PULMONARY REHABILITATION
OK let us suppose that you have been diagnosed with COPD and your condition is moderate to severe. If you are having symptoms such as breathlessness when making beds or shopping then you will be probably asked by the hospital or GP if you would like to go on a course for Pulmonary Rehabilitation . If so take it - we'll explain what it means in a minute - some patients don't, or say they don't need it, but we do, believe us, we know, we've been on one.
The vast majority of patients will be those with COPD but it should be pointed out that other chest conditions causing breathlessness such as chronic asthma, bronchiectasis and pulmonary fibrosis may also benefit.
Patients with serious heart disease may be unable to exercise safely. If you are addicted to drugs including alcohol, it is unlikely that you will be able to attend the programme or benefit from it. Likewise you might be too depressed, feeling hopeless or lack motivation. You might not be able to travel to the Pulmonary Rehabilitation centre. Frequent exacerbations may prevent you finishing the programme.There is no justification for selection based on age, impairment, disability or smoking. I'm also sorry to say that pulmonary rehabilitation is not available throughout the country.
So what is this pulmonary rehabilitation and how long does it last?
Here is one typical example. It took place in an out-patients department of the nearest city hospital, although it can be held in other places, even village halls, provided the staff and equipment is available.
It was really like a small gym with about 20 machines (a couple of static bicycles, a weight lifting machine, step-up benches, a big wheel to turn with your hand and so on, nothing too frightening!). The course was conducted by a nurse and a physiotherapist, all very firm but very friendly. Nobody pushed you into doing anything too hard for you – each exercise was tailor made for you and you worked at your own pace. There were about 10 of us. Anybody who gets an exacerbation (bad cold/bronchitis/ infection) that needs treatment with antibiotics can miss a few sessions or drop out).
In all we met 12 times (twice a week, six weeks), and the aims of the course were as follows
To teach patients and their families about chronic lung disease, its effects and consequences and ways to minimise or control the problems that chronic lung disease may cause. So yes you can bring your carer along with you if you wish.
- To make you as a strong as possible and so make it easier for you to exercise.
- To reduce your symptoms and gain control over them
- To make you feel better about yourself and give you more confidence and less anxiety.
- To help you cope with the limitations and frustrations caused by having chronic lung disease.
You may be asked to take a shuttle walking test first – this is to try and walk slowly and then faster and faster between two markers on the floor (you will be prompted by a tape recording). At the end of the course you may be tested again to note any improvement.
Ok so you exercise for a few minutes on each piece of equipment for about 30 minutes, but what happens after that?
Well the idea is to increase each week the time spent on each piece of equipment (for example you record the number of step ups you do each week.) And after 30 minutes or so you sit down and have a hard earned rest and a cup of tea and a chat. Then in the final hour or less we were given a talk on the following
Exercise – why bother? How the lungs work. Questions and answers to a consultant, Pacing, Breathe Easy Groups, Goal Setting, Social Benefits, Use of inhalers and oxygen, diet, relaxation, exacerbations, chest clearance techniques, purse lip breathing and so on.
Each of these talks was given by an expert in the field. You come out of the course feeling much better about how to deal with the disease and enjoy life as much as one could. John felt that, without a doubt, if he hadn't taken the course and received such help from the physiotherapist, then he would not have writing much of his experiences on this web site.
Some people were disappointed that it did not increase their lung function as measured by the FEV1 (mine did. David) but remember that when