Professional Documents
Culture Documents
Lecture Objectives
Define pulmonary rehabilitation
List medical and surgical indications for
pulmonary rehabilitation services
Outline essential components of a
comprehensive pulmonary rehabilitation
program
Lecture Objectives
Discuss the recommended medical tests
and procedures required of patients
before starting pulmonary rehabilitation
Discuss the indications and
contraindications of exercise testing for
patients with pulmonary disease
Lecture Objectives
Describe common exercise tests used to
assess exercise capacity of patients with
pulmonary disease
Describe the measures used to monitor a
patient during exercise testing and training
Know the indicators for terminating an
exercise test
Lecture Objectives
Recommend an appropriate exercise
program (mode, intensity, frequency,
duration) for a patient in pulmonary
rehabilitation from case data
Calculate intensity of aerobic exercise
using measures of VO2, dyspnea, and
peak heart rate on 6MWT for patients in
pulmonary rehabilitation from case data
Lecture Objectives
Apply an appropriate PT diagnosis (Guide
to PT Practice 3.0) to a patient in
pulmonary rehabilitation using case data
Outline the expected outcomes of
participating in a comprehensive
pulmonary rehabilitation program
Pulmonary Disease
COPD is the 4th leading cause of death in
the US
Approximately 5% of residents of New
England have COPD or chronic bronchitis
Only 10-15% of eligible patients receive
pulmonary rehabilitation
Pulmonary Rehabilitation
Evidence based
Multidisciplinary
Designed for patients with chronic
respiratory diseases who are symptomatic
and have decreased daily life activities
Pulmonary Rehabilitation
Designed to reduce symptoms, optimize
functional status, increase participation,
and reduce health-care costs
Comprehensive programs include:
Patient assessment
Exercise training
Education
Psychosocial support
Eligibility Criteria
Inclusion
Diagnosis of COPD or restrictive lung disease
Significant limitations in social and family
activities, employment, and/or ADLs
Tobacco free or participating in a smoking
cessation program
Be motivated and willing to participate
Eligibility Criteria
Exclusion
Patients with musculoskeletal or neurological
disorders that prevent exercise
Patients with unstable cardiovascular disease
Multidisciplinary Pulmonary
Rehabilitation Team
Patient and family
Physician
Nurse
Physical Therapist
Exercise Physiologist
Respiratory Therapist
Psychologist
Dietitian
PT Physical Examination
Chart Review
Patient Interview
Systems Review
Inspection
Auscultation
Palpation
PT Examination
Exercise Capacity
Symptom limited graded exercise test
Submaximal exercise test
Field tests
Symptoms
Dyspnea
Fatigue
Health related quality of life
Acute pulmonary
embolism
Acute myocarditis or
pericarditis
Suspected or known
dissecting aneurysm
Acute systemic infection
with fever
Neuro, musculoskeletal,
or rheumatoid disorders
High degree AV block
Ventricular aneurysm
Uncontrolled metabolic
disease
Chronic infectious
disease (HIV)
Mental or physical
impairment
Exercise Physiologist
Nurse
PA
PT
All personnel must have appropriate
training and ACLS certification
Exercise Protocols
Max vs. Sub-max
Treadmill
Cycle Ergometer
Field Tests
Field-tests
Shuttle test
6 minute walk test
During test
During the test, monitor for signs and
symptoms of exercise intolerance
Patient must keep up with the metronome
otherwise the test is not valid
End of test:
Have patient sit
Immediately note HR during the 1 minute
period post exercise
Components of PT Program
Breathing exercises
Stretching and flexibility exercises
Aerobic exercise
UE and LE resistance
Energy conservation techniques/pacing
Adaptive equipment
Stair climbing
Swimming
Resistance Exercises
Guidelines:
Start with low resistance and high repetitions
Increase repetitions (from 10 to 20) before
addition weight
Begin with 1 set with weight equal to 8 10 RM
In 3 4 weeks progress to 2 sets with weight
equal to 8 10 RM
2 to 3 rest intervals between sets
2 3x /week
Monitoring - Dyspnea
Monitoring - Sp02
SpO2 < 88% (on room air) is common criteria
for needing to introduce supplemental O 2
If SpO2 drops below minimum level, PT may:
Reduce intensity of activity OR STOP activity
Continue to monitor patient
Increase flow of O2 to keep saturation in the prescribed
range , but only in consultation with and prior approval of
physician
Recall: increasing O2 may reduce hypoxic drive to breathe
in patients with COPD and the PaCO 2 may increase
Breathing techniques
Pacing
Prioritizing and planning
AIR QUALITY
DESCRIPTOR
OZONE
HEALTH
EFFECTS
PARTICULATE
MATTER
HEALTH
EFFECTS
COLOR
CODE
0-50
Good
No Health Notice
No Health Notice
GREEN
51-100
Moderate
Limited Health
Notice
Limited Health
Notice
YELLOW
101-150
Unhealthy for
Sensitive Groups
Health Notice
Health Notice
ORANGE
151-200
Unhealthy
Health Advisory
Health Advisory
RED
201-300
Very Unhealthy
Health Alert
Health Alert
PURPLE
Heat Index
Heat Stress
Risk of heat stress
65 years
Overweight
Heart disease or high blood pressure
Workers in hot environments
Firefighters,
Bakery workers
Farmers
Construction workers
Miners
Factory workers