Continuing to do physical exercise

The major challenge facing any treatment: succeed in having the patient continue to follow the program.

Pulmonary rehabilitation is no exception to the rule. Notwithstanding the acknowledged benefits of pulmonary rehabilitation, the dropout rate in maintenance programs after 3-6 months is 50%, and after 12 months, another 25-45% will drop out. The same observations are true for patients with COPD.

At the end of a pulmonary rehabilitation program, it is vital to implement a strategy that will help the patient to continue following the exercise program, either in the community or at home, as well as to increase their daily physical activity.

Reminder - It's important to keep nurturing the patient's attitude towards exercise after the end of the pulmonary rehabilitation program.

A pulmonary rehabilitation program is for naught if one doesn't succeed in changing the patient's lifestyle (exercise, physical activities, managing COPD on a daily basis, etc.) over the long term.

Sticking with a maintenance program must be perceived by the patient and the physician as a critical goal that has to be achieved. Right from the very beginning, it's important to work at making sure that the patient clearly understands the challenges ahead, that his or her concerns are addressed, as is the case with regard to any obstacles that might stand in the way of his or her chances of success.

To do this, the patient must have a goal, they have to participate in decision making, in resolving any problems that arise and in any endeavour that will help them to stick with the program over the long term. Self-management skills that are exercised all the time - along with good communications - will make it easier for the patient to continue following the treatment and to adopt and maintain a healthy lifestyle.

Use the following tools to do systematic follow-ups with your patients:

• Following up self-management strategies
• Home exercise program

Source : Living well with COPD program, Module: Integrating an exercise program into your life, p.43.

• Doing cardiovascular and muscle strengthening exercises must be continuous for the long-term benefits to be felt by the patient.
• After only a few days of inactivity, the endurance and strength gained from the exercise program will already begin to diminish.

People who are physically active will maintain their autonomy, as well as their physical and mental fitness longer.

Possible obstacles to continuing with an exercise program:

• Aggravation of the symptoms caused by pulmonary disease (exacerbations)
• Environmental factors (e.g.: heat, humidity, rain, wind, cold, etc.)
• Accessibility, problems related to getting about
• Lack of financial resources
• Emotional problems, stress, anxiety, depression
• Lack of interest
• Vacation

Possible solutions to deal with these obstacles (to be suggested to the patient):

• Reduce the intensity of the physical activities or temporarily stop them until the symptoms get better.
• Use the action plan (if the patient has one) and contact a resource-person. If the patient does not have a resource person, they should contact a physician.
• Resume light physical activities as soon as the symptoms get better and then increase them gradually thereafter.
• Identify activities that can be done indoors (physical fitness centres, stationary bicycle, swimming) and that have the advantage of not being compromised by the weather outside.
• When it's very hot: make use of an air-conditioner or a fan, or go for a walk in a shopping centre, or then again, choose a time of day when it's cooler outside.
• To get about, find out about the services that are offered in the community (volunteer services, paratransit, car pooling, vignettes for people with reduced mobility).
• If money is a problem, consider activity programs that are inexpensive or offered for free in the community.
• Check with the people around you if you can't recuperate some second hand equipment (to buy or receive as a donation).
• Remind the patient that physical activity can be a good strategy to help them get through difficult periods and that they shouldn't hesitate to consult with a health care professional or their physician.
• Remind the patient to be proud of what they're doing and have done and to reward themselves.
• To maintain and increase their interest in doing exercise, suggest changing the location or their routines, or to ask someone else to join them.
• Plan to have exercise periods during their vacation and take advantage of them to do different kinds of exercises.

One can provide the patient with various tools, such as a timetable to chart their long term progress, to stimulate their interest in doing physical exercise daily. The rehabilitation team can also do a re-evaluation of the patient, for example, 6 or 12 months later, to find out if they are still interested and motivated in their exercises, or if they are once more a candidate for a structured pulmonary rehabilitation program.

The Living well with COPD program supplies the necessary tools to prescribe a home exercise program to evaluate the patient's personal effectiveness and to help professionals promote exercise and physical activity.

To prepare the professional to do post-pulmonary rehabilitation follow-ups with the patient, see the table taken from the Reference Guide for Professionals in the Living well with COPD program.