martes, 21 de agosto de 2012

What To Expect During Pulmonary Rehabilitation - NHLBI, NIH

What To Expect During Pulmonary Rehabilitation - NHLBI, NIH

What To Expect During Pulmonary Rehabilitation

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.


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

The illustration shows the pursed-lip breathing technique. The “inhale” illustration shows how to inhale correctly using this technique. The “exhale” illustration shows how to exhale correctly. Click your mouse on the “inhale” and “exhale” tabs at the top of the illustration to view each step of the technique.
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.

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