exercise and copd - integrated care · 1) pulmonary rehabilitation for chronic obstructive...
TRANSCRIPT
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Exercise and COPD
Providers
Lyn Menchin CNS2
Rocco Micco Physiotherapist
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Dyspnoea
Dyspnoea or “breathlessness” is the invisible final pathway for many suffers of lung disease
Dyspnoea creates behavior and psychological responses in people
These responses limit exercise in many COPD patients
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Pulmonary Rehab Program
A multi-disciplinary exercise program for people with lung disease
Tailored to suit each individuals ability and needs
Designed to maximize individuals Goals
Targeted to optimise psychological and physical wellbeing
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Lismore ProgramCarroll Centre St Vincent’s
Four programs a year Two exercise sessions a week One education session a week Over an eight week program Twelve clients per program Carers, family and partners
encouraged to attend education sessions
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Exercise Program
Breathing Techniques Warm Up / Stretches / Walking Exercise Circuit
Cardiac Strength Endurance
Cool Down Stretches Relaxed Breathing HOME PROGRAM
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Psychological Barriers to Exercise
Fear of breathlessness
Fear escalates into panic and helplessness
Increasing dyspnoea
Sudden panic stimulates the adrenals and sympathetic nervous system as well as the central limbic structures
Which in turn amplifies the sensation of respiratory discomfort
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Emotional Impact..
Of COPD can be equal to or greater than the physical symptoms
suffers feel like they are “a burden”
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Embarrassment Fear Altered body
image Guilt Altered role in
the family Shame Loss of control
and independence
Isolation
Altered relationships and friendships
Panic Frustration Anxiety Loss of intimacy Depression Inability to work
loss of income
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Managing the Psychosocial Impact
Goal setting
Good communication Involving your patients in the
decision making Education leads to self efficacy
promotes self management
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Managing Psychosocial Impact
Encourage people to develop there own coping strategies
Encourage pharmacological as well as non pharmacological
Relaxation
Counselling
Social work
Financial Advice
Referrals as needed
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Emotional Benefits of Exercise
Very Subjective people feel “ Better Happier ”
They enjoy the socializing associated with Pulmonary Rehab
They enjoy the peer interaction and start to rethink there illness
They realize its ok to become breathless they can still exercise just pace themselves
They find a new self confidence
Their perception of the disease burden changes when they realize they can exercise
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Common Psychological Benefits Improved Mood
Reduced Stress
Improved Self- Esteem
Pride in Accomplishments
Improved Body Image
Increased Energy
Improved Confidence
Decreased Anxiety
Decreased Fear
Decreased depression
Association of Applied Sportpsychology
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Physical benefits of Exercise in COPD
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Increased functional exercise capacity (1), (4)
Increased muscle strength (2), (3) Decreased dyspnoea (3), (8) Decreases risk factors of associated
co-morbidities (8)
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Possible benefits……..????
Stabilisation or improvement in pulmonary function (9),(10), (13)
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Benefits differ between individuals with COPD
WHY?
Complex range of individual responses to exercise based on age, gender, Phx, genetics
COPD is a complex and poorly defined condition that potentially includes a multitude of physiological processes in various systems of the body.
Difficult to ascertain accurately what factors are driving disease progression in any given individual
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The multisystem effects of Exercise remain elusive
“ ~50% of protection afforded by physical activity remains unexplained” (5)
. P. Darrell Neufer et al 2015
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Evidence that exercise has a systemic anti-inflammatory effect (6), (12)
To what extent does this benefit individuals with COPD?
Does regular physical activity modulate inflammation and tissue remodelling and assist in disease stabilisation?
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Long term benefits of exercise for people with COPD difficult to accurately ascertain
Most studies have 6-12 week interventions which show benefits gradually decline over 12-18mths (7)
Long term maintenance of progressive exercise programmes difficult d/t a variety of factors
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L.F.F Reis et al.
41 individuals with diagnosed COPD, 96 week pulmonary rehab programme, 3x per week
Ongoing improvements in 6mwt, dyspnoea, hemodynamic and lipid profile
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We know that regular exercise has many benefits for individuals with COPD but it is likely that the reasons for these benefits are multi-factorial and individually specific
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QUESTIONS???
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References
1) Pulmonary rehabilitation for chronic obstructive pulmonary disease (Review) The Cochrane Library2006 issue 4
2) Skeletal muscle strength and endurance training in patients with mild COPD and the effects of weight training. C.J. Clark, L.M. Cochrane, E Mackay , B. Paton, European Respiratory Journal 2000 15:92-97
3) Low intensity peripheral muscle conditioning improves exercise tolerance and breathlessness in COPD. C.J. Clark, L. Cochrane, E Mackay , , European Respiratory Journal 1996 9:2590-2596
4) Home-based pulmonary rehabilitation improves clinical features and systemic inflammation in chronic obstructive pulmonary disease patients. Eloisa Sanches Pereiera do Nascimento et al, International Journal of COPD 2015: 10 645-653
5) Understanding the cellular and molecular mechanisms of Physical Activity-induced Health benefits. P. Darrell Neufer et al. Cell Metabolism 22 July 7 2015 4-11
6) The anti-inflamatory effect of exercise. Anne Marie, W. Peterson and Bente Klarlund Pedersen. Journal of Applied Physiology 2005 98: 1154-1162
7) Pulmonary Rehabilitation: Summary of an Evidence –Based Guidline. Andrew L Ries MD MPH. Respiratory Care September 2008 Vol 53 No 9.
8) A long-term pulmonary rehabilitation program progressively improves exercise tolerance, quality of life and cardiovascular risk factors in patients with COPD. L.F.F Reis et al. European Journal of Physical Rehabilitation Medicine 2013;49:491-497
9) Effect of Aerobic Exercise Training on Pulmonary Function and Tolerance of Activity in Asthmatic Patients. Reza Farid et al. Iranian Journal of Allergy, Asthma And immunology 4(3) September 2005
10) Exercise Training Decreases Ventilatory Requirements and Exercise-Induced Hyperinflation at Submaximal Intensities in Patients with COPD. Janos Porszasz et al.CHEST 128(4) October 2005
11) Regular Physical Activity Modifies Smoking-related Lung Functyion Decline and Reduces Risk of Chronic Obstructive Pulmonary Disease. A population-based Cohort Study. Judith Garcia-Aymerich et al. American Journal of Critical Care Medicine Vol 175. 458-463 2007
12) Exercise as Mean to Control Low-Grade Systemic Inflammation. Neha Mathur and Bente KlarlundPederson. Mediators of Inflammation. 2008. ID 109502
13) The Effects of Traditional Chinese Exercise in Patients with Chronic Obstructive pulmonary disease: A Meta-Analysis. Xiaotian Luo et al. PLOS One september2016
Exercise and COPDDyspnoeaPulmonary Rehab Program Lismore Program�Carroll Centre St Vincent’sExercise Program Psychological Barriers to Exercise Emotional Impact..Slide Number 8Managing the Psychosocial Impact Managing Psychosocial Impact Emotional Benefits of Exercise Common Psychological Benefits Physical benefits of Exercise in COPDSlide Number 14Possible benefits……..????�Slide Number 16The multisystem effects of Exercise remain elusive�Slide Number 18Long term benefits of exercise for people with COPD difficult to accurately ascertain �Slide Number 20Slide Number 21Slide Number 22Slide Number 23