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. a multidisciplinary continuum of

services directed to persons with

pulmonary disease & their families,

usually by an interdisciplinary team of

specialists, with the goal of achieving &

maintaining the individuals maximum

level of independence & functioning in

the community.

(National Institutes of Health 1994)


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Aims

Reducedyspnoea

Increase msendurance &

strength

Increaseexercisecapacity

Improve dailyfunctioning &ensure long -

termcommitment

to exercises

Help allayfear & anxiety

& improvehelath -related

quality of life

Increaseknowledge oflung condition

& promoteself

management


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1. A training programme consisting of

between 14 & 24 sessions, supervised

at least twice a week, should be

offered : longer programmes generally

results in better long - term effects.

2. Encourage pts to exercise

independently in addition to

supervised sessions.

3. Progression of the training load

should be based on pts tolerance.


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4. Strength training is indicated for mostpatients, especially for those with

severe ms weakness. Training can be

performed with 2-4 sets of 6-12repetitions at intensities ranging from

50-85% of one repetitions maximum.

5. A combination of endurance andstrength training is recommended.

6. Both upper and lower extremities

should be trained.


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ASSESSMENT TOOLS

Used to measure various outcomes and to characterize a

population.

Allowing the health professional and the patient theopportunity to monitor progress in meaningful terms.

Divided into 2 :

- Assessment of exes tolerence & ms

function

- Assessment of activities of daily living

(ADL)


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Assessment of exercise tolerance is required in order to assess

risks, characterize initial disability, set targets of training intensity,

assess the benefit of rehabilitation programmes and motivate

patients to continue with training regimes.

All pts should perform standardized test of ex. capacity before

and after training.

There are 3 ways to assess exe. tolerance & ms function.

a) laboratory incremental maximal

b) the 6-minute walking test

c) the shuttle walking tests

ASSESSMENT OF EXERCISE TOLERANCE AND

MUSCLE FUNCTION


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a) Laboratory incremental maximal tests

Laboratory tests measuring

maximal oxygen consumption,

heart rate, workload, arterialoxygenation and blood lactate

levels remain the gold

standard in exe. testing and

are appropriate in pts with

COPD.


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Simple test that measure the distance walked over6 minutes.

Participants is asked to walk for 6 minutes as fast

as reasonable possible along measured flat corridor.

Stopping to rest is allowed but included within 6

minutes .

Physiotherapist can inform the participants when

each minutes is completed.

Data was record are :

- 6 minutes distance

- Heart rate

- symptoms

b) The 6-minute walking test


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The SWT demonstrate validity with other measure of ex.

tolerance and is reliable on test-retest, requiring only one

practice walk.

The shuttle walk test involves the perambulation of an oval

10m course.

Patient is asked to turn around the cone in the shuttle walk

in time with an audio signal.

Patient is wearing heart rate telemeter on his wrist.

The walking speed are increased every minute and thereby

increase the number of shuttles per level.

c) The shuttle walking test


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(a) Activities of daily living ( ADL )

- ADLs are defined as the things we

normally do...such as feeding ourselves,

bathing, dressing, grooming, work,

homemaking, and leisure.

ASSESSMENT OF ACTIVITIES OF

DAILY LIVING


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(b) Subjective tools ( questionnaires and scales )- The short 15-item questionnaire, the London

Chest Activity of Daily Living Scale have been

validated in patients with COPD.

- Improvements in dysponea during ADL were

documented following pulmonary rehabilitation and

the change in exe. tolerance.


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(c) Objective tools (motion sensors)

-Increasing attention has been given to the objective

monitoring of daily physical activity in differentpopulation, include patient with COPD.

-The recent advent of motion sensors, including digital

pedometers (to count step and estimate the distancewalked and energy expenditure ) and accelerometers

(allow quantity and intensity of movement to determined )


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ROLE OF PHYSIOTHERAPY

The major breathing

techniques:

(a)Pursed lip breathing

(b)Diaphragmatic breathing

(c) Posture techniques


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(a) Pursed lip breathing


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(b) Diaphragmatic breathing


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(c) Posture techniques

Frequent leaning relieves

dyspnoea in COPD pts by

reducing respiratory efforts.

The most benefit occurs in

pts with severe

hyperinflation, who haveparadoxical inward

movement of the upper

abdomen.


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CONCLUSION

Pulmonary rehabilitation is aneffective theraphy.

- improve exes tolerance

- Ability to perform ADLs

- Improve ms strength

It s important for therapeutic

intervention & relatively low budget

interventions.

A multidisciplinary combine

approach will spread the workload

& offer the most effectives and

evidence based treatment to pts.


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