South TynesideNHS Foundation Trust

Pulmonary Rehabilitation

Breathe Well, Live Well

Providing a range of NHS services inGateshead, South Tyneside and Sunderland.

Patient Information Booklet

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What is pulmonary rehabilitation?

Pulmonary rehabilitation is an eight to 12 week programme that includes exercise, as well as education on all aspects of your condition such as breathing techniques, chest clearance, psychosocial support, nutrition, self-management, medication advice.

The group programme is delivered by a multi professional team that consists of a Respiratory Specialist Nurse, Specialist Pulmonary Rehabilitation Nurses, Occupational Therapist and Health Exercise Lifestyle officers (HELP).

Pulmonary rehabilitation has been proven to improve breathlessness, improve fatigue, improve circulation, improve anxiety/low mood, improve over all well- being and improve quality of life.

Home Exercise Programme

We also offer a 10 week Home Exercise Programme for patients who are unable to attend Pulmonary Rehabilitation classes in the community. You do not need any specialist equipment to take part in the sessions which are adapted to suit the ability of each patient. The programme is led by an Occupational Therapist and aims to improve patient’s self- management of their condition through providing advice and education in the following areas:-

3 Graded Home Exercise Programme

3 Breathing and Relaxation Techniques

3 Energy Conservation

3 Fatigue Management

3 Anxiety Management

3 Psycho-Social Support

3 Equipment to promote independence

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What are the benefits of exercising?

3 Lower blood pressure and heart rate

3 Help lower bad cholesterol / increase good cholesterol

3 Weight maintenance

3 Reduce body fat

3 Improve circulation - improve blood flow to the heart

3 Improve blood flow to the muscles and the brain

3 Reduce stickiness of the blood

3 Increase energy levels

3 Improve posture

3 Increase functional strength

3 Improve and maintain bone density

3 Reduce risk of diabetes, coronary heart disease andosteoporosis

3 Reduce risk of certain cancers including bowel and colon

3 Increase angina threshold

3 Increase functional / exercise capacity

3 Reduce effort of everyday living

3 Increased feeling of wellbeing

3 Reduce stress

3 Improve mood

3 Improve confidence

3 Improve mobility / independence

3 Improve sleep patterns

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Frequently asked questions

Q Who is suitable for Pulmonary Rehabilitation?A Any individual whom has chronic obstructive pulmonary disease (COPD) or a respiratory condition.

Q What preparation will I need before each session?A It is important to have something to eat two hours before each session, and also to make sure all medication has been taken as prescribed.

Q What will happen during a home exercise session?A You will be provided with an exercise programme to be completed every day. Your instructor will visit you at home once a week to supervise your programme and make any changes as you progress. You will have your pulse and oxygen saturations taken and a conversation about how you have been and if there have been any changes in your medication/ treatment.

The exercises consist of a gentle warm up followed by exercises to increase your strength and stamina and followed by some cool down stretches. The exercises can be carried out either sitting or standing and you will be monitored throughout the session.

Q What will happen during pulmonary rehabilitation sessions?A Firstly you will have your pulse and saturations taken (the amount of oxygen in your blood) with a quick conversation on how you have been and if there have been any changes in your medication/ treatment.

Then when you are ready the exercise instructor will lead the class in gentle warm up exercises, following on with the main exercises which you will perform at your own level of ability, followed by a gradual cool down. You will be monitored throughout the session. An educational talk will follow (please see the sheet of educational talks).

Q What would I need to bring with me?A You will need to bring the following with you if you are prescribed them:

• Salbutamol inhaler• Oxygen- please ensure you have enough to last for the session• GTN spray• Any walking aid needed• A bottle of water (however water will be provided if you prefer).

Q What will I need to wear?A We recommend anything comfortable and loose fitting. Soft/comfortable flat shoes or trainers if you have them are advisable.

