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Chapter 50
Cardiopulmonary Rehabilitation
Objectives

State the definition and general goals of pulmonary rehabilitation
programs.

Describe the rationale for exercise conditioning and
psychosocial support of patients with chronic pulmonary
disease.

Describe how to evaluate and select patients for pulmonary
rehabilitation.

Describe pulmonary rehabilitation program design including
format and content.
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Objectives (cont.)

List the educational content to be addressed in a pulmonary
rehabilitation program.

Describe the implementation of a pulmonary rehabilitation
program including staffing, facilities, scheduling, class size,
equipment, and costs.

Describe the outcome measures that can be used to evaluate
pulmonary rehabilitation programs.

Identify the potential hazards associated with pulmonary
rehabilitation.
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Definition and Goals

Defined as the restoration of the individual to the fullest medical,
mental, emotional, social, and vocational potential

The overall goal is to maximize functional ability and minimize
the impact of the disability.

Other goals are to control symptoms and improve the overall
quality of life.
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Historical Perspective

In 1951, Alvan Barach recommended reconditioning programs
for chronic lung disease patients.

In 1962, Pierce and associates published data that confirmed
the value of reconditioning.

Gradually the medical community came to appreciate the value
of pulmonary rehab for patients with COPD and other disorders.
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Scientific Basis
Physical reconditioning

Physical activity increases energy demands.

Poor conditioning of muscles leads to inefficient use of oxygen
and excess acid production.

Pulmonary rehab aims to recondition the muscles and increase
exercise tolerance.
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Scientific Basis (cont.)
Psychosocial support

COPD can negatively affect the patient’s overall outlook and
reduce motivation.

Patients with COPD often have anxiety and stress.

Psychosocial support in combination with physical
reconditioning is needed to cause the best possible outcome.
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Structure of a Pulmonary
Rehab Program
Program goals and objectives
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Structure of a Pulmonary
Rehab Program (cont.)
Patient evaluation

Patient evaluation begins with a complete patient history.

Next, a complete physical examination is done.

A chest radiograph, CBC, and ECG may be needed.

Pulmonary function testing and exercise evaluation are often
needed.
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Structure of a Pulmonary
Rehab Program (cont.)
Patient evaluation (cont.)

Contraindications include
 Patients who cannot perform the test
 Those with severe pulmonary hypertension
 Those with hypertension
 Those with neuromuscular disease
 Those with untreated or unstable asthma
 Those with angina with exercise
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Structure of a Pulmonary
Rehab Program (cont.)
Patient selection
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Structure of a Pulmonary
Rehab Program (cont.)
Program design

Open-ended designs allow the patient to enter the program and
progress through it until he or she achieves certain goals.

Closed designs use a set time period to cover the program
content.

Classes meet 1 to 3 times per week for 6 to 16 weeks.
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Structure of a Pulmonary
Rehab Program (cont.)
Format

Long-term improvements are most likely to occur if planned
follow-up is completed.

Follow-up must be ongoing and available to all patients who
complete the program.
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Structure of a Pulmonary
Rehab Program (cont.)
Content
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Structure of a Pulmonary
Rehab Program (cont.)
Physical reconditioning

Consists of an exercise prescription with target heart rate based
on the initial evaluation

For most patients, an initial target heart rate is 20 beats/min
above resting rate.
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Structure of a Pulmonary
Rehab Program (cont.)
Physical reconditioning (cont.)

The exercise prescription includes the following:
 Lower extremity aerobic exercises
 Timed walking (6- or 12-minute walk)
 Upper extremity aerobic exercises
 Ventilatory muscle training using progressive resistance
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Structure of a Pulmonary
Rehab Program (cont.)
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Structure of a Pulmonary
Rehab Program (cont.)
Educational component
1.
Respiratory structure, function, and pathology
2.
Breathing control methods
3.
Methods of relaxation and stress management
4.
Exercise techniques and personal routines
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Structure of a Pulmonary
Rehab Program (cont.)
Educational component (cont.)

Bronchial hygiene techniques

Home O2 and aerosol therapy

Medications

Dietary guidelines

Recreation and vocational counseling
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Structure of a Pulmonary
Rehab Program (cont.)
Psychosocial and behavioral component

Emotional stress is a common problem for a patient with chronic
lung disease.

Experts can be brought in to help patients cope with their
anxieties and sources of stress.
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Structure of a Pulmonary
Rehab Program (cont.)
Staffing

Pulmonary rehabilitation is a multidisciplinary endeavor.

Staff conducting the program should be certified in basic and
advanced life support.
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Structure of a Pulmonary
Rehab Program (cont.)
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Structure of a Pulmonary
Rehab Program (cont.)
Facilities

The facility must be easy to reach, be accessible to public
transportation, and have available parking.

Rooms should be spacious and comfortable with adequate
lighting and ventilation.

A room for counseling is helpful.
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Structure of a Pulmonary
Rehab Program (cont.)
Scheduling

Class times need to be scheduled at a time most convenient for
the patients.

Traffic patterns, bus schedules, and availability of rides are
important factors to consider.
Class size

The ideal class size is 3 to 15 patients.
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Structure of a Pulmonary
Rehab Program (cont.)
Equipment

Class room equipment to facilitate teaching is needed.
 Blackboard or flipchart
 35-mm projector or PowerPoint projector
 Formal learning packages
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Structure of a Pulmonary
Rehab Program (cont.)
Equipment (cont.)

Physical reconditioning equipment is needed.
 Stationary bicycles, treadmills, rowing machines
 Pulse oximeters
 Inspiratory resistance devices
 Emergency O2 should be in the room.
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Structure of a Pulmonary
Rehab Program (cont.)
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Structure of a Pulmonary
Rehab Program (cont.)
Program results
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Structure of a Pulmonary
Rehab Program (cont.)
Potential hazards




Cardiovascular abnormalities
Blood gas abnormalities
Muscular abnormalities
Miscellaneous
 Exercise-induced asthma
 Hypoglycemia
 Dehydration
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Structure of a Pulmonary
Rehab Program (cont.)
Cardiac rehabilitation

A comprehensive exercise and educational program designed
for patients with cardiovascular diseases

Goals are to improve heart health and work capacity, weight
loss, and return to work.
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