Pulmonary Rehabilitation

Pulmonary (PULL-mun-ary) rehabilitation, also called pulmonary rehab or PR, is a broad program that helps improve the well-being of people who have chronic (ongoing) breathing problems.

For example, PR may benefit people who have COPD (chronic obstructive pulmonary disease), sarcoidosis (sar-koy-DOE-sis), idiopathic pulmonary fibrosis, or cystic fibrosis.

PR also can benefit people who need lung surgery, both before and after the surgery.

PR doesn't replace medical therapy. Instead, it's used with medical therapy and may include:

• Exercise training
• Nutritional counseling
• Education on your lung disease or condition and how to manage it
• Energy-conserving techniques
• Breathing strategies
• Psychological counseling and/or group support

PR involves a long-term commitment from the patient and a team of health care providers. The PR team may include doctors, nurses, and specialists. Examples of specialists include respiratory therapists, physical and occupational therapists, dietitians or nutritionists, and psychologists or social workers.

PR often is an outpatient program based in a hospital or clinic. Some patients also can receive PR in their homes.

When you start PR, your rehab team will create a plan that's tailored to your abilities and needs. You'll likely attend your PR program weekly. Your team also will expect you to follow your plan, including exercises and lifestyle changes, at home.

PR has many benefits. It can improve your ability to function and your quality of life. The program also may help relieve your breathing problems. Even if you have advanced lung disease, you can still benefit from PR.

Your doctor may recommend pulmonary rehabilitation (PR) if you have a chronic (ongoing) lung disease. He or she also may suggest PR if you have a condition that makes it hard for you to breathe and limits your activities.

For example, you may benefit from PR if you have:

• COPD (chronic obstructive pulmonary disease). COPD includes emphysema (em-fi-SE-ma) and chronic bronchitis (bron-KI-tis). The symptoms of COPD include coughing (either a dry cough or a cough that expels phlegm or mucus from your airways), wheezing, shortness of breath, chest tightness, and other symptoms.
• An interstitial (in-ter-STISH-al) lung disease. This type of disease causes scarring of the lung tissue over time. This can lead to coughing, shortness of breath, and other symptoms. Examples of interstitial lung diseases include sarcoidosis and idiopathic pulmonary fibrosis.
• Cystic fibrosis (CF). CF is an inherited disease that causes thick, sticky mucus to collect in the lungs and block the airways. CF can cause coughing and frequent respiratory infections.

Your doctor also may recommend PR before and after lung surgery to help you prepare for and recover from the surgery. For example, people who have surgery for lung cancer or COPD may benefit from PR.

PR also can help people who have muscle-wasting disorders that may affect the muscles used for breathing. One example of this type of disorder is muscular dystrophy.

PR works best if you start it when your disease is in a moderate stage. However, even people who have advanced lung disease can benefit from PR.

When you first start pulmonary rehabilitation (PR), your team of health care providers will want to learn more about your health.

For example, they'll want to know how well you're able to breathe and exercise. You'll have lung function tests to check your breathing. These tests measure how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood.

Your team can check your ability to exercise several ways. They may measure how far you can walk in 6 minutes (called a 6-minute walk test). Or, they may ask you to exercise on a treadmill while your oxygen level, blood pressure, and heart rate are measured.

Your PR team also will review your medical therapy to see whether it needs to be changed during the PR program. For example, you may need to start using, or increase the use of, inhaled bronchodilators. These medicines can help you breathe easier during exercise. You also may need oxygen therapy to help you get the most out of your exercise plan.

Your PR team may assess your mental health. If you have anxiety or are very depressed, they may refer you to a specialist who can treat these issues.

In addition, the team may measure your weight and height, ask about your food intake and general nutrition, and recommend a blood test to assess loss of muscle mass.

The data your PR team gathers at the start of your program will help them create a plan that's tailored to your abilities and needs.

Pulmonary rehabilitation (PR) can have many parts, and not all programs offer every part. PR programs may include:

• Exercise training
• Nutritional counseling
• Education on your lung disease or condition and how to manage it
• Energy-conserving techniques
• Breathing strategies
• Psychological counseling and/or group support

Exercise Training

Your PR team will give you a physical activity plan tailored to your needs. They'll design the plan to improve your endurance and muscle strength, so you're better able to carry out daily activities.

The plan will likely include exercises for both your arms and legs. You might use a treadmill, stationary bike, or weights to do your exercises.

If you can't handle long exercise sessions, your plan may involve several short sessions with rest breaks in between. While you exercise, your team may check your blood oxygen levels with a device that's attached to your finger.

You'll probably have to do your exercises at least three times a week to get the most benefits from them.

Nutritional Counseling

The data your PR team gathers when you start the PR program will show whether you're overweight or underweight. Both of these conditions can make it hard for you to breathe.