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Q Where will I receive the pulmonary rehabilitation programme? A Currently you can choose from five sites:

• Washington Leisure Centre• Silksworth Tennis Centre• Houghton Medical Centre• Bunny Hill Primary Care Centre• Hendon Raich Carter Sports Centre

Q Who do I contact if I am unable to come to rehabilitation?A You will need to contact:

If you are unable to attend for more than four sessions you may be asked to leave the programme. If you fail to inform us of not being able to attend on two occasions you will not be able to continue on the course.

Life After Pulmonary Rehabilitation

Hurray you’ve completed the programme but it doesn’t stop there! We don’t want you losing the benefits you have worked so hard to gain. There are currently 3 options you can consider for further exercise:

Gym or Maintenance Class (with the HELP Team)

The first option is a referral to the gym. Gym sessions are currently at the same sites as the Pulmonary Rehabilitation classes plus the Sunderland Aquatic Centre. Please do not be afraid of the gym or think you are not suitable because of your condition as this is certainly not the case. The HELP Team deliver this 12 week programme so you will have continued support.The HELP Team also offer maintenance classes at the same centres as the rehabilitation class.

Age UK

The third option is exercise classes with Age UK. They deliver a wide variety of activities (not just exercise classes!) More information can be found in the Age UK leaflet, which you will be provided with.

It can be hard to keep up your motivation if just exercising by yourself at home, so please do consider taking part in at least one of these follow on options.

Grindon Lane Primary Care Centre on 0191 5252346

Or call your rehabilitation nurse: Angela Ridley 0191 5252371Patricia Heatlie 0191 5252313

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Your Home Exercise Programme

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Exercise Plan

Tips for Exercise

• Always do a light warm up before the main exercises. Ideally copy some of the moves from the circuit, but without using resistance (eg weights/band)

• You may need a chair to sit and perform your exercises, or to use for support.

• Use small hand weights and/or a resistance band where needed.

• Practice your breathing techniques throughout the session. You should not feel any pain which is not normal for you.

• You should try and perform between 2 – 4 minutes on each CV station.

• Resistance exercises are performed in sets and reps.

• Always listen to your body and have recovery time if your breathing is over 5 on the dyspnoea scale.

• Ensure that you have your salbutamol inhaler or GTN spray when exercising if appropriate.

The current physical activity guidelines for patients with COPD state that you should accumulate 30 minutes moderate intensity activity on at least 5 days of the week.

This is a structured exercise plan for you to follow, remember that you can also be physically active by doing housework, enjoying a light sporting activity e.g. bowls or taking the dog for a walk. You do not have to accumulate your 30 minutes all at once.

Warm up and cool down exerciseso Shoulder Shrugs 4 x each directiono Shoulder circles 4 x each directiono Head turns 4 x each directiono Trunk twists 2 x each directiono Side bends 2 x each directiono Knee lifts 4 x each sideo Heel digs 4 x each sideo Toe taps 4 x each sideo Side taps 4 x each sideo March on the spot 4 x each side

You can perform the warm up seated or standing, maintaining good posture. After performing the mobilisation exercises you can add some small arm movement e.g. heel digs/ arm curl, toe taps/ front arm raise, march on the spot/ swing the arms. You should not be above 1-2 on the Exertion Scale (see below) during the warm up.

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After you have completed the main circuit you can cool down by performing the warm up exercises above in reverse order and carry out some stretches that you have learned in rehab.

How much is too much?

The Rating of Perceived Dyspnoea (RPD) Scale on the next page is useful during exercise or tasks to monitor the intensity of your activity. Exercising or working at moderate levels will help you to increase your exercise endurance and improve your lung function.

As your strength and endurance improve with exercise, you will note that your feelings of being breathless during daily activities will decrease. In addition, you will note that all daily activities require less energy. Your actions will not be as limited by breathlessness.

To use the scale, consider how hard you are breathing on a scale of 0 to 10.

On the scale, 0 is “no shortness of breath“

A 10 represents “so much shortness of breath that you have to stop the activity“

Your goal during the circuit exercises marked with a is to keep a rating between 3 and 5

Remember: Exercise will not harm your lungs! It is normal to get shortness of breath during activity - this is simply an indication that your body needs more oxygen. If you slow your rate of breathing and concentrate on exhaling through pursed lips, you will restore oxygen to your system more rapidly.

