EXPH 3180- Exercise Testing and Prescription for Pulmonary Patients

Pulmonary Rehabilitation

improves exercise tolerance, reduces symptoms,, and improves quality of life

What is the key focus regarding pulmonary diseases?

long term behavior change for participation in PA and exercise

Types of Static Pulmonary Function

normal, obstructive, restrictive

Total Lung Capacity

overall size of lung

Lung Elasticity 

ability of lungs to move air in/out

Obstructive Lung Disease

harder for air to move in/out

-same lung size

-assess via tidal volume

Restrictive Lung Disease

smaller lung size

-tidal volume growth limited

is COPD reversible?

not really

What does COPD typically consist of?

chronic bronchitis, emphysema, asthma, cystic fibrosis, bronchiectasis

Asthma

multi-factorial chronic inflammatory disorder of the airways

What is asthma characterized by

-history of bronchial hyperresponsiveness, variable airflow limitation

-recurring wheeze, dyspnea, chest tightness, and coughing (particularly at night or early morning) 

Asthma’s symptoms are…..

variable + reversible 

-provoked or worened by exercise

Deconditioning effect on Asthma

downward cycle or “spiral” 

Asthma + PA

there is strong evidence for recommending regular PA 

-general health benefits and reduced incidence of exacerbations

-improvements in days without asthma symptoms, aerobic capacity, maximal work rate, exercise endurance, pulmonary VE

Exercise Induced Bronchoconstriction

-experienced in a substantial proportion ofpeople with asthma, but people without a diagnosis must also experience

How is asthma/exercise induced asthma treated?

pharmacotherapy

-bronchodilators

What is assessed w/ asthma + exercise testing?

cardiopulmonary capacity, pulmonary function (before and after exercise) and oxygen saturation

Can you administer bronchodilator prior to exercise testing?

yes, to prevent EIB, allowing for more optimal assessment of cardiopulmonary capacity

Where is exercise testing with asthma patients typically done? 

on a motor-driven treadmill or an electronically braked cycle ergometer

-targets high ventilation and HR are better achieved with treadmill

-sport specific mode for athletes 

Criterion for exercise induced bronchoconstriction in most laboratories 

decrease in FEV1 from baseline of >15% because of its greater specificity 

Is physician supervision required with asthma patients

only when testing higher risk individuals

-potential bronchoconstriction is a potential hazard following testing 

What is potential criteria for termination in exercise tests w/ asthma patients? 

oxyhemoglobin desat <80%

What test may be more appropriate in patients with moderate-severe persistent asthma if no equpiment is available? 

6MWT

What is the goal with asthma? 

to eliminate/control symptoms as much as possible with use of a bronchodilator

Bronchodilator Inhalation impact on HR in exercise testing

Beta agonist

-increased HR faster/causes flutter

-timing of administration is important 

(can use RPE for exertion instead) 

What may be beneficial for individuals on prologned treatment with oral corticosteroids

resistance training

(may experience peripheral muscle wasting)

What should be avoided to avoid triggering bronchoconstriction in susceptible individuals

exercise in cold environments or environments with airborne allergens or pollutents 

Is there evidence of a clinical benefit from inspiratory muscle training in individuals with asthma 

no, evidence is insufficient 

Chronic Obstructive Lung Disease morbidity

4th leading cause of death and a major cause of chronic morbidity throughout the world 

What is COPD characterised by?

chronic airway inflammation due to exposire to noxious gases and particles, especially tobacco smoke and various environmental and occupational exposures 

What are common symptoms of COPD

dyspnea, chronic cough, and sputum production

COPD systemic effects

weight loss, nutritional abnormalities, sarcopenia, and skeletal muscle dysfunction

Emphysema

chronic inflammation of alveoli (eventually breakdown)

-decrease in surface area of lungs

-air trapping

Mild COPD

FEV1.0>80% predicted

Moderate COPD

50%<FEV1.0<80% predicted

Severe COPD

30%<FEV1.0<50% of predicted

Very Severe COPD

FEV1.0<30% predicted

What % FEV1.0 is very difficult to reverse effects of?

<30% predicted

Modificationf of traditional protocold for patients with COPD

-test duration of 8-12 minutes for those with mild-to-moderate COPD

-test duration of 5-9 minutes for those with severe and very severe diseases

Is age-predicted HRmax appropriate criteria for terminating a submaximal GXT?

No

What work rate approximates the type of work-related activity likely to be encountered in daily life for COPD patients

a constant work rate test using 80-90% of peak work rate 

COPD + Termination of exercise test

in addition to standard criteria:

-severe arterial oxyhemoglobin desaturation (<80%)

-exertional dyspnea  (modify borg category ratio) 

COPD- Resistance training frequency recommendation

at least 2 days/week on nonconsecutive days

COPD- resistance training intensity recommendation

strength: 60-70% 1RM for experienced weight trainers

endurance: <50% 1RM

COPD- resistance training time recommendation

strength: 2-4 sets, 8-12 reps

endurance: <2 sets, 15-20 reps

COPD- resistance training type recommendation

weight machines, free weight, or body weight exercises

Higher intensitiy exercise + COPD patients

yield greater physiologic benefits (ex: reduced minute ventilation and HR at a given workload) and should be encouraged when appropriate

What exercise training is appropriate for individuals with severe COPD or very deconditioned individuals

light intensity aerobic

COPD + ventilatory limitation in exercise 

coincides with significant metabolic reserves during whole body exercise

-may allow these patients to tolerate relatively high work rates that approach peak levels and achieve significant training effects 

COPD- supplemental oxygen w/ exercise

indivated for individuals with a PaO2<55mmHG or SaO2<88% while breathing room air

When should exercise be limited?

in individuals suffering from acute exacerbations of their disease