Can’t Access Pulmonary Rehabilitation? Wonder What are to Do after Completing Pulmonary Rehabilitation? By Chris Garvey NP

There are several potential reasons that may limit access to pulmonary rehabilitation, including geographical, financial, medical, transportation issues, etc. Several principles and resources are available to help you improve physical function, stamina, quality of life, symptom control, etc.

Before you start: Many key principles are important before you get started. Most importantly, ongoing care with your physician is vital. Don’t just see your doctor when you are ill. Regular medical care will help to keep you stable and detect problems before they become serious. Bring a list of discussion topics and your current medications to each doctor visit. Ask your doctor to watch you take your inhalers to assure effective technique. Other topics to discuss with your doctor are strategies to prevent and manage lung infections. Regular hand washing, pneumococcal (pneumonia) and annual influenza vaccinations are very important to prevent respiratory infections. Be sure to contact your doctor promptly if you are coughing up thicker and / or increased amount of mucus, have worsening cough, breathlessness and / or fatigue. Discuss with your doctor your interest in becoming more active and ask if there are any medical safety issues related to getting started. Also ask your doctor what your oxygen needs are during physical activity and if you should use a short acting inhaler such as albuterol or Combivent before exercise.

Where to begin? Controlled breathing techniques such as pursed lips breathing helps to control breathlessness with activity. Pursed lip breathing provides a way to slow your pace of breathing, making each breath more effective and controlled. Practice this pattern 4-5 times a day to make it easier to use with exercise, stair climbing and when you are short of breath.  

o      Relax your neck and shoulder muscles. Breathe in (inhale) slowly through your nose for two counts, keeping your mouth closed. Pucker or "purse" your lips as if to whistle or gently blow the flame of a candle. Breathe out (exhale) slowly and gently through pursed lips for a count of four and repeat.  

Exercise recommendations: Begin slowly, and gradually work on increasing the length of your exercise or activity. For some who have not been exercising, seated exercises such as ‘Sit and Be Fit’ videos may be a good starting point. See below for specific recommendations.

One of the most important exercises for persons with breathing problems is walking. Begin walking slowly at a comfortable pace for 5 to 10 minutes, 3 to 5 days a week. When you can walk without stopping to rest, increase the time you are walking by 1 to 3 minutes each week. Some people with lung problems require oxygen during exercise. If walking is difficult, ask your doctor about a rolling walker. If you have been prescribed oxygen for regular use, be sure to use it with exercise. Some of the resources below may help you either find a Pulmonary Rehabilitation program or provide you with your exercise plan.

Five principles of exercise apply whether you are beginning an exercise routine or a fitness specialist: FITTE or Frequency, Intensity, Type, Time, and Enjoyment

o      Frequency: Begin with exercise three times weekly and work up to 5-7 days per week

o      Intensity: Moderate intensity of work of breathing during exercise is generally appropriate. You should be able to speak in short sentences. If you can converse easily, work slightly harder. If you can’t talk or feel significantly short of breath, go slower.

o      Type: Walking is generally one of the best choices for exercise because we need to do it in our everyday life, and it is inexpensive and safe for many. Other options include using a stationary bicycle, swimming, dancing, etc.

o      Time: Begin with a few minutes if you haven’t been active. Gradually add 1-3 minutes per week until you are exercising 30 minutes per day. Longer exercise times are recommended for those who want to loose weight.

o      Enjoyment: Pick options that are enjoyable. Consider watching your favorite TV show or listening to music or comedy recordings while using a treadmill or bike, or walking with a good friend. Select choices that are affordable, safe, and convenient. Have indoor options for bad weather or ‘spare the air’ days.

Three types of exercise are important to consider

o      Aerobic: increasing the heart rate through use of large muscles by walking, bicycle, swimming, dancing, etc.

o      Resistance training: building muscles though weight lifting or use of elastic bands. Consider beginning with 8 oz. water bottles for arm exercises or ask your doctor if a physical therapist can instruct you in use of elastic band exercises.

o      Flexibility uses stretching and range of motion to improve joint and muscle flexibility.

Additional consideration

o      If you are having a ‘bad day’ or feel low energy, do less than your usual routine.

o      Stop if you become severely short of breath, have any chest pain, dizziness or significant discomfort of any kind. Report and chest pain or dizziness promptly to your doctor. Call 911 if it doesn’t improve with rest.

Resources for living more fully with breathing problems:   

·       American Association for Cardiovascular and Pulmonary Rehabilitation (AACVPR), telephone 312-644-6610

Pulmonary Rehabilitation DVD includes information on exercise and education provided in rehab programs: http://www.aacvpr.org/COPDvideo

Pulmonary Rehabilitation program directory:  http://www.aacvpr.org/programdirectory

                 Patient information:  http://www.aacvpr.org/patientresource

·       American Lung Association, telephone 1-800-LUNGUSA or contact your State or local chapter of the Lung Association.

·       American College of Chest Physicians

·       Canadian Lung Association

·       The Pulmonary Education and Research Foundation (PERF)