Chapter 50 Chapter 50

Cardiopulmonary RehabilitationCardiopulmonary Rehabilitation

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ObjectivesObjectives

State the definition and general goals of pulmonary State the definition and general goals of pulmonary rehabilitation programs.rehabilitation programs.

Describe the rationale for exercise conditioning and Describe the rationale for exercise conditioning and psychosocial support of patients with chronic pulmonary psychosocial support of patients with chronic pulmonary disease. disease.

Describe how to evaluate and select patients for pulmonary Describe how to evaluate and select patients for pulmonary rehabilitation.rehabilitation.

Describe pulmonary rehabilitation program design including Describe pulmonary rehabilitation program design including format and content.format and content.

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Objectives (cont.)Objectives (cont.)

List the educational content to be addressed in a pulmonary List the educational content to be addressed in a pulmonary rehabilitation program.rehabilitation program.

Describe the implementation of a pulmonary rehabilitation Describe the implementation of a pulmonary rehabilitation program including staffing, facilities, scheduling, class size, program including staffing, facilities, scheduling, class size, equipment, and costs.equipment, and costs.

Describe the outcome measures that can be used to evaluate Describe the outcome measures that can be used to evaluate pulmonary rehabilitation programs.pulmonary rehabilitation programs.

Identify the potential hazards associated with pulmonary Identify the potential hazards associated with pulmonary rehabilitation.rehabilitation.

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Definition and GoalsDefinition and Goals

Defined as the restoration of the individual to the fullest medical, Defined as the restoration of the individual to the fullest medical, mental, emotional, social, and vocational potentialmental, emotional, social, and vocational potential

The overall goal is to maximize functional ability and minimize The overall goal is to maximize functional ability and minimize the impact of the disability.the impact of the disability.

Other goals are to control symptoms and improve the overall Other goals are to control symptoms and improve the overall quality of life.quality of life.

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Historical PerspectiveHistorical Perspective

In 1951, Alvan Barach recommended reconditioning programs In 1951, Alvan Barach recommended reconditioning programs for chronic lung disease patients.for chronic lung disease patients.

In 1962, Pierce and associates published data that confirmed In 1962, Pierce and associates published data that confirmed the value of reconditioning.the value of reconditioning.

Gradually the medical community came to appreciate the value Gradually the medical community came to appreciate the value of pulmonary rehab for patients with COPD and other disorders.of pulmonary rehab for patients with COPD and other disorders.

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Scientific BasisScientific Basis

Physical reconditioningPhysical reconditioning Physical activity increases energy demands.Physical activity increases energy demands.

Poor conditioning of muscles leads to inefficient use of oxygen Poor conditioning of muscles leads to inefficient use of oxygen and excess acid production.and excess acid production.

Pulmonary rehab aims to recondition the muscles and increase Pulmonary rehab aims to recondition the muscles and increase exercise tolerance.exercise tolerance.

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Scientific Basis (cont.)Scientific Basis (cont.)

Psychosocial supportPsychosocial support COPD can negatively affect the patient’s overall outlook and COPD can negatively affect the patient’s overall outlook and

reduce motivation.reduce motivation.

Patients with COPD often have anxiety and stress.Patients with COPD often have anxiety and stress.

Psychosocial support in combination with physical Psychosocial support in combination with physical reconditioning is needed to cause the best possible outcome.reconditioning is needed to cause the best possible outcome.

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Structure of a Pulmonary Structure of a Pulmonary Rehab ProgramRehab Program

Program goals and objectivesProgram goals and objectives

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Structure of a Pulmonary Structure of a Pulmonary Rehab Program (cont.)Rehab Program (cont.)

Patient evaluationPatient evaluation Patient evaluation begins with a complete patient history.Patient evaluation begins with a complete patient history.

Next, a complete physical examination is done.Next, a complete physical examination is done.

A chest radiograph, CBC, and ECG may be needed.A chest radiograph, CBC, and ECG may be needed.

Pulmonary function testing and exercise evaluation are often Pulmonary function testing and exercise evaluation are often needed.needed.

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Structure of a Pulmonary Structure of a Pulmonary Rehab Program (cont.)Rehab Program (cont.)

Patient evaluation (cont.)Patient evaluation (cont.) Contraindications includeContraindications include

Patients who cannot perform the testPatients who cannot perform the test Those with severe pulmonary hypertensionThose with severe pulmonary hypertension Those with hypertensionThose with hypertension Those with neuromuscular diseaseThose with neuromuscular disease Those with untreated or unstable asthmaThose with untreated or unstable asthma Those with angina with exerciseThose with angina with exercise

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Structure of a Pulmonary Structure of a Pulmonary Rehab Program (cont.)Rehab Program (cont.)

Patient selectionPatient selection

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Structure of a Pulmonary Structure of a Pulmonary Rehab Program (cont.)Rehab Program (cont.)

Program designProgram design Open-ended designs allow the patient to enter the program and Open-ended designs allow the patient to enter the program and

progress through it until he or she achieves certain goals.progress through it until he or she achieves certain goals.

Closed designs use a set time period to cover the program Closed designs use a set time period to cover the program content.content.

Classes meet 1 to 3 times per week for 6 to 16 weeks.Classes meet 1 to 3 times per week for 6 to 16 weeks.

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Structure of a Pulmonary Structure of a Pulmonary Rehab Program (cont.)Rehab Program (cont.)

FormatFormat Long-term improvements are most likely to occur if planned Long-term improvements are most likely to occur if planned

follow-up is completed.follow-up is completed.

Follow-up must be ongoing and available to all patients who Follow-up must be ongoing and available to all patients who complete the program.complete the program.

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Structure of a Pulmonary Structure of a Pulmonary Rehab Program (cont.)Rehab Program (cont.)

ContentContent

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Structure of a Pulmonary Structure of a Pulmonary Rehab Program (cont.)Rehab Program (cont.)

Physical reconditioningPhysical reconditioning Consists of an exercise prescription with target heart rate based Consists of an exercise prescription with target heart rate based

on the initial evaluationon the initial evaluation

For most patients, an initial target heart rate is 20 beats/min For most patients, an initial target heart rate is 20 beats/min above resting rate.above resting rate.

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Structure of a Pulmonary Structure of a Pulmonary Rehab Program (cont.)Rehab Program (cont.)

Physical reconditioning (cont.)Physical reconditioning (cont.) The exercise prescription includes the following:The exercise prescription includes the following:

Lower extremity aerobic exercisesLower extremity aerobic exercises Timed walking (6- or 12-minute walk)Timed walking (6- or 12-minute walk) Upper extremity aerobic exercisesUpper extremity aerobic exercises Ventilatory muscle training using progressive resistance Ventilatory muscle training using progressive resistance

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Structure of a Pulmonary Structure of a Pulmonary Rehab Program (cont.)Rehab Program (cont.)

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Structure of a Pulmonary Structure of a Pulmonary Rehab Program (cont.)Rehab Program (cont.)

Educational componentEducational component1.1. Respiratory structure, function, and pathologyRespiratory structure, function, and pathology

2.2. Breathing control methodsBreathing control methods

3.3. Methods of relaxation and stress managementMethods of relaxation and stress management

4.4. Exercise techniques and personal routinesExercise techniques and personal routines

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Structure of a Pulmonary Structure of a Pulmonary Rehab Program (cont.)Rehab Program (cont.)

Educational component (cont.)Educational component (cont.) Bronchial hygiene techniquesBronchial hygiene techniques

Home OHome O22 and aerosol therapy and aerosol therapy

MedicationsMedications

Dietary guidelinesDietary guidelines

Recreation and vocational counselingRecreation and vocational counseling

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Structure of a Pulmonary Structure of a Pulmonary Rehab Program (cont.)Rehab Program (cont.)

Psychosocial and behavioral componentPsychosocial and behavioral component Emotional stress is a common problem for a patient with chronic Emotional stress is a common problem for a patient with chronic

lung disease.lung disease.

Experts can be brought in to help patients cope with their Experts can be brought in to help patients cope with their anxieties and sources of stress.anxieties and sources of stress.

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Structure of a Pulmonary Structure of a Pulmonary Rehab Program (cont.)Rehab Program (cont.)

StaffingStaffing Pulmonary rehabilitation is a multidisciplinary endeavor.Pulmonary rehabilitation is a multidisciplinary endeavor.

Staff conducting the program should be certified in basic and Staff conducting the program should be certified in basic and advanced life support.advanced life support.

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Structure of a Pulmonary Structure of a Pulmonary Rehab Program (cont.)Rehab Program (cont.)

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Structure of a Pulmonary Structure of a Pulmonary Rehab Program (cont.)Rehab Program (cont.)

FacilitiesFacilities The facility must be easy to reach, be accessible to public The facility must be easy to reach, be accessible to public

transportation, and have available parking.transportation, and have available parking.

Rooms should be spacious and comfortable with adequate Rooms should be spacious and comfortable with adequate lighting and ventilation.lighting and ventilation.

A room for counseling is helpful.A room for counseling is helpful.

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Structure of a Pulmonary Structure of a Pulmonary Rehab Program (cont.)Rehab Program (cont.)

SchedulingScheduling Class times need to be scheduled at a time most convenient for Class times need to be scheduled at a time most convenient for

the patients.the patients.

Traffic patterns, bus schedules, and availability of rides are Traffic patterns, bus schedules, and availability of rides are important factors to consider.important factors to consider.

Class sizeClass size The ideal class size is 3 to 15 patients.The ideal class size is 3 to 15 patients.

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Structure of a Pulmonary Structure of a Pulmonary Rehab Program (cont.)Rehab Program (cont.)

EquipmentEquipment Class room equipment to facilitate teaching is needed.Class room equipment to facilitate teaching is needed.

Blackboard or flipchartBlackboard or flipchart 35-mm projector or PowerPoint projector35-mm projector or PowerPoint projector Formal learning packagesFormal learning packages

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Structure of a Pulmonary Structure of a Pulmonary Rehab Program (cont.)Rehab Program (cont.)

Equipment (cont.)Equipment (cont.) Physical reconditioning equipment is needed.Physical reconditioning equipment is needed.

Stationary bicycles, treadmills, rowing machinesStationary bicycles, treadmills, rowing machines Pulse oximetersPulse oximeters Inspiratory resistance devicesInspiratory resistance devices Emergency OEmergency O22 should be in the room. should be in the room.

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Structure of a Pulmonary Structure of a Pulmonary Rehab Program (cont.)Rehab Program (cont.)

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Structure of a Pulmonary Structure of a Pulmonary Rehab Program (cont.)Rehab Program (cont.)

Program resultsProgram results

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Structure of a Pulmonary Structure of a Pulmonary Rehab Program (cont.)Rehab Program (cont.)

Potential hazardsPotential hazards Cardiovascular abnormalitiesCardiovascular abnormalities Blood gas abnormalitiesBlood gas abnormalities Muscular abnormalitiesMuscular abnormalities MiscellaneousMiscellaneous

Exercise-induced asthmaExercise-induced asthma HypoglycemiaHypoglycemia Dehydration Dehydration

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Structure of a Pulmonary Structure of a Pulmonary Rehab Program (cont.)Rehab Program (cont.)

Cardiac rehabilitationCardiac rehabilitation A comprehensive exercise and educational program designed A comprehensive exercise and educational program designed

for patients with cardiovascular diseasesfor patients with cardiovascular diseases

Goals are to improve heart health and work capacity, weight Goals are to improve heart health and work capacity, weight loss, and return to work.loss, and return to work.