lung and airway disorders
Pulmonary Rehabilitation
Components of Pulmonary Rehabilitation
A pulmonary rehabilitation program has several components, including Exercise training Inspiratory muscle training Neuromuscular electrical stimulation Psychosocial counseling Nutritional evaluation and counseling Education, including on proper use of prescribed drugs Exercise training is the most important component of pulmonary rehabilitation. It reduces the effects of inactivity and deconditioning, resulting in less shortness of breath and an increased ability to exercise. However, physical limitations may restrict the types of exercise training that can be used. Aerobic exercise and strength training are both important components of exercise training in people with lung disorders. Exercise of the legs is the cornerstone of training. Because walking is necessary for most activities of daily living, many rehabilitation programs use walking (sometimes on a treadmill) as the preferred mode of training. Some people may prefer exercising on a stationary bicycle. Choosing an exercise that is comfortable and satisfying for the person enhances willingness to participate long-term. Exercise training of the arms is also beneficial for people with chronic lung diseases who have shortness of breath or other symptoms during their normal activities of daily living, such as washing their hair or shaving. Such training is needed because chronic lung disease can cause muscle loss, and some of the shoulder muscles are used in breathing as well as in moving the arms. Activities involving arm work can quickly overexert these muscles. Inspiratory muscle training (IMT) is often a component of pulmonary rehabilitation. With IMT, the person uses breathing exercises and devices to strengthen the Respiratory muscles . IMT is usually used together with traditional aerobic exercise. Neuromuscular electrical stimulation (NMES) uses a device that applies electrical impulses through the skin to selected muscles to stimulate contraction. NMES can be effective in people with severe lung and/or heart disease because it does not cause the shortness of breath that often prevents these people from participating in typical exercise training. Depression and anxiety are common reactions to the life changes a person with lung disease experiences. In addition, shortness of breath itself may cause anxiety and depression, interfere with sexual activity, and cause difficulty managing stress and relaxing. Through counseling, group therapy, and, when needed, drug treatment, people may be able to better cope with these psychosocial problems. Sometimes family members participate in counseling to help them cope with the stress involved in caring for a person with lung disease. People who have lung disease often need nutritional evaluation and counseling. For example, those with the most severe chronic obstructive pulmonary disease often experience weight loss. Pulmonary rehabilitation programs help people avoid weight loss and maintain muscle mass. People must be taught to eat in such a way that they maintain adequate caloric intake while avoiding becoming too full, which can interfere with breathing. Alternatively, some people gain weight because of a reduced activity level. In this case, breathing places a greater demand on an already taxed respiratory system. Weight reduction benefits such people. People with severe lung disease usually take several drugs. Often these drugs must be taken according to precise instructions and a complex schedule. Through a rehabilitation program, people can learn about the appropriate timing and doses of all drugs they need to take. Education often includes information about the nature of the lung disease and the role of drug therapy, including expected benefits, potential side effects, and the proper technique for use of inhaled drugs. Programs closely monitor how well people follow instructions and teach them and their families about the importance of appropriate use. People are also taught about the need for Smoking Cessation , breathing strategies (such as 