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Pulmonary Rehabilitation

Pulmonary Rehabilitation  is a holistic, complex, multidisciplinary therapy providing comprehensive treatment for the patient with chronic pulomonary rehabilitation.  Its is an intergration of both physical and emotional therpay and consist of combination of exercise and eductaion.



1. To promote independent functioning in activity of daily living.

2. Reduce depending on others.

3. To increase exercise tolerance

4. To educate patient regarding diseases process, medication and patient treatment.

5. Methods to control respiratory infection.

6. Pyschological support.

7. To strengthen respiratory muscles.



An improved quality of life.

Decrease anxiety and depression.

Increase exercise tolerance.

Decrease breathlessness and other symptoms.

Increase ability to perform Activity of daily living.

Decreased hospitality stay.

Early return to work.



1. COPD Condition

2. Pulmonary surgeries/ transplantion.



1. Untreated pneumothorax

2. Unstable hypertension

3. Recent eye surgeries

4. Arrhythmias

5. Infective conditions

6. End stage lung cancer


Structure of pulmonary rehabilitation

Small group are optimal

Rehabilitation can be provided by 2 basis

1. Out patient

– It is less costly

– More common

– 6 to 8 weeks

2. In patients

– weeks

– costly

– Allow maximum time with staff, opportunity for discussion and sharing.


For out patient particular time is fixed in a day which is combination for both patient and team memeber.

Day time is appropriate.

Difficult for patient to wake up early in the morning and do their activites.

If the exercise program is kept in the afternoon, make sure patients has only light meal.

Duration 2- 3 hours with exercise + education.

Exercise program can be given twice in a week for 6 -8 week.

FIIT principle


Rehabilitation team

1. Physcian

2. Physiotherapist 

3. Occupational therapist 

4. Nutrionist

5. Psychologists 

6. Pulmonologist 

7. Nurse

8. Pharmacist 


Material used

1. Cough

2. Treadmill 

3. Weight

4. Pulse oximeter 

5. Arm erogometry

6. O2 cylinder 

7. Nebulizer

8. Defibrillator


Protocol/ exercise component 

A. Effect of exercise

1. Improve exercise capacity

2. Enhance ADL activites

3. To overcame breathlessness, lack of activities, lack of fitness, social isolation, depression. 

4. Increase neuromuscular co-ordination 

5. Increase exercise tolerance 

6. Increase confidence 

7. Increase cardiovascular endurance 


B. Exercise prescription 

1. Specificity

-It relates response to exercise training. 

-Effect is training specific.

-If the walking test is done, it will not benifit upper limb program.


-Intensity should be sufficient to produce effect.


-If regimens is disconnected, traning effect will disappear. 


2 school of training

I. Aerobic training 

There is a involvement of large muscle group

Whole body exercise. 



Increase cardiovascular endurance 

Physiologocal and structural / change’s 


Frequeny: 3-4 times a week

Intensity:  50% of individual maximal 02 consumption.

Time: 20- 30 min


severely disabled people- walking 2-3 min twice day.

Able patient 10 min per day

Once the patient reach 20 min- frequency 5 times in a week.

Warms up: Warm up can be done atleast  5-10 mins

Uses –  to increase resting metabolic rate.

-Gentile stretching 

Cool down: 5- 10 min


Upper limb exercise 

To perform activity of daily living, upper limb strength  and co-ordination is required.

COPD patient usually use accessory muscle for respiration to avoid this upper limb strength is required.


II. Strength training


To improve strength of muscle group trained.

Increase endurance

Improve quality of life 

Can be done at home without any need for sophisticated equipment. 


Exercise included 

Sitting to stand 

Walking on spot

Full arm circles

Quadriceps exercise 


Ventilatory muscle training.


Impove strength 

Improve indurance

Decreased work of breathing.

Decrease dyspnea.



Endurance training- requires low intensity.

Strength training- requires high intensity.


Educational component

1. Breathing control

2. Medication 

3. Diet and nutrition 

4. Benefit of exercise 

5. Stress management 

6. Smooking

7. Technical support – Nebulizer,  ventilatory support.

8. Social support

9. Airway clearance techniques. 





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