What does a pulmonary rehabilitation program include?
Pulmonary rehabilitation is an amalgam consisting of both a "physical exercise" component and a "self-management" component. The nature and intensity of the interventions of each component may vary depending upon the individual, the stages of the disease and the comorbidities. However, the success of any program will depend upon the presence of both these components.
The "exercise" component
This crucial component is recognized as being very effective. It derives much of its significance when one takes into account the anxiety-shortness of breath cycle generated by physical inactivity.
The optimal elements in the "exercise" component
According to probative data from the Joint American College of Chest Physicians / American Association of Cardiovascular and Pulmonary Rehabilitation, the optimal elements (probative evidence according to the medical literature) of a pulmonary rehabilitation program are as follows:
- Exercise training of the muscles of ambulation (lower limbs) is a mandatory component of pulmonary rehabilitation for patients with COPD (e.g.: bicycle, treadmill, walking).
- A pulmonary rehabilitation program lasting 6 to 12 weeks will produce positive effects for the following 12 to 18 months; these effects appear to diminish gradually thereafter.
- The addition of a strength training component to a pulmonary rehabilitation program increases muscle strength and muscle mass.
- Endurance training for the upper limbs, without any kind of physical or mechanical support, is beneficial for patients with COPD and should be included in pulmonary rehabilitation programs (e.g.: stationary bicycle for the arms).
- Patients with exercise-induced hypoxemia should use oxygen during their exercise program.
- Administering supplemental oxygen during high-intensity exercise programs for patients without exercise-induced hypoxemia may improve their exercise endurance.
The "self-management" component
This component seeks to improve the patient's knowledge and skills needed to abide by a specific medical plan and to help guide changes related to adopting a healthy life style (exercise and motivation) in order to enable the patient to control their disease and improve their well being.
This component must not only seek to impart knowledge, but also to change people's behaviours. It requires coaching and follow-up to ensure that the patient builds up their self-confidence and becomes an expert on their disease on a day-to-day basis. It generally includes the following elements:
- A written action plan
- Follow-ups over the phone and/or post-rehabilitation
- Advice on how to stop smoking
- Basic information on physiopathology
- Information on medication and techniques for using inhalators
- Strategies to control shortness of breath
- Action plan for the early treatment of severe exacerbations
- End-of-life decision making