pulmonary rehab

what happened in 1894?

“exercise and food for pulmonary invalids” - 1st publication on exercise training and pulmonary disease

what happened in 1969?

Dr Petty was the 1st to describe the effects of a comprehensive care program to people with COPD

positive effects on symptoms, exercise tolerance, return to work and healthcare utilization

what happened in 1981?

ATS published the 1st official statement on pulmonary rehab

what happened in 2010?

medicare started covering pulmonary rehab

what happened in 2023?

most recent clinical practice guideline that recommends PR for adults with COPD ILD

what is pulmonary rehab?

• multidisciplinary and comprehensive intervention for patients with chronic respiratory diseases

what does pulmonary rehab consist of?

• exercise training

• nutritional support

• education

• psychosocial support

• airway clearance techniques

what are the settings for pulmonary rehabs?

outpatient, home setting, virtual

what is the frequency of pulmonary rehab?

2-3 times a weeks x 6 weeks

what are benefits of pulmonary rehab?

• improves exercise capacity

• reduces dyspnea

• improves QoL

• reduces anxiety and depression

• reduces number of hospitilizations and days of admissions (COPD)

• improves survival of COPD

what does pulmonary rehab result in no change of?

often results in no change in the disease process or reduction in medication usage

what are indications for pulmonary rehab?

• COPD

• interstitial lung disease

• pulmonary hypertension

• asthma

• lung cancer

• pre and post lung transplant

• recovering from COVID

what are COPD factors that contribute to exercise limitations?

• ventilatory limitations

• gas exchange abnormalities

• cardiac dysfunction (cor pulmonale)

• skeletal muscle dysfunction (type 1 to type 2)

• respiratory muscle dysfunction

what are ILD factors that contribute to exercise limitations?

• impaired gas exchange

• circulatory limitations

• skeletal muscle dysfunction

what should the frequency be for aerobic activity?

min 3 days a week, prefer 5 days a week

what is the intensity for aerobic exercise?

moderate to vigorous intensity

50-80% peak work rate or 3-6 on the BORG scale

what should the time be for aerobic exercise?

20-60 min/day, if not achievable use of interval training is acceptable for a total of at least 20 min

what type of exercise should be done for aerobic exercise?

overground or TM walking, stationary bike, UE ergometry

what should the frequency be for resistance exercise?

at least 2 days a week, on non consecutive days

what should the intensity be for resistance exercise?

strength 60-70% of 1 RM for beginners

>- 80 for experienced

what should the time be for resistance rehab?

strength: 2-4 sets, 8-12 reps

endurance: <2 sets, 15-20 reps

what should the type of resistance training be?

weight machine or free weights

what is the eduction for pulmonary rehab?

• anat and phys of lung and disease processes

• benefits of exercise and safety guidelines

• self management skills

• symptom management

• meds

• energy conservation/work simplification techniques

• oxygen therapy

• psychosocial education

• avoidance of environmental irritants

• smoking cessation

• nutrition

what are the alternative pulmonary rehab programs?

• home based PR program

• virtual PR program

what does the BODE of BODE index stand for?

B: body mass index

O= degrees of obstruction

D= Dyspnea

E= exercise capacity

what does the BODE index stand for?

• objectively measure a patient’s response to pulmonary rehab

• predict risk of death and hospitilzations

• scored 0-10 with higher scores indicating WORSE outcomes

what is the COPD assessment test? aka CAT

• completed by a DR every 2-3 months

• reliable and valid test that quantifies the impact of COPD on the patient’s health

• scored 0-40

• higher scores = GREATER disease impact

what is the 6MWT?

• objective measurement of functional exercise capacity

• 100 ft hallway is recomended

what is the normal value for healthy adults and the 6MWT?

400-700 meters

what is the COPD values for the 6MWT?

300-450 meters

what happens if the 6 MWT is less than 350 meters?

increased risk of mortality, hospitilizations, and exacerbations in COPD

what is the MCID for the 6 MWT, pulmonary?

30 meters

what does the 6MWT measure in pulmonary conditions?

• measures exercise capacity and effectiveness of pulmonary rehab

• tracks disease progression

what is the BORG dyspnea scale?

• measures SOB during or immediately after an activity

• scored from 0-10

what is the modified medical research council dsypnea scale?

• how does SOB affect physical activity

• only measures breathlessness

• GETS WORSE THE HIGHER IT GOES

• 0-4 scale

• 0 is great

what is the university of california san diego shortness of breath questionnaire?

• measure how severe SOB is during ADLs

• 24 item self report tool

• scored 0-5 with 0= not at all and 5=maximaly or unable to perform due to breathlessness

• scored 0-120 with higher scores indicating worse breathlessness

what is the St. George’s respiratory questionnaire?

• 50 item questionnaire that covers symptoms, activity and impact of disease on daily life

• scored 0-100 with HIGHER SCORES INDICATING GREATER FREQUENCY OF SYMPTOMS AND LOWER QoL

• items are weighted and you need to use an excel calculator to calculate the score

what is the chronic respiratory questionnaire?

• 20 item questionnaire that measures dyspnea, fatigue, emotional function and mastery

• scored on a 7 point Likert scale with HIGHER SCORE INDICATING BETTER QoL

what what does the hospital anxiety and depression scale assess?

both anxiety and depression

what des the PHQ 9 depression scale look at ?

depression with a 9 item scale that is scored from 0-27

what does the timed up and go TUG test look at?

• measures functional mobility and balance

• valid and responsive test in COPD populations

what is the TUG score that leads to an increased risk of falls?

greater than or equal to 12 seconds

MCID is 0.9-1.4 sec

what is gait speed for pulmonary conditions?

• valid and reliable in various pulmonary conditions

• strongly correlates with the 6MWT

what is the number we need to know for gait speed?

less than 0.8 m/s

predicts very poor exercise capacity, longer hospital LOS, higher mortality rate, increased risk for long term O2 use in various pulmonary patient populations

what does the 5 time sit to stand test measure?

• measures LE function and strength

• reliable, valid, and responsive test for COPD and ILD

what is scoring equal to or more than 16 seconds for 5 time sit to stand

poor functional performance, increased risk of falls, reduced functional capacity, higher risk for severe exacerbations and increased risk for mortality

what is the activities specific balance confidence scale used for??

• used in pulmonary populations to identify fall risk status

• 16 item tasks are rated from 0% (no confidence) to 100% (complete confidence)

• the MDC for patients with COPD has been determined to be 8.25%

what happens if the score is below 58% on the ABC scale?

indicates high risk of falls in people with lung disease

what are common pulmonary impairments?

• impaired gas exchange

• ineffective airway clearance

• excessive secretions

• inefficient breathing patterns/dyspnea

• reduced respiratory and skeletal muscle strength

• exercise intolerance

• lack of knowledge

what is hypoactivity syndrome?

• principle movement impairment = decreased endurance due to insufficient movement of the body

• unable to participate in activity for prolonged period of time

• good vs poor potential

• treatment: increase movement/activity to improve endurance