1. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 13 Resistance-Training Strategies for Individuals with Chronic Obstructive Pulmonary Disease

2. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. COPD Main term for group of respiratory diseases, including: –Asthma –Emphysema –Chronic bronchitis Progressive diseases

3. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. COPD Impairment quantified by measuring forced expiratory volume in one second (FEV1) Refer to Table 13.1

4. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. COPD Characteristics Gradual loss of lung function Airflow obstruction Dyspnea with exertion Weight loss associated with muscle wasting Recurrent bronchial infections

5. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. COPD Characteristics Chronic disability Reduced quality of life Downward spiral of inactivity, social isolation, and disability

6. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Greater Risk for Comorbidities Congestive heart failure Osteoporosis Diabetes Depression and anxiety

7. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Prevalence of COPD Almost 10 million adults have emphysema and/or chronic bronchitis –3 million men –6 million women People over age 50 likely to be disabled Younger individuals still significantly contribute to economic impact of COPD

8. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Prevalence of Asthma 11 million adults 9 million children More than 8 million males More than 11 million females

9. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Economic Impact of COPD Third major cause of lost work days Fourth most common noncommunicable cause of disability More than 32 billion dollars spent on associated medical costs Costs likely higher due to under-diagnosis

10. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Etiology of Asthma Airway hypersensitivity to allergens (triggers) Causes airway inflammation, asthmatic episode (bronchospasm), and mucosal edema

11. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Etiology of Asthma Leads to decreased ventilation, lung perfusion, and respiratory failure Lung obstruction usually reduced by pharmacological management

12. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Signs of Asthma Coughing –Includes frequent throat clearing Wheezing –Hoarse whistling sound on exhalation Shortness of breath Chest tightness

13. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Etiology of Emphysema Destruction of alveolar walls and permanent enlargement of airspaces distal to terminal bronchioles, resulting in: –Airflow limitations –Impaired gas exchange efficiency –Loss of lung elastic recoil –Intraluminal pressure –Loss of small airway patency

14. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Etiology of Emphysema Caused by smoking, occupational exposures, or air pollution In early stages, dyspnea during activity As disease progresses, dyspnea at rest Hypoxia can ultimately cause respiratory failure

15. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Etiology of Bronchitis Hypersecretion of mucus and chronic productive cough –Continues for at least three months per year for two consecutive years Exacerbated by pollution and cigarette smoke

16. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Etiology of Bronchitis Results in: –Decreased exercise tolerance –Wheezing –Shortness of breath –Frequent, productive cough –Frequent respiratory infections –Hypoventilation –Right-sided heart failure

17. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Benefits of Resistance Training Increased muscular strength Trabecular bone content Glucose tolerance and lean body tissue Decreased falls

18. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Benefits of Resistance Training Enhanced ability to handle orthostatic challenges Improvements in performing activities of daily living

19. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Research Supports Resistance Training Major theme: –Resistance training is safe, effective modality to increase strength and improve quality of life Individuals can tolerate maximal testing and high-intensity resistance training

20. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Research Supports Resistance Training Safety depends on proper exercise selection, training volumes, and intensities Refer to Table 13.2

21. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Program Design Considerations Obtain physician clearance Review medical history and medications Perform physical assessment with baseline physiological measures: –Heart rate –Blood pressure –Body composition –Oxygen saturation

22. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Program Design Considerations May require supplemental oxygen, oxygen delivery devices, or pulse oximeter Record heart rate, blood pressure, and oxygen saturation at rest/during exercise for clients with moderate to severe COPD Document goals for rehabilitation and participation

23. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Exercise Testing Considerations 1 RM assessment safe to use –Even on severely deconditioned clients Cardiopulmonary responses during 1 RM testing significantly lower than during aerobic exercise at sub-maximal level

24. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Program Components Goal: –Achieve maximal physiologic training effects May require modification due to disease severity, limitations, comorbidities, or motivation level Include 2 to 4 sets of 6 to 12 repetitions

25. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Program Components Intensities range from 50 to 85 percent of 1 RM Exercises should mimic actual movements Interval training an appropriate exercise modality See sample 24-Week Program

26. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Increased Risk for Anxiety and Depression Include screening as part of initial assessment Requires beginning exercise at lower intensity/duration than individual can tolerate

27. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Increased Risk for Anxiety and Depression Mild to moderate levels may improve with pulmonary rehabilitation Individuals with significant psychiatric disease require appropriate professional care