infection. Alcohol gel is widely available at the patient bedside for staff use and at the entrance of each clinical area for visitors to clean their hands before and after entering. Other formats This information is available in alternative formats such as large print or electronically on request. Interpreters can also be booked. Please contact the Patient Advice and Liaison Service (PALS) offices, found in the main reception areas: Conquest Hospital Email: esh-tr.palsh@nhs.net - Telephone: 01424 758090 Eastbourne District General Hospital Email: esh-tr.palse@nhs.net - Telephone: 01323 435886 Page 5 of 6
After reading this information are there any questions you would like to ask? Please list below and ask your nurse or doctor. A special thank you to the patients who gave their permission to use the photographs in this this leaflet. Reference Written by: Claire Lockwood, Specialist Respiratory Physiotherapist. The following clinicians have been consulted and agreed this patient information: Shankar Nair, Senior Specialist Respiratory Physiotherapist Emily Robertson, Specialist Respiratory Physiotherapist Louise Green, Specialist Respiratory Physiotherapist The directorate group that have agreed this patient information leaflet: Regional East Sussex Pulmonary Service. (RESPS). Next review date: September 2018 Responsible clinician/author: Claire Lockwood. East Sussex Healthcare NHS Trust www.esht.nhs.uk Page 6 of 6