However, on some days you may feel that you cannot coordinate your breathing to reduce shortness of breath. Or you may have aches and pains longer than 20 to 30 minutes after your exercise session. If so you will need to slow your pace down to 1 or 2 on the scale.

As you get fitter, you may want to challenge yourself more by performing several CV

stations back to back so you are doing more continuous cardiovascular work.

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MODIFIED BORG DYSPN0EA SCALE

0 NOTHING AT ALL

1 VERY, VERY LIGHT

2 MILD SHORTNESS OF BREATH

3 MODERATE SHORTNESS OF BREATH

4 SOMEWHAT HARD

5 STRONG OR HARD BREATHING

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7 VERY HARD

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9 VERY, VERY SEVERE

10 MAXIMAL, CAN’T CONTINUE

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Count sets and reps

2) Seated row backs : 10 – 15 Repetitions rest and repeat.

Sitting tall without the support of the chair back, place one or both heels out on the floor in front of you. Place your band under your feet as shown, holding near the ends firmly, arms extended in front of you near your knees.

Without leaning forward or back, slowly draw back with your elbows in a diagonal direction, hands moving towards your hips. Think about drawing your abdomen in and gently squeezing your shoulder blades together. Only your arms and shoulder blades move, and there should be no strain in your wrists. Keeping your wrists/forearms and the band in a line will help avoid strain. Return slowly to start.

Shortening your grip on the band (or having two feet on it) will increase difficulty.

Exercise 2

Timed

1) Heel digs / knee lifts 2 – 4 minutes

Standing tall, touch alternate heels in front whilst keeping the supporting knee slightly bent (“soft”) and abdomen drawn in.

You can use your arms to increase your effort if needed, or bend your supporting knee a little more, or perform some alternate knee lifts for more of a challenge.

If you need a little help with your balance, stand at right angles to a chair back or other suitable support (like a table) so you can place one hand lightly on it for support. Always stand tall and do not lean your weight on your arm.

Exercise 1

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Timed

3) Side Taps / step backs : 2 -4 minutes

Stand with good posture, looking straight ahead. With a slight bend in your supporting leg, tap alternate feet out to the side. Your weight should stay mostly over your supporting leg. To increase effort, include a side raise of one or both arms, or bend your supporting leg a little more.

For variety, you might like to include some step-backs: step back right then left with a transfer of your weight (rather than just tapping back) and then step both feet forward again. Again, ‘pumping’ the arms as shown increases effort.Remember you can stand behind a chair if your need a little support.

Count sets and reps

4) Slow sit-to-stand: 0 – 15 Repetitions rest and repeat.

Sit tall in the chair with both feet flat on the floor and at shoulder width apart, slowly stand up, maintaining good posture and keeping the eyes focused straight ahead. From the standing position return to your seat and repeat the action. Use support if needed e.g. hands on thighs.

Alternative exercisesSquat (below left)Standing tall behind a chair, feet about hip width apart and your weight back in your heels, slowly lower your hips behind you whilst keeping your abdomen drawn in and knees over your ankles/mid foot. Do not go any lower than is comfortable for you. Your upper body will incline slightly forward but keep your head and chest lifted, looking straight ahead. Return to start.

Seated leg extension (below right)From a seated position, slowly extend one leg in front from the knee, tightening up the upper thigh muscles, then return. Perform several on one leg then switch sides, and repeat.

Exercise 3

Exercise 4

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Timed

5) Shuttle Walk: 2 – 4 mins

Standing tall, looking straight ahead, walk at a comfortable pace using walking aids if required. You should practice your breathing techniques throughout your session. As you get fitter you could aim to walk at a pace you find slightly more challenging.

Alternative exercises March on the spot or seated marchMaintaining a good posture, march on the spot, use the chair for support if needed. Or sit tall in the centre of a chair unsupported by the back rest, and march on the spot with feet a comfortable width apart.

