Exercise & Pulmonary Rehabilitation
   

It has become clear in the last few years that activity, lifestyle and nutrition play an important role in improving the symptoms of patients with COPD. Pulmonary Rehabilitation is a multi-disciplinary continuum of services directed to persons with pulmonary disease and their families, usually by an interdisciplinary team of specialists with the goals of achieving and maintaining the individual’s maximum level of independence and functioning in the community.  (Cole and Fishman, 1994) MDT members include a physiotherapist, Pharmacist, Dietician, Respiratory Physician, Respiratory Nurse and a Benefits and Pensions advisor

What are the aims of Pulmonary Rehabilitation?

  1. Increase exercise tolerance
  2. Increase muscle strength and endurance
  3. Improve health-related quality of life
  4. Increase independence in daily functioning
  5. Increase knowledge of lung condition and self management
  6. Promote long term commitment to exercise                      

How does the service run? 
Pulmonary Rehabilitation classes run twice weekly for six weeks. They are supervised by a qualified Physiotherapist. Locally these classes are located at SUHT/SGH, Bitterne HC and Lymington Hospital. Exercise training is the cornerstone of the program, with patients encouraged to participate in a home exercise program as well. Educational sessions aim to promote a greater understanding of COPD, and improved self-management. Assessment prior to commencing a course is essential to obtain baseline data, such as using the 6 minute walk test, and to ensure the patient is motivated and committed to participating fully in the sessions

Who would benefit from Pulmonary Rehabilitation?

  1. Those with a diagnosis of COPD, confirmed with spirometry FEV1<80%
  2. Those on optimal therapy, as per COPD guidelines
  3. Patients with a known cardiac condition can be referred as long as the condition is stable and well controlled
  4. Patients who are motivated and willing to actively participate

 Those not suitable for Pulmonary Rehabilitation

  1. Patients with poorly controlled angina on minimal exertion
  2. Patients who have had an MI 6 weeks prior to commencement of program
  3. Patients whose dyspnoea is as a result of cardiac disease
  4. Patients with uncontrolled hypertension
  5. Patients with any other medical condition that severely limits mobility
  6. Patients with poor motivation
  7. Patients with conditions that affect their ability to follow instructions

How are patients referred to Pulmonary Rehabilitation?
Patients can be referred via their GPs, Physicians, Respiratory Nurses, Therapists and other Community nurses. 

What happens once patients have completed the course?
Patients are actively encouraged to continue with exercise on completion. There are several ways in which this can be achieved:

  1. Home exercise programs, including the ‘Move on up’ DVD
  2. Active Options or Healthy Horizons exercise schemes
  3. Maintenance group run by the community COPD team
  4. Patients are also encouraged to join the local Breathe-Easy group

         What evidence do we have to support Pulmonary Rehabilitation?

  1. Exercise training can reverse features such as exercise intolerance and muscle wasting (Troosters et al, 2002)
  2. Improved walking distances reduced social deprivation and isolation and therefore improved HRQOL (Morgan et al, 1997)
  3. Reduced symptoms of dyspnoea and fatigue (Bendstrup et al, 1997)
  4. Reduces health care utilisation-fewer exacerbations (Guell, 2000)
  5. Decreased number of days spent in hospital, decreased use of oxygen and decreased number of GP visits (Griffiths et al, 2000)
  6. The effects of resistance training on functional outcomes in patients with chronic obstructive pulmonary disease (Panton LB et al), Eur J Appl Physiol 2004.
  7. Endurance and strength training in patients with COPD, (Mador MJ et al), Chest 2004.

Symptom Management
Breathlessness is one of the main clinical features of COPD, and individuals’ perception of this will vary. Some patients become completely pre-occupied with their breathing, which can lead to anxiety and a worsening of their symptoms. Breathlessness can be eased through exercise programs, advice on breathing control techniques and positioning.

Breathing Control.
This is a technique that promotes and emphasises diaphragmatic breathing with a normal size breath with the upper chest and shoulders relaxed. It can be taught to patients to use when they are feeling breathless.

  • Find a comfortable well supported position
  • Breathe out gently and allow shoulders and upper chest to relax
  • Breathe in gently, through your nose, and feel your abdomen expand as the air flows in to your lungs
  • It may be helpful at first to place one hand on the upper abdomen so you can feel the movement
  • Breathe out through either your nose or mouth
  • Practice everyday so that it becomes a more natural pattern should you be breathless