Pulmonary Disease

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obstructive pulmonary diseases

Airflow into and out of lungs impeded

restrictive lung disease

Expansion of lungs reduced due to problems in the chest cavity or lung tissue

types of chronic obstructive pulmonary diseases

Asthma

Chronic bronchitis

Emphysema

Obstructive pulmonary disorder (genetic): cystic fibrosis

asthma pathophysiology

Varies from wheezing and slight breathlessness to severe attacks resulting in suffocation

Causes: allergic reactions, emotional stress, exercise, viral infections, or unidentifiable cause

exercise induced bronchoconstriction pathophysiology

a reactive airway disease that can occur in individuals with asthma as well as in the general population

Exercise tends to cause bronchioles to constrict, especially when there is evaporative water loss, temperature change, or exposure to irritants

chronic bronchitis and emphysema pathophysiology

Common risk factor: cigarette smoking

Other risk factors: secondhand smoke, air pollution, chemical fumes, workplace or environmental dust, or genetics (rare)

bronchitis

inflammation of bronchi with sputum-producing cough

emphysema

destruction of alveolar walls and enlargement of air spaces, which reduces lung surface area for gas exchange

cystic fibrosis pathophysiology

Recessively inherited genetic disorder

Genetic mutation that impacts a mucus-producing protein found in body organs

Mucus thick and sticky, which can block airways and make infections more likely

restrictive lung disease causes

Many causes, including pulmonary edema, pulmonary embolism, exposure to inorganic or organic dust, and radiation therapy

Neuromuscular diseases including muscular dystrophy, amyotrophic lateral sclerosis, and polio potentially restrictive of lung expansion

lung volume comparison: normal vs restrictive lung disease

pulmonary rehabilitation

Comprehensive intervention: exercise, education, psychological evaluation, nutrition, and behavior change

Typically does not directly improve lung function, but offers symptom relief, enhances exercise tolerance, and provides health-related quality of life benefits

dyspnea spiral

pulmonary function test: normal vs obstructive lung disease

pulmonary diseases: exercise considerations

Exercise testing
• May include standard graded exercise test
• Field tests: 6-minute walk test, shuttle walk test

Exercise capacity limited more by lungs than by the cardiovascular system

Pulse oximeter used to assess percent saturation of hemoglobin in the arterial blood

Symptom evaluation with dyspnea rating scale (ratio or visual analog)

Exercise program components:
• Aerobic exercise 3 to 5 days per week (use percentage of peak work rate or ratio scale)
• Resistance training at least 2 nonconsecutive days per week
• Flexibility daily, or at a minimum 2 or 3 days per week

Supplemental oxygen possibly required during exercise

Program individualization in consultation with health care provider

exercise prescription CODP: aerobic

F: 1-2 sessions/day; 3-5 sessions/week

I: 40-60% of Wmax cycle ergometer; 80% of 6MWT speed on
treadmill; aquatic exercise may be used – 12-14 RPE (Borg)

T: 30-60 min/session; Shorter sessions if >1 bout per day;
Shorter interval exercise if unable to complete continuous
exercise; Circuit training.

T: Walking; upper body cycle ergometry

exercise prescription COPD: RT

F: 2-3 days/week; non-consecutive

I: 30-40% of 1 RM (upper body); 50-60% 1RM (lower body)

T: 8-15 comfortable reps; 1-3 sets; build muscular endurance

T: Machine/free weights; Body weight exercises; 8-10 whole
body exercises

exercise prescriptio COPD: flexibility

F: 3-5 days/wk

I: not given, to the point of mild stretch

T: 30-60 seconds of stretching for each muscle group

T: static stretching; complete at beginning/end of the session

exercise prescription COPD: severe cases

Neuromuscular Electrical Stimulation (NMES)

F: 4-7 days/wk; 1-2 sessions/day

I: maximum tolerated by client

T: 30-60 min/session

T: NMES for major muscle groups