Exercise and Pulmonary Rehabilitation
Mary Lester, RRT, RCP
Pulmonary Rehabilitation Program
Medical University of South Carolina

People with lung conditions are often caught in a vicious circle of deconditioning.
Inactivity
(avoiding activity)
Decreased work capacity and increased shortness of breath
Muscle weakness
Increased effort to do work

Physical Activity
“Lifestyle Exercise”
• The Surgeon General’s report recommends that we accumulate a minimum of 30 minutes of moderate intensity activity on most if not all days of the week.

What is Pulmonary Rehabilitation?
• Pulmonary Rehabilitation is a program for people with Chronic Lung Diseases such as
Emphysema, Chronic Bronchitis, Asthma,
Bronchitis and Interstitial Lung Disease.
• Motivates people to regain a normal and active lifestyle.

Pulmonary Rehabilitation Objectives
• Improve Quality of Life.
• Improve ability to cope with their illness and health status.
• Restore the patient to their highest possible Functional Capacity.
• To Lead and Full and Satisfying Life.

Pulmonary Rehabilitation Components
• Medical Management
• Education
• Breathing Retraining
• Anxiety Control
• Emotional Support
• Exercise

Medical Management
• Team approach with the Physician
• Medications
– Oxygen Requirements and Benefits
• Exercise Prescription

Education
• Disease Process
• Medications
– What, Why, How
• Stress Management
– Relaxation Techniques
• Energy Conservation
• Benefits of Exercise

Breathing Retraining
• Pursed Lip Breathing
– Respiratory Rate Control
– Improve Oxygen Saturation
• Diaphragmatic Breathing
• Identification of Stress (symptoms)
• Relaxation Techniques

Emotional Support
• Grieving the Loss
– Recognizing & Accepting your limitations
– Adapting life style changes
• Relationships
• Group Support

Benefits of Exercise
• Improve Independence
• Reduce Isolation
• Consistent exercise reduces sensitivity to breathlessness
• Improves efficiency of breathing
• Improves confidence

How do I start?
• What are your goals?
– Talk to your doctor before starting any new exercise program.
• Types of Exercise
– Aerobic Exercise
– Strength Training
– Flexibility / Stretching

Aerobic Exercise Facts
• Two to three weeks to begin improving your fitness level.
• 6 weeks to 3 months to achieve significant improvement.
• 2 days of inactivity to begin losing endurance.
• Most of the exercise benefits will be lost within 2 weeks of inactivity.

What is Aerobic Exercise?
• It is Exercise for the Heart and Lungs.
– Work up to at least 30 minutes five or more days a week.
• Moderate Intensity
– Target Heart Rate
– Exertion Scale
– Talk Test

Aerobic Exercise Activities
• Walking
• Biking
• Swimming
• Water Aerobics
• Low Impact Aerobics
• Dancing
• Hiking

Borg Scale of Breathlessness
• To exercise comfortably you should:
– Keep your shortness of breath rating between 3 and 4.
– Keep oxygen level above 90%.
• Talk Test
– Able to speak in short phrases during exercise.
Scale and Severity
0 - No Breathlessness
1 - Very Slight
2 - Slight Breathlessness
3 - Moderate
4 - Somewhat Severe
5 - Severe Breathlessness
6
7 - Very Severe Breathlessness
8
9 - Very Very Severe
10 - Maximum Scale

Stretching
• Stretching Tips
– Stretch to the point of mild tension
– Hold 20 to 30 seconds
– No bouncing
– Breathe
• If you feel pain STOP!

Exercise Tips
• If you use a fast acting inhaler be sure to take it before exercise.
• You may need to use oxygen during exercise. Oxygen will help your muscles work more efficiently.Biking

Other Important Tips
• To help with anxiety and breathlessness use pursed lip breathing and diaphragmatic breathing.
• Your are encouraged to use a walker, shopping cart or wheel chair if it allows you to be more active.

Staying on Track
• Look for ways to increase your activity.
• Set short and long term goals.
• Think of possible barriers and make a plan.
Change your lifestyle and make exercising a top priority!