If you're overweight, fat around your waist can push up against your diaphragm (a muscle that helps you breathe). This will give your lungs less room to expand during breathing. Your team may recommend a healthy eating plan to help you lose weight.

You also can have breathing problems if you're underweight. Some people who have chronic (ongoing) lung diseases have trouble maintaining weight. If you lose too much weight, you can lose muscle mass. This can weaken the muscles used for breathing.

If you're underweight, your team may recommend a healthy eating plan to help you gain weight. They also may give you calorie and protein supplements to help you avoid weight loss and loss of muscle mass.

Education

Part of PR involves learning about your disease or condition and how to manage it (including how to avoid situations that worsen symptoms). Your symptoms may get worse if you have a respiratory infection or breathe in lung irritants, such as cigarette smoke or air pollution.

Your PR team will teach you about the importance of vaccinations and other ways to prevent infections. If you smoke, you'll be offered a program to help you quit.

Part of PR education is making sure you know when and how to take your medicines. Your PR team will teach you how to use inhalers and nebulizers if you need them to take your medicine. They also will show you how to use oxygen if you're getting oxygen therapy.

In addition, your PR team will help you create a self-management plan. This plan will explain what you should do if your symptoms get worse or you have signs of a respiratory infection.

The self-management plan will describe what you can do on your own to relieve symptoms. It also will explain when you should contact your doctor or seek emergency care.

Most PR programs last a few months. To fully benefit from your program, you'll be taught how to use the exercises, breathing strategies, and other lifestyle changes you learn in PR at home. This also will be part of your self-management plan.

Energy-Conserving Techniques

One way to help prevent symptoms like shortness of breath is to find easier ways to do daily tasks. PR programs often give you tips on how you can conserve your energy and breathe easier.

These tips include ways to avoid reaching, lifting, and bending. Such movements use energy and tighten your abdominal muscles, making it harder for you to breathe.

Stress also can use up energy and make you short of breath. Many PR programs teach relaxation skills and ways to avoid or relieve stress.

Breathing Strategies

While in PR, you'll learn strategies that can improve your breathing. For example, you may learn how to take longer, deeper, less frequent breaths. One example of this type of exercise is pursed-lip breathing.

Pursed-lip breathing decreases how often you take breaths and keeps your airways open longer. This allows more air to flow in and out of your lungs so you can be more physically active.

To do pursed-lip breathing, you breathe in through your nostrils. Then you slowly breathe out through slightly pursed lips, as if you're blowing out a candle. You exhale two to three times longer than you inhale. Some people find it helpful to count to two while inhaling and to four or six while exhaling.

Pursed-Lip Breathing

Other breathing strategies involve positioning your body so your lungs can expand the most when you breathe in. You also may learn how to use your abdominal muscles to more effectively breathe out.

If you have cystic fibrosis or another condition that's causing a buildup of mucus in your airways, you'll be taught how to loosen and expel the mucus. For example, you may learn techniques such as chest physical therapy (CPT) and more effective breathing.

CPT also is called chest clapping or percussion. It involves having someone pound your chest and back over and over with his or her hands cupped. This loosens the mucus from your lungs so that you can cough it up. You also can use a device to pound your chest and back and loosen mucus.

Psychological Counseling and Support

People who have chronic lung diseases are more prone to depression, anxiety, and other emotional problems. Thus, many PR programs offer counseling or support groups. If your program doesn't, your PR team can refer you to such services.

Most pulmonary rehabilitation (PR) programs last a few months. At the end of your program, you'll undergo tests and answer questions. Some of these tests, such as exercise tests, will be the same ones you had at the start of your program.

The data gathered at the end of the program will show whether your symptoms, physical activity level, and quality of life have improved. If they have, your team will encourage you to continue your exercises, breathing strategies, and other prescribed changes on your own.

If you have little to no improvement, talk with your doctor. He or she might want to change your medical therapy. Or, your doctor might recommend more tests. These tests can show whether you have another condition that also may have to be treated to improve your breathing.

Benefits

Pulmonary rehabilitation (PR) can't cure your lung disease or completely relieve your breathing problems. However, PR does have many benefits. For example, it may:

• Improve your quality of life
• Help you function better in your daily life
• Increase your ability to exercise
• Decrease the symptoms of your disease or condition
• Help you manage anxiety and depression

You also may have fewer breathing problems as a result of PR. Although PR doesn't improve your lung function, it allows you to make the most of the limited lung function you have.

Risks

PR usually is safe. The only risks are related to the exercise part of the program. For example, physical activity may cause injuries to your muscles or bones.

If you have another disorder, such as heart disease, physical activity may increase your risk of having a heart attack or arrhythmia (ah-RITH-me-ah). An arrhythmia is a problem with the rate or rhythm of your heartbeat.

The health data that your PR team collects at the start of your program and during the program can help prevent these problems.