Exercise 5

Count sets and reps

6) Upright Row: 10 – 15 Repetitions, rest and repeat

Standing tall, place one or both feet in the middle of your band, holding the ends of the band in a relaxed position in front of the thigh/hip area, palms facing your body. You could use weights instead of the band .

Relaxing your neck and shoulder area, slowly raise the elbows towards shoulder level and return equally slowly to the starting position. Wrists should always be below elbows and you should feel no strain in the wrists.

Alternative exercise:Seated upright row 10 – 15 Repetitions, rest and repeat. Perform seated using small hand weights, starting with the weights held down at the sides of your chair

Exercise 6

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Timed

7) Step Ups: 2 – 4mins

Standing tall with good posture, using support from a wall or a walking aid (stick) if needed, slowly step up and down in a 4 count pattern.

eg. right, left, right, left. Remember to change your leading leg every so often.

Always look straight ahead and ensure that the whole foot is on the step. This is a good exercise to be practicing those breathing techniques!!

Exercise 7

Count sets and reps

8) Wall Press: 10 – 15 repetitions, rest and repeat

Standing a short distance from the wall, feet shoulder width apart and looking straight ahead, place both hands on the wall, around chest /shoulder height. From this starting position flex the elbows and allow the body to move closer to the wall. The back should remain straight, abdomen pulled in and feet remain flat on the floor. Extend the arms at the elbow joint, returning to the starting position.

Standing further back from the wall will increase difficulty.

Alternative exerciseChest press with band 10 – 15 repetitions, rest and repeatStand or sit tall with the band behind your back, ends under your arms as shown. Begin with a grip that creates only a little tension on the band in the starting position (you can increase starting tension as you get fitter).Slowly extend arms forward at chest height until elbows are almost straight, then return.

Exercise 8

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Timed

9) Tap Backs / Hamstring curls: 2 – 4mins

Using a chair for support if necessary, tap alternate toes behind you, keeping a slight bend in the supporting leg. The exercise can be progressed by adding some arm work. Look straight ahead as you perform this exercise but avoid arching your lower back. This is another good opportunity to practice your breathing techniques.

You can also perform some hamstring curls for variety if desired, lifting alternate heels as shown in the second picture.

Again your posture should be tall, abdomen drawn in and with no arching of the lower back.

If using a chair, try to use only for light support, avoid leaning your weight onto your arms.

Exercise 9

Count sets and reps

10) Outer Thigh Push: 10 – 15 Repetitions rest and repeat

Sitting tall in the chair unsupported from the back rest with feet flat on the floor at hip distance apart or slightly less. Wrap the band around the mid part of the thighs and hold firmly in place. From this position move the knees outwards, maintaining your posture and keeping the feet flat on the floor, return the knees to the starting position and repeat.

To increase difficulty, begin with the band wrapped a little tighter.

Exercise 10

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Count sets and reps

Bicep Curls : 10 – 15 Repetitions, rest and repeat

Stand or sit tall holding weights down by your thighs, elbows slightly bent and close to the body. Slowly bend your arms at the elbow raising the palms of the hands toward the shoulder. Elbows should remain pointing towards the floor and close to your body.

Slowly return to the starting position.

Count sets and reps

Tricep Press : 10 – 15 repetitions, rest and repeat.

Sitting or standing with good posture, hold the band close to the upper body with one long pony tail in front of the body. Hold the pony tail with the other hand and slowly press forward under resistance until the arm is fully extended, but without ‘locking’ your elbow joint.

Slowly release the tension as you return to start. Do a complete set on one arm then switch sides and repeat. You can work towards two sets on each arm.

Additional weight and band exercisesIn addition to your circuit exercises, you may like to try these extra exercises for upper limb strength:

Production date: May 2017 Author: Pulmonary Rehabilitation Code: 0117/465 Review date: May 2020

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This information can be made available in another format or language on request. For further copies of this leaflet please contact on telephone numbers above.

For further information please contact:

Grindon Lane Primary Care Centre on 0191 5252346

Or call your rehabilitation nurse: Angela Ridley 0191 5252371Patricia Heatlie 0191 5252313