SPECIAL CONSIDERATIONS Pulmonary Rehab SPECIAL CONSIDERATIONS OBSTRUCTIVE PULMONARY
SPECIAL CONSIDERATIONS Pulmonary Rehab
SPECIAL CONSIDERATIONS – (OBSTRUCTIVE PULMONARY DISEASE) COPD patients experience greater amounts of dyspnea during ADL - Focus on upper extremity resistance training (mainly shoulder girdle) Patients experiencing inspiratory muscle weakness -Frequency: 4 -5 days/week -Intensity: 30% of maximal inspiratory pressure measured at functional residual capacity -Time: 30 min or two 15 min sessions -Type: Inspiratory resistive training, threshold loading, and normocapnic hyperpnea. (Data suggest they are equally effective)
BREATHING TRAINING • • • Resistive training • This method requires individuals to inspire or expire via a variable-diameter orifice • The smaller the orifice the greater the load achieved. Threshold Loading • Individuals produce a negative pressure sufficient to overcome the load of the device and thereby initiate inspiration. • Allows variable loading at a detectable intensity Normocapnic Hyperpnea • This method requires individuals to maintain high target levels of ventilation up to 30 minutes. • 70 -90% of maximal sustainable voluntary ventilation
OBSTRUCTIVE CONTINUED • Health professionals should monitor initial hemodynamic and %Sa. O 2 responses to exercise and adjust accordingly • Consider monitoring exercise using a dyspnea scale instead of HR. • • Supplemental oxygen should be administered if %Sa. O 2 drops below 89% • • Maintain a rating of 4 -6 on a 0 -10 dyspnea scale when exercising Supplemental oxygen for those who do not meet the requirements can lead to increased exercise endurance Severe acute symptoms should be monitored closely • Limit exercise until symptoms subside • Be sure to take all recommended medications • Restrain from smoking before exercise
SPECIAL CONSIDERATIONS(RESTRICTIVE PULMONARY DISEASE) • Choose activities that you enjoy doing • • • Walking, cycling, swimming, tai chi, or yoga Start slowly and gradually increase time, not intensity • Start with 5 -10 min and work up to 30 min before changing intensity • Start low-resistive, high-repetition strength training exercises Monitor breathing carefully • Used pursed lip and diaphragm breathing • Supplemental oxygen if needed
RESTRICTIVE: CONTINUED • Avoid extreme weather conditions • Schedule exercise sessions during mid-to-late morning hours • Avoid late evenings and mid-day • Take all medications prescribed • Do not monitor patients using just HR • • Dyspnea scale 0 -10 or 0 -4 • Rate of Perceived Exertion scale 6 -20 Restrain from smoking before exercise as they may alter %Sp. O 2
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