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Cardiorespiratory Physiotherapy > Pulmonary Rehabilitation > Flashcards

Pulmonary Rehabilitation Flashcards

1
Q

Why do patients with COPD have reduced exercise tolerance?

A

Reduced ventilatory threshold

  • increased work of breathing due to flattening of diaphragm with hyperinflation
  • increased TLC and RV means tidal breathing closer to dyspnoea threshold - quicker to become dyspnoiec

Gas Exchange Limitation
- due to destruction of alveolar tissue and increased dead space

Cardiac Limitation

  • increased pulmonary vascular resistance as a result of hypoxic vasoconstriction, vascular remodelling and increased number of RBC
  • causes right ventricular hypertrophy and failure
  • leads to impaired left side filling and reduced cardiac output

Lower limb dysfunction

  • deconditioning due to inactivity and disues
  • systemic inflammation
  • oxidative stress
  • nutritional impairment
  • aging
  • corticosteroid use
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2
Q

Benefits of pulmonary rehab

A
  • reduced symptoms
  • reduction in anxiety and depression
  • improved QOL
  • improved CV fitness, peripheral muscle function and exercise capacity
  • enhanced sense of self control over condition
  • reduced hospitalisation for COPD exacerbation
  • cost-effective
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3
Q

Goals of pulmonary rehab

A 
increase exercise capacity 
reduced activity limitation, increase participation 
improve QOL 
improve mood and motivation 
improve treatment adherence 
build self management capacity 
reduce health care burden
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4
Q

Inclusion/Exclusion Criteria

A

INCLUSION

  • patient with COPD/respiratory condition
  • patient recovering from acute exacerbation
  • patient is willing to participate

EXCLUSION

  • patient with severe cognitive impairment
  • exhibit severe psychotic disturbance
  • infectious disease
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5
Q

Potentional Barriers

A

referral
patient willingness
transport

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6
Q

Medical History/Subjective history components

A
  • respiratory diagnosis
  • PMHx
  • medication hx
  • subjective respiratory history
  • oxygen therapy
  • exercise tolerance and limiting factors
  • current and previous exercise participation
  • BMI
  • lung function via spirometry
  • social/psychological concerns
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7
Q

Exercise Testing

A
  • determines the level of functional impairment and activity limitation
  • determines factors that limit exercise capacity
  • provides information that will guide exercise prescription
  • identify impairments of O2 saturation that may benefit from supplemental oxygen
  • evaluate effectiveness of rehabilitation in altering exercise capacity and exertional dyspnoea
  • risk assessment
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8
Q

Compare 6MWT and ISWT

A

6MWT

  • self paced
  • intra subject
  • continuous/intermittent
  • steady state
  • 2 tests
  • suitable for very disabled patients
  • estimate of VO2 max
  • primary outcome measure is distance
  • exercise prescription = based on percentage of average speed walked

ISWT

  • externally paced
  • intra/inter subjct
  • continuous
  • incremental
  • 2 tests
  • unsuitable for very disabled patient
  • estimates VO2 max
  • primary outcome measure = distance
  • exercise prescription = based on percentage of maximum speed achieved
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9
Q

Exercise Prescription

A 
MUST INCLUDE - LL endurance training and HEP 
Can include 
- UL endurance 
- LL strength 
- UL strength 
- flexibility 
- balance
- inspiratory muscle training
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10
Q

LL Endurance Prescription

A 
ideally walking 
F - 2-3 supervised sessions a week, 1-2 HEP sessions a week 
I - 80% average speed 6MWT
- 70% max speed ISWT
Type - continuous or interval 
Time - 30 mins total session
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11
Q

UL Endurance Prescription

A

ideally arm cranking - if not any unsupported UL exercise
F - supervised x3 per week, 1-2 HEP
I - low weight and high reps, 1-3 sets, RPE 2-3
Type - continuous or interval
Time - aim is 10 mins

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12
Q

Strength Prescription

A

F - supervised 2-3 sessions per week
I - 10 RM
Type - continuous/interval/circuit
Time - reps, 3 sets of 8-12

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13
Q

Patient Education Aims

A
  • promote behaviour change
  • enhance physical fitness and increase physical activity
  • improve QOL
  • reduce length of stay in hospital
  • reduce hospital admissions
  • optimise nutritional status
  • improve mental health
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14
Q

Patient Education Topics

A
  • role and correct use of medications
  • managing breathlessness
  • physical exercise
  • information on disease
  • nutrition and healthy eating
  • coping with chronic lung disease and mental health
  • sputum clearance
  • energy conservation techniques
  • continence
  • sexual issues
  • importance of vaccination
  • community resources
  • home oxygen
  • action plan
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15
Q

Prescription from exercise testing

A

6MWT - 70-80% average pace
Cycling 60-80%
IMWT - 60-80%

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16
Q

Safety - when to stop exercise testing

A 
Chest pain 
Intolerable dyspnoea 
Leg cramps 
Pale/ashen appearance 
Lose balance/staggering 
Patient request 
If SpO2 drops below 80% can be recommenced once returns to 85%

Cardiorespiratory Physiotherapy (35 decks)

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