exercise in copd

8/7/2019 Exercise in Copd

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Dr. ANIRBAN MALLICK


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Varying degrees ofairflow obstruction due

to inflammation andincreasedbronchomotor tone.After long periods ofirritation, excessive

mucous is producedconstantly, thebronchial tubes becomethickened


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A conditioncharacterized by

abnormalenlargement of thespaces distal to theterminal bronchiole,

accompanied by thedestruction of theirwalls and withoutobvious fibrosis.

EMPHYSEMA

Normal Lung Emphysematic Lung


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Characterised by a chronic cough and excessivesputum production.

There is an enlargement and an increased density

of mucous glands. The airway becomes thickened and undergo

squamous metaplasia

Reduced number of ciliated cells

Causes an increase in air flow resistance Plugged airways and decreased ciliary action

encourages stagnant bronchial secretions and anincreased risk of infection.


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Can be caused by smoking, air pollution andenvironmental and occupational hazards

Main characteristic is loss of lung elasticity andreduction of elastic recoil due to alveolardestruction

Destruction of elastic tissue leads to loss of elasticrecoil of lungs during expiration and forcedexpiration necessitated

Eventual destruction of airway / capillary

membranes


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Airflow obstruction Elastic recoil of lung promote,airway ressistance

limit

Reduced FEV1/FVC

Inspiratory phase

preserved


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Hyperinflation Increased RV , increased TLC causing

hyperinflation


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Become flat

+ve abdominal pressure not generated duringinspiration

Short fibres ,less contract

More radius, more tension


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Gas exchange Pao2 N even FEV1


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Even in the face of irreversible

abnormalities of lung architecturepulmonary rehabilitation can:

Reduce symptoms

Increase functional ability Improve quality of life


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These benefits occur not because of

Reduced airway obstruction

Decreased dynamic hyperinflation

But due to improvements in secondarymorbidities that are treatable

Reversal of muscle deconditioning Increased respiratory muscle strength

Desensitization to dyspnea


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Four major components

ExerciseTraining Education

Psychosocial/behavioral

interventions Outcome assessment


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Endurance training

Breathing exercise

Resistance training


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GRADE CAUSE OFDYSPNEA

FEV1 % VO2 MAX MAX V E BLOOD

GAS

1 Fast walkingStair

climbing

>60 >25 Not limiting N Paco2Sao2

2 Walking atnormal

space

90%

3 Slowwalking


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Assess cardiac risk Assess exercise capacity

(Vo2max)

Appropriate level to preventarrhythmia

Amount of o2, bronchodilator

needed


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Vo2 max = h.rate max x stroke volume max x

(a-v ) o2 difference max COPD > V/P mismatch > Pao2 reduced > a-v

o2 dif. reduced > reduce Vo2max > reduce CRF

Pt become more inactive


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AIR-FLOW OBSTRUCTION

PROLONGED EXPIRATION

PULMONARY HYPERINFLATION

DUE TO AIR-TRAPPING

INCREASED WORK OF BREATHING

DYSPNOEA


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ALVEOLAR DISTORTION

AND DESTRUCTION

LOSS OF HYPOXIA CAUSINGCAPILLARY BED PULMONARY

VASOCONSTRICTION

PULMONARY HYPERTENSION

SECONDARY VASCULAR CHANGES

COR-PULMONALE


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Hypoxia

H

ypercapnea Dynamic airway

compression

^ cardiac output

Reduced resting BP Increased peripheral

utilization of o2


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Compression of alveolar

capillary

Hypoxia induced pulmonaryvasoconstriction

Secondary pulmonaryhypertension

RV failure

^ Pao2

^a-v o2( o2 extraction)

Increased capillarization oftrained musclesa) new capillaries develop- o capillary to fiber ratio.b)Greater opening of

existing capillaries.c) More effective bloodredistribution (shunting

away from areas that dontneed high flow).


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HRR = MHR RHR

% ofH

RR = % of Vo2max Intensity threshold for deconditioned 50%

Vo2max

50%HRR + RHR = THR


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Start with 30% Vo2max

Proper warm-up,cooling down

Duration -15-20 mns

3 times wkly

Cont. for 4-6 wks

Increase by 10% Change speed & inclination

cautiously


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To improve jt motion

To improve support of chest wall


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To improve day to day activityTo prevent fall


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Exercise for both inspiratory & expiratory muscle

Improve value of breathing Decrease dyspnea

Increase exercise performance


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Diaphragmatic breathing

20 mins at a time,2-3 times daily To increase air in basal area

,more perfused


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Study published in American Journal ofRespiratory Medicine

Pi max measured by manometer

RMT done at 30% Pi max,for 8 wks, compared

with control group


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Pursed lip breathing

Increase intra-ductal pressure Decrease residual volume

Breath in through nose,

out through mouth Ins time -4 s ,

Exp. time 6-8 s


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Hypertrophy of muscleHypertrophy of muscle Cardiac hypertrophyCardiac hypertrophy Agility progressionAgility progression Flexibility progressionFlexibility progression


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Measure 1 RM for each important muscle group

Aim hypertrophy / endurance Target 70% of 1 RM

Start with low %

G

radual increment Target in 8 wks


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Determine 1RM (repetition max.)

Set -1 Repetition - 8-12

No. of ex 8-10

Frq. 2-3 d/ wk


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exercise in copd

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