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800 > Week 12 (Pulmonary Rehab) > Flashcards

Week 12 (Pulmonary Rehab) Flashcards

1
Q

What is pulmonary rehab

A

An effective intervention for those with COPD as those with COPD decrease their levels of PA due to dyspnoea leading to a disability spiral. PR can’t change the disease process but aims to break the disability spiral.

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2
Q

Groups that benefit from pulmonary rehab

A

COPD, chronic asthma, bronchiectasis, interstitial lung disease, pre/post lung surgery, pulmonary arterial hypertension, lung cancer

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3
Q

Groups that don’t benefit from pulmonary rehab

A

MSK or neurological disorders that prevent exercise, unstable CVD e.g. unstable angina, aortic valve disease, severe cognitive impairment, severe psychotic disturbance, relevant infectious disease

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4
Q

Benefits of pulmonary rehab

A

Improve: exercise capacity, health-related QOL, muscle strength, health behaviours
Reduce: dyspnoea, health costs, reduction in hospital admission/length of stay

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5
Q

The 3 systems that limit pulmonary rehab

A
  1. Cardiovascular system
  2. Peripheral system
  3. Pulmonary system
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6
Q
  1. Impaired ventilation: normal response to exercise
A

Vt increases by increasing in lung capacity and ERV decreases

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7
Q
  1. Impaired ventilation: COPD response to exercise
A

ERV increases. As we blow out air, airways collapse and air doesn’t come out so each breath becomes deeper.

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8
Q

Pathophysiology of dynamic hyperinflation

A

Increased RR and ERV > not enough time for lung emptying > gas trapping leading to dynamic hyperinflation and increased EELV > flattened/shortened diaphragm means decreased inspiratory reserve > impaired respiratory mechanics and WOB > reach max ventilation and/or dyspnoea tolerated

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9
Q
  1. Impaired gas exchange: due to
A

Decreased ventilation, diffusion and perfusion leading to desaturation with exercise

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10
Q

Pulmonary limitation: when will it be seen in measurement at peak exercise?

A
  • Abnormally high RR
  • Severe dyspnoea
  • Decreased Spo2
  • Abnormal POB
  • Lower Vt
  • VE/MVV > 70%
  • Increased EELV
    Max HR not achieved
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11
Q

Peripheral limitation to exercise in COPD

A

COPD > progressive decrease in PA + systemic inflammation > skeletal muscle atrophy and decreased oxidative capacity of SKM > decreased mm strength and endurance > early onset of muscle fatigue

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12
Q

Cardiovascular limitation to exercise in COPD

A

Late stage COPD > RHF common > decreased SV > decreased CO > decreased PA

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13
Q

What system benefits from COPD

A

Peripheral system

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14
Q

Benefits of pulmonary rehab on the peripheral system

A

Improve muscle endurance and strength and decrease fatigue. Increase muscle endurance through reversed muscle fibre distribution, increased capillary density in muscles and oxidative enzymes

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15
Q

How does improving the pulmonary system help with dyspnoea

A
  • Better oxygen extraction
  • Reduced dyspnoea
  • Delay dynamic hyperinflation
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16
Q

How does exercise help maintain aerobic metabolism longer

A

Delay onset of lactic acidosis (metabolic acidosis) by producing a respiratory acidosis through hyperventilation and increases exercise capacity

17
Q

Benefits for PR other than the pulmonary, cardiovascular and peripheral

A

Psychological benefits: improve emotional function, self-confidence, coping strategies and reduces depression, social impediments and mood disturbance
Improves adherence with medications

18
Q

Common components of PR

A
  • Initial assessment
  • Exercise training
  • Nutrition advice
  • Education
  • Psychosocial support
  • Final assessment and strategies for ongoing exercise
19
Q

Endurance exercise testing for PR: lower limb

A
  • 6MWT x 2 (most common)
  • ISWT
  • Endurance shuttle walk test
  • Lab tests e.g. incremental cycle/treadmill test
20
Q

Endurance exercise testing for PR: upper limb

A

Unsupported upper limb exercise test

21
Q

Strength exercise testing: lower/upper limb

A
  • 8-10RM depending on the condition of the patient. Use hand weight or weight training equipment.
  • 5 STS test
22
Q

Setting of PR include

A
  • Hospital based (inpatient/outpatient)
  • Community based
  • Home based
  • Tele rehabilitation
  • Hydrotherapy
23
Q

Length of PR include

A

Standard programs 8-12 weeks with at least 20 sessions. Those with severe COPD may need a longer program up to half a year to achieve changes.

24
Q

Assessment of PR

A
  • Medical history
  • Physical exam
  • Investigations e.g. spirometry, CXR
  • Exercise testing
  • QOL measures: disease specific and generic
25
Q

Endurance training for lower limb: FITT

A

F: minimum 3x/week
I: For walking: 80% of better average 6MWT, Dyspnoea score of 3-4. For cycling: 60-80% of peak cycle work rate from cycle test (in Watts).
T: 30-45 mins, 60-90 mins if interval training

26
Q

Endurance training for upper limb: FITT

A

F: 3-5x/week
I: free weights 15RM or borg dyspnoea sore of 2-3
T: unsupported arm exercises (dowel lifts, hand weights, passing bean bags, pulling ropes) - similar to ADLs or supported arm exercises e.g. arm ergometer

27
Q

What to do if a patient desaturates?

A

If continuous training > consider interval training

Those who desaturate <80% may benefit from supplemental oxygen

28
Q

Strength training for lower limb: FITT

A

F: 2-3x/week, rest day in between
I: start at 1 set and build up to 3 sets with 2 min rest in between sets
T: without weights - squats, straight leg raises, step-ups, with weights - leg press, quad extension
P: once they can perform 3 sets, weight can be increased by 5%

29
Q

Strength training for upper limb: FITT

A

F: 2-3x/week, rest day in between
I: start at 1 set and build up to 2 sets with 2 min rest in between sets
T: free weights or fixed weight machines working on pec major, serratus anterior, lat dorsi, trapezius, biceps, triceps

30
Q

How would you re-assess PR

A
  • Completion
  • Improvement in exercise capacity
  • Improvement in QOL
  • Improvement in breathlessness
  • Improved patient compliance
  • Commence LT exercise program

800 (12 decks)

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