2ObjectivesState the definition and general goals of pulmonary rehabilitation programs.Describe the rationale for exercise conditioning and psychosocial support of patients with chronic pulmonary disease.Describe how to evaluate and select patients for pulmonary rehabilitation.Describe pulmonary rehabilitation program design including format and content.
3Objectives (cont.)List the educational content to be addressed in a pulmonary rehabilitation program.Describe the implementation of a pulmonary rehabilitation program including staffing, facilities, scheduling, class size, equipment, and costs.Describe the outcome measures that can be used to evaluate pulmonary rehabilitation programs.Identify the potential hazards associated with pulmonary rehabilitation.
4Definition and GoalsDefined as the restoration of the individual to the fullest medical, mental, emotional, social, and vocational potentialThe overall goal is to maximize functional ability and minimize the impact of the disability.Other goals are to control symptoms and improve the overall quality of life.
5Historical Perspective In 1951, Alvan Barach recommended reconditioning programs for chronic lung disease patients.In 1962, Pierce and associates published data that confirmed the value of reconditioning.Gradually the medical community came to appreciate the value of pulmonary rehab for patients with COPD and other disorders.
6Scientific Basis Physical reconditioning Physical activity increases energy demands.Poor conditioning of muscles leads to inefficient use of oxygen and excess acid production.Pulmonary rehab aims to recondition the muscles and increase exercise tolerance.
7Scientific Basis (cont.) Psychosocial supportCOPD can negatively affect the patient’s overall outlook and reduce motivation.Patients with COPD often have anxiety and stress.Psychosocial support in combination with physical reconditioning is needed to cause the best possible outcome.
8Structure of a Pulmonary Rehab Program Program goals and objectives
9Structure of a Pulmonary Rehab Program (cont.) Patient evaluationPatient evaluation begins with a complete patient history.Next, a complete physical examination is done.A chest radiograph, CBC, and ECG may be needed.Pulmonary function testing and exercise evaluation are often needed.
10Structure of a Pulmonary Rehab Program (cont.) Patient evaluation (cont.)Contraindications includePatients who cannot perform the testThose with severe pulmonary hypertensionThose with hypertensionThose with neuromuscular diseaseThose with untreated or unstable asthmaThose with angina with exercise
11Structure of a Pulmonary Rehab Program (cont.) Patient selection
12Structure of a Pulmonary Rehab Program (cont.) Program designOpen-ended designs allow the patient to enter the program and progress through it until he or she achieves certain goals.Closed designs use a set time period to cover the program content.Classes meet 1 to 3 times per week for 6 to 16 weeks.
13Structure of a Pulmonary Rehab Program (cont.) FormatLong-term improvements are most likely to occur if planned follow-up is completed.Follow-up must be ongoing and available to all patients who complete the program.
14Structure of a Pulmonary Rehab Program (cont.) Content
15Structure of a Pulmonary Rehab Program (cont.) Physical reconditioningConsists of an exercise prescription with target heart rate based on the initial evaluationFor most patients, an initial target heart rate is 20 beats/min above resting rate.
16Structure of a Pulmonary Rehab Program (cont.) Physical reconditioning (cont.)The exercise prescription includes the following:Lower extremity aerobic exercisesTimed walking (6- or 12-minute walk)Upper extremity aerobic exercisesVentilatory muscle training using progressive resistance
18Structure of a Pulmonary Rehab Program (cont.) Educational componentRespiratory structure, function, and pathologyBreathing control methodsMethods of relaxation and stress managementExercise techniques and personal routines
19Structure of a Pulmonary Rehab Program (cont.) Educational component (cont.)Bronchial hygiene techniquesHome O2 and aerosol therapyMedicationsDietary guidelinesRecreation and vocational counseling
20Structure of a Pulmonary Rehab Program (cont.) Psychosocial and behavioral componentEmotional stress is a common problem for a patient with chronic lung disease.Experts can be brought in to help patients cope with their anxieties and sources of stress.
21Structure of a Pulmonary Rehab Program (cont.) StaffingPulmonary rehabilitation is a multidisciplinary endeavor.Staff conducting the program should be certified in basic and advanced life support.
23Structure of a Pulmonary Rehab Program (cont.) FacilitiesThe facility must be easy to reach, be accessible to public transportation, and have available parking.Rooms should be spacious and comfortable with adequate lighting and ventilation.A room for counseling is helpful.
24Structure of a Pulmonary Rehab Program (cont.) SchedulingClass times need to be scheduled at a time most convenient for the patients.Traffic patterns, bus schedules, and availability of rides are important factors to consider.Class sizeThe ideal class size is 3 to 15 patients.
25Structure of a Pulmonary Rehab Program (cont.) EquipmentClass room equipment to facilitate teaching is needed.Blackboard or flipchart35-mm projector or PowerPoint projectorFormal learning packages
26Structure of a Pulmonary Rehab Program (cont.) Equipment (cont.)Physical reconditioning equipment is needed.Stationary bicycles, treadmills, rowing machinesPulse oximetersInspiratory resistance devicesEmergency O2 should be in the room.
28Structure of a Pulmonary Rehab Program (cont.) Program results
29Structure of a Pulmonary Rehab Program (cont.) Potential hazardsCardiovascular abnormalitiesBlood gas abnormalitiesMuscular abnormalitiesMiscellaneousExercise-induced asthmaHypoglycemiaDehydration
30Structure of a Pulmonary Rehab Program (cont.) Cardiac rehabilitationA comprehensive exercise and educational program designed for patients with cardiovascular diseasesGoals are to improve heart health and work capacity, weight loss, and return to work.