Get Permission Kumar and Kant: Pulmonary rehabilitation care: Current perspective


Pulmonary Rrehabilitation

Pulmonary rehabilitation is a comprehensive program designed to improve the lung function and overall health of people with chronic respiratory diseases. These diseases can cause significant limitations in daily activities, reduce exercise capacity, and lead to poor quality of life. The primary goals of pulmonary rehabilitation are to increase exercise tolerance, reduce symptoms such as shortness of breath, improve the ability to perform daily activities, reduce hospitalizations and emergency room visits, and also improve quality of life.1, 2, 3

Pulmonary rehabilitation is recommended for patients with chronic respiratory diseases who experience limitations in daily activities and have reduced exercise tolerance. The primary indications for pulmonary rehabilitation include COPD, interstitial lung disease, bronchiectasis, pulmonary hypertension, and cystic fibrosis. It may also be recommended for patients who have had lung surgery or a lung transplant, or who are preparing for surgery or a transplant.4, 5, 6 It may also be recommended for patients who have experienced a recent exacerbation of their respiratory disease, or who have been hospitalized for a respiratory-related issue.

Components of pulmonary rehabilitation (Table 1)

Pulmonary rehabilitation is a comprehensive program that typically includes the following components: 7

Exercise training

This component involves a structured program of physical activity tailored to meet the individual needs and abilities of each patient. Exercise training can include a variety of activities such as walking, cycling, strength training, and flexibility exercises. Exercise training helps to improve exercise tolerance, reduce shortness of breath, and improve muscle strength and endurance. The exercise targets different aspects of physical function and overall health. 8

Aerobic exercise

Also known as cardio exercise, is any activity that increases heart rate and breathing rate for an extended period of time. Examples include walking, cycling, swimming, and jogging. Aerobic exercise is important for patients with chronic respiratory diseases as it helps to improve cardiovascular health, increase lung function, and reduce shortness of breath. During pulmonary rehabilitation, patients gradually increase the intensity and duration of their aerobic exercise, starting with low-intensity activities. 9

Resistance exercise

Involves using weights, resistance bands, or body weight to build muscle strength and endurance. Examples include squats, lunges, and bicep curls. Resistance exercise is important for patients with chronic respiratory diseases as it helps to improve overall physical function, increase muscle strength, and reduce the risk of falls and other injuries. Patients typically start with low-intensity resistance exercises during pulmonary rehabilitation and gradually increase the intensity and number of repetitions over time. 10

Flexibility exercise

Involves stretching and lengthening muscles to improve range of motion and reduce the risk of injury. Examples include yoga, Pilates, and static stretching. Flexibility exercise is important for patients with chronic respiratory diseases as it can help to improve posture, reduce muscle tension, and improve overall physical function. Patients engage in a variety of flexibility exercises designed to target specific muscle groups during pulmonary rehabilitation. 11

Table 1

Component of pulmonary rehabilitation

Component

Description

Examples

Exercise Training

Structured program of physical activity designed to improve overall fitness and endurance

Walking, cycling, strength training, flexibility exercises

Aerobic Exercise

Increases heart and breathing rate for an extended period of time

Walking, cycling, swimming, jogging

Resistance Exercise

Uses weights, resistance bands, or body weight to build muscle strength and endurance

Squats, lunges, bicep curls

Flexibility Exercise

Involves stretching and lengthening muscles to improve range of motion

Yoga, Pilates, static stretching

Breathing Exercises

Helps patients learn to breathe more efficiently, reduce shortness of breath, and improve lung function

Pursed-lip breathing, diaphragmatic breathing, paced breathing

Education and Self-Management Strategies

Provides education about the condition, how to manage symptoms, and how to live with a chronic respiratory disease

Disease management, coping strategies, nutrition

Nutritional Counselling

Provides guidance about maintaining a healthy diet, managing weight, and avoiding trigger foods

