Pulmonary Rehabilitation Health Article

Definition

Pulmonary rehabilitation is a multidisciplinary, individually designed intervention program, including exercise and education, that helps patients with chronic lung disorders manage the physiological and psychosocial symptoms of their condition and improve their level of daily functioning and well-being.

Purpose

The purpose of a pulmonary rehabilitation program is to help patients with chronic obstructive pulmonary disease (COPD) or other chronic lung conditions manage their condition. Exercise and education are provided to help increase the patient's level of fitness and independent functioning; reduce dyspnea and psychological symptoms (anxiety, depression, social isolation); slow down or prevent the progression of disease; and improve quality and possibly length of life.

Pulmonary rehabilitation has not been found to improve pulmonary function, and that is not its goal. Other measures of physiologic improvement such as improved muscle function, cardiac function, and aerobic function have been found, and the main purpose of cardiac rehabilitation is to "reverse the deconditioning and psychosocial accompaniments of pulmonary disability." Pulmonary rehabilitation is also increasingly recognized as valuable in preparation for lung transplantation and lung volume-reduction surgery, which require patients to have good physical conditioning.

Precautions

Patients should be examined by a physician before beginning rehabilitation. Certain coexisting medical conditions, especially those that preclude or limit exercise, may contraindicate pulmonary rehabilitation, or require

modification and special precautions. Since treatment is individualized, any special needs will be addressed in the exercise prescription and program design. Some particular conditions that may contraindicate participation in pulmonary rehabilitation include acute respiratory infection, ischemic cardiac disease, congestive heart failure, serious liver dysfunction, disabling stroke, severe psychiatric or cognitive disorders, acute cor pulmonale, severe pulmonary hypertension, and metastatic cancer.

Description

Pulmonary rehabilitation is a multidisciplinary, comprehensive program of education, exercise, and behavior modification, individually designed for patients with such lung diseases as COPD. COPD includes such conditions as chronic bronchitis and emphysema, which can be progressive and life-threatening. Other chronic lung conditions that may be suitable for pulmonary rehabilitation include cystic fibrosis, asthma, bronchiectasis, and environmental lung disease, as well as such neuromuscular disorders as Parkinson's disease and multiple sclerosis.

The rehabilitation program is designed to help patients learn more about their condition and how to manage its symptoms, as well as to take active steps, such as smoking cessation, oxygen use, and exercise, in order to improve their level of physical functioning; stop the progression of the disease as much as possible; and learn how to better live with the condition. Improved physical functioning, reduction in physical and psychological symptoms, and ability to perform activities of daily living (ADLs) more easily and independently, can contribute to improved quality of life.

A typical program, which is individually designed but involves group participation, may last up to three hours per session, a few days each week. Programs generally last a few weeks to a few months, and prepare the patient to continue exercise, symptom management, and other skills learned in the program on their own. An in-home follow-up program may also be included. Patients may participate in rehabilitation as inpatients or outpatients, and will also be encouraged to exercise on their own at home if it is safe for them to do so without monitoring. Some insurance companies cover all or part of the rehabilitation program.

The two main components of the daily program are exercise and education. Exercise is important for maintaining or improving muscle strength, endurance and overall fitness, which may have declined due to inactivity and symptoms of the disease. Decreased physical activity and associated decline in fitness play a large part in causing the physical limitations associated with COPD. A regular exercise program can improve overall fitness and energy, and make performance of ADLs easier.

The exercise program is individually prescribed to meet the physical needs of each patient, and includes a warm-up and cool-down period, and aerobic activity. The warm-up and cool-down periods may include stretching and light strength or resistance training. Exercises involving upper and lower extremities are important for overall fitness and for improvement in function during specific activities. For example, lower body exercise helps with ambulation, stair climbing, and general fitness; and conditioning of the arms facilitates improved functioning in many tasks that require arm and upper body use, such as grooming, cooking, and household