Pulmonary rehab

PRATIGYA DEUJA- PULMO REHAB definition, goals, phases of rehab, breathlessness management, assessment, test and review

1. PULMONARY REHAB PRATIGYA DEUJA

2. DEFINITION Pulmonary rehabilitation is a program of education and exercise that helps you manage your breathing problem, increase your stamina(energy) and decrease breathlessness. (American Thoracic Society). It is an integra l part of the clinical management and health maintenance of those patient with chronic respiratory disease who remain symptomatic or continue to have decreased function despite standard medical treatment.

3. GOALS The goals of rehabilitation are to reduce the symptoms, disability and handicap and to improve functional independence in people with lung disease. To increase the muscle strength and endurance(peripheral and respiratory). To help in managing anxiety and depression. These goals are achieved through patient and family education, exercise training, psychosocial and behavioral intervention and outcome assessement .

4. BENEFITS Decrease breathlessness by 65%. Increase capacity and quality of life even for severely impaired patients. Decrease health care costs. In modified form, increase ability to wean from mechanical ventilation. Reduced exacerbations post pulmonary rehabilitation.

5. ASSESSMENT Respiratory impairment: Decrease lung function. e.g , FEV₁ Respiratory disability: The effect of this impairment, e.g. anxiety or decrease exercise capacity. Respiratory handicap: social and other disadvantages.

6. TEST BY PHYSICAL THERAPIST Oximetry 6 minute distance Stair climbing:- Climbing upstairs, counting the number of steps that can be climbed up and down in 2 minutes. Shuttle test Treadmill walking

7. Shuttle test

8. PHASES OF REHAB 1) Check in phase: Pre-training vitals are taken. 2) Warm up phase: Preparing muscle for exercise which includes walking, stretching and jogging. Done for 5-15 minutes Stretching followed in expiration, during inspiration it might leads to valsalva maneuver.

9. PHASES OF REHAB 3) Aerobic exercises: All mobility exercises are done. It includes walking, cycling, treadmill, postural drainage, ACBT( active cycle of breathing technique) Before the aerobic training session they should complete a course which includes: A course duration of 4-12 weeks Training session 2-5 times per week A session duration of 20-30 minutes A target heart rate corresponding to 60% V0₂ max

10. PHASES OF REHAB Strategies to progress exercise: setting the duration and increasing the work rate setting the intensity and increasing the duration of exercise The training intensity may be set using heart rate, treadmill speed, shuttle walking speed, or cycle ergometer load at the given percentage of peak work rate during the preliminary exercise test.

11. PHASES OF REHAB 4) Cool down phase: It is done for 5-10 minutes The work load are decreased PATIENT EDUCATION Dyspnoea and it’s management Nutritional advice Anxiety management Relaxation Oxygen therapy

12. BREATHLESSNESS MANAGEMENT IN ADL Prioritize activities Organize chores by location to avoid multiple trips. Co-ordinate breathing. Example; inhale with pulling and exhale with pushing. Lean on shopping trolleys. Organize work space to reduce clutter and minimize reaching and bending. Ensure that work surfaces are at the correct height. Keep heavy items on top of the work. Develop economic lifting methods using leg power rather than back and shoulders.

13. BREATHLESSNESS MANAGEMENT Slide pots and pans along the work top rather than lifting them. Soak washing up. Use a stool for kitchen work and ironing (it saves 24% of energy) Reduce bending by crossing one leg over other to put on socks, trousers and shoes. Avoid aerosols or strongly scented perfumes.

14. BREATHLESSNESS MANAGEMENT

15. GRADED EXERCISE TEST TERMINATION CRITERIA Maximum shortness of breath Fall in partial pressure of O₂ >20 mmhg or partial pressure of O₂ <55 mmhg Rise in partial pressure of Co₂ >10 mmhg and <65 mmhg Cardiac ischemia Symptoms of fatigue Increased diastolic pressure >20 mmhg , systolic HTN >250 mmhg Leg pain Total fatigue Signs of insufficient cardiac output Reaching ventilatory maximum

16. REVIEW;benefits of pulmo rehab 1) K. Liu et al. in their RCT took total 76 patients and divide them into two groups i.e intervention group (n=38), out of which 2 abandoned in between and control group (n=38). The intervention group performed Respiratory rehab which includes Respiratory muscle training, cough exercise, diaphragmatic training and stretching. This was done 2 sessions per week for 6 weeks. The outcome measures were, Respiratory function exercise, endurance (6 min walk test),ADL and quality of life, psychological status assessment (anxiety, depression scores). The study concluded that 6 week rehab can improve QoL , Respiratory function and anxiety in elderly patient’s with COVID-19.

17. REVIEW;benefits of pulmo rehab 2) Andrew et al. in their RCT took 119 out patients with COPD and divide them into intervention group (n=57) and control group (n=62). The intervention group performed the pulmonary rehab which includes 30 min walk, treadmill, isokinetic upper body ergometer whereas the control group were given education program like coping with stress, energy conserving technique, oxygen therapy. The intervention was performed for 4 hour session until 8 week. The study concluded that the pulmonary rehab significantly improved exercise performance and symptoms for patients with moderate to severe COPD.