Maintaining a healthy diet, managing weight, avoiding trigger foods

Psychosocial Support

Provides counselling, support groups, and other resources to help patients manage the emotional impact of their condition

Counselling, support groups, other resources

Monitoring and Progression

Monitors patients using heart rate monitors or pulse oximeters to ensure appropriate exercise level and prevent overexertion; adjusts exercise program as patients progress

Heart rate monitor, perceived exertion rating, personalized exercise program

Breathing exercises

Breathing exercises are designed to help patients learn to breathe more efficiently, reduce shortness of breath, and improve lung function. Two commonly used breathing techniques in pulmonary rehabilitation are pursed-lip breathing and diaphragmatic breathing.

Pursed-lip breathing

Pursed-lip breathing is a breathing technique that involves exhaling through pursed lips. To perform pursed-lip breathing, patients take a deep breath in through their nose and then exhale slowly through pursed lips, as if blowing out a candle. This technique is used to help slow down the rate of breathing, reduce shortness of breath, and improve oxygen exchange in the lungs. Pursed-lip breathing can be particularly helpful for patients with chronic obstructive pulmonary disease (COPD) and other chronic respiratory diseases, as it can help to reduce feelings of breathlessness and improve exercise tolerance. It can also help patients to relax and reduce feelings of anxiety and stress.

Diaphragmatic breathing

Diaphragmatic breathing, also known as belly breathing, is a breathing technique that involves using the diaphragm to breathe instead of the chest muscles. To perform diaphragmatic breathing, patients lie down or sit comfortably with one hand on their chest and the other on their belly. They take a slow, deep breath in through their nose, allowing their belly to rise and expand, and then exhale slowly through their mouth, letting their belly fall. Diaphragmatic breathing is used to help patients with chronic respiratory diseases improve their breathing efficiency, reduce feelings of breathlessness, and improve lung function. By using the diaphragm to breathe instead of the chest muscles, patients can take deeper breaths and increase the amount of oxygen that enters their lungs. Diaphragmatic breathing can also help to reduce stress and anxiety and promote relaxation. 12

Benefits of breathing techniques in pulmonary rehabilitation: 13, 14

Improved breathing control and efficiency

Increased lung capacity and oxygen uptake

Reduced shortness of breath

Improved exercise tolerance and endurance

Reduced anxiety and stress

Improved relaxation and sleep

Improved cough effectiveness

Improved secretion clearance

Reduced risk of respiratory infections

Education and Self-Management Strategies

When it comes to pulmonary rehabilitation, education and self-management play crucial roles in improving the health and well-being of individuals with chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD) and asthma.

Education

Education can also provide individuals with the necessary knowledge and skills to manage their condition effectively. For instance, individuals with COPD can benefit from education on proper breathing techniques, medication management, and lifestyle changes such as quitting smoking and regular physical activity. Education can also provide individuals with the necessary knowledge and skills to manage their condition during exacerbations or flare-ups.

Self-management

Self-management skills can include medication adherence, symptom monitoring, and recognizing early warning signs of exacerbations. Pulmonary rehabilitation programs often incorporate self-management techniques such as pulmonary rehabilitation exercises, relaxation techniques, and goal-setting strategies. These techniques can help individuals manage their symptoms and improve their overall quality of life. 15, 16, 17

Nutritional counselling

Proper nutrition is important for patients with chronic respiratory diseases to maintain good health and manage symptoms. Patients may receive guidance about maintaining a healthy diet, managing weight, and avoiding foods that may trigger symptoms. Here are some ways in which nutritional counselling can benefit individuals with these conditions: 18

Managing weight

Weight management is essential for individuals with COPD and asthma as excess weight can worsen symptoms and reduce lung function. Nutritional counselling can help individuals achieve and maintain a healthy weight by providing them with information about healthy eating habits and portion control.

Meeting Nutritional Requirements

Individuals with COPD and asthma may have increased nutrient requirements due to increased energy expenditure, increased inflammation, and decreased nutrient absorption. Nutritional counselling can help individuals meet their nutritional requirements by providing them with information about nutrient-dense foods and supplements if necessary.

Managing comorbidities

Individuals with COPD and asthma are at increased risk of developing comorbidities such as diabetes, cardiovascular disease, and osteoporosis. Nutritional counselling can help manage these conditions by providing individuals with information about the impact of diet on these conditions and strategies for preventing and managing them.

Improving Lung Function

Nutritional counselling can also help improve lung function by providing individuals with information about the impact of diet on lung health. For example, diets high in fruits and vegetables have been shown to improve lung function in individuals with COPD.

Psychosocial Support

Patients with chronic respiratory diseases may experience anxiety, depression, and other emotional issues related to their condition. Psychosocial support can include counselling, support groups, and other resources to help patients manage the emotional impact of their condition. 19

Monitoring and progression

Are are important aspects of exercise training in pulmonary rehabilitation. Patients may be monitored using a heart rate monitor or pulse oximeter to ensure they are exercising at an appropriate level and to prevent overexertion. Patients may also rate their perceived exertion level to help healthcare providers adjust the intensity of their exercise program. As patients progress through their pulmonary rehabilitation program, the intensity and duration of their exercise program may be adjusted to ensure continued progress. Patients may work with a physical therapist or other healthcare providers to develop a personalized exercise program that meets their individual needs and goals. 20

Outcome Measures (Table 2)

Outcome measures are important tools used to evaluate the effectiveness of pulmonary rehabilitation programs. These measures are used to assess the impact of the program on the health and well-being of individuals with chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD) and asthma. Here are some commonly used outcome measures in pulmonary rehabilitation. 21, 22, 23

Table 2

Tool used to measurefunctional capacity and outcomes

Measure

Definition

Measurement Tools

Exercise Capacity

Measure of an individual's ability to perform physical activity

Six-minute walk test (6MWT), Incremental shuttle walk test (ISWT)

Quality of Life

Measure of an individual's overall well-being, including physical, emotional, and social aspects

St. George's Respiratory Questionnaire (SGRQ), Chronic Respiratory Questionnaire

Dyspnoea

Measure of breathlessness, a common symptom in individuals with chronic respiratory diseases

Modified Borg scale, Medical Research Council (MRC) dyspnoea scale

Healthcare Utilization

Measure of the frequency and type of healthcare services utilized by individuals with chronic respiratory diseases

Hospitalization rates, emergency department visits, medication use

Overall, pulmonary rehabilitation plays a crucial role in improving the health and well-being of individuals with chronic respiratory diseases. By addressing the physical, emotional, and social needs of these individuals, pulmonary rehabilitation can help reduce symptoms, improve quality of life, and reduce healthcare utilization. As such, it is essential that individuals with chronic respiratory diseases are referred to and participate in pulmonary rehabilitation programs to receive the benefits of this important component of healthcare.

Conflicts of Interest

None.

Source of Funding

None.

Acknowledgements

None.

References

1 

MA Shenoy V Paul Pulmonary RehabilitationTreasure Island (FL): StatPearls Publishing2022https://www.ncbi.nlm.nih.gov/books/NBK563166/

2 

MT Arnold BA Dolezal CB Cooper Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease: Highly Effective but Often OverlookedTuberc Respir Dis (Seoul)20208342576710.4046/trd.2020.0064

3 

MAB Siddiq FA Rathore D Clegg JJ Rasker Pulmonary Rehabilitation in COVID-19 patients: A scoping review of current practice and its application during the pandemicTurk J Phys Med Rehabil20206644809410.5606/tftrd.2020.6889

4 

N Ubolnuar A Tantisuwat P Thaveeratitham S Lertmaharit C Kruapanich W Mathiyakom Effects of Breathing Exercises in Patients With Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-AnalysisAnn Rehabil Med20194345092310.5535/arm.2019.43.4.509

5 

R Gosselink Breathing techniques in patients with chronic obstructive pulmonary disease (COPD)Chron Respir Dis20041316372

6 

R Gosselink Controlled breathing and dyspnea in patients with chronic obstructive pulmonary disease (COPD)J Rehabil Res Dev20034052533

7 

K Hill I Vogiatzis C Burtin The importance of components of pulmonary rehabilitation, other than exercise training, in COPDEuropean Respir Rev20132212940513

8 

SR Colberg RJ Sigal JE Yardley MC Riddell DW Dunstan PC Dempsey Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes AssociationDiabetes Care2016391120657910.2337/dc16-1728

9 

H Patel H Alkhawam R Madanieh N Shah CE Kosmas TJ Vittorio Aerobic vs anaerobic exercise training effects on the cardiovascular systemWorld J Cardiol201792134810.4330/wjc.v9.i2.134

10 

J De Brandt MA Spruit D Hansen FME Franssen W Derave MJH Sillen Changes in lower limb muscle function and muscle mass following exercise-based interventions in patients with chronic obstructive pulmonary disease: A review of the English-language literatureChron Respir Dis201815218221910.1177/1479972317709642

11 

R Pate M Oria L Pillsbury Committee on Fitness Measures and Health Outcomes in Youth; Food and Nutrition Board; Institute of Medicine, Fitness Measures and Health Outcomes in YouthWashington (DC): National Academies Press (US)201210.17226/13483[Last accessed 2023 on January 1]

12 

Effectiveness of diaphragmatic breathing exercise and pursed lip breathing exercise in reducing dyspnea in patients with acute bronchial asthmawww.ppgphysiotherapy.ac.in[Last accessed 2023 on January 1]

13 

L Dowman CJ Hill A May AE Holland Pulmonary rehabilitation for interstitial lung diseaseCochrane Database Syst Rev2014610CD00632210.1002/14651858.CD006322

14 

H Hamasaki Effects of Diaphragmatic Breathing on Health: A Narrative ReviewMedicines (Basel)20207106510.3390/medicines7100065

15 

J Bourbeau D Nault T Dang-Tan Self-management and behaviour modification in COPDPatient Educ Couns20045232717

16 

J King S Tessier M J Charette D Gaudet Patient Education Provided by Physiotherapists for Patients with Chronic Obstructive Pulmonary Disease: Results of a Scoping ReviewPhysiotherapy Canada201870214151

17 

E Monninkhof P Van Der Valk J Van Der Palen C Van Herwaarden M Partidge E Walters Self-management education for chronic obstructive pulmonary diseaseCochrane Database Syst Rev20031CD00299010.1002/14651858.CD002990

18 

BS Berthon LG Wood Nutrition and Respiratory Health-Feature ReviewNutrients201573161843

19 

J Turner B Kelly Emotional dimensions of chronic diseaseWest J Med200017221248

20 

E Crisafulli EM Clini Measures of dyspnea in pulmonary rehabilitationMultidiscip Respir Med20105320210

21 

T Glaab C Vogelmeier R Buhl Outcome measures in chronic obstructive pulmonary disease (COPD): strengths and limitationsRespir Res2010111111

22 

A V Jones R A Evans Wdc Man C E Bolton S Breen P J Doherty Outcome measures in a combined exercise rehabilitation programme for adults with COPD and chronic heart failure: A preliminary stakeholder consensus eventChron Respir Dis201916111

23 

AL Oliveira AS Marques Outcome Measures Used in Pulmonary Rehabilitation in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic ReviewPhys Ther2018983191204



jats-html.xsl


This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

  • Article highlights
  • Article tables
  • Article images

Article History

Received : 28-03-2023

Accepted : 10-04-2023


View Article

PDF File   Full Text Article


Copyright permission

Get article permission for commercial use

Downlaod

PDF File   XML File   ePub File


Digital Object Identifier (DOI)

Article DOI

https://doi.org/ 10.18231/j.ijirm.2023.003


Article Metrics






Article Access statistics

Viewed: 649

PDF Downloaded: 1620