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
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
– 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
3. Occupational therapist
4. Pulse oximeter
5. Arm erogometry
6. O2 cylinder
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
-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.
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.
• 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.
1. Breathing control
3. Diet and nutrition
4. Benefit of exercise
5. Stress management
7. Technical support – Nebulizer, ventilatory support.
8. Social support
9. Airway clearance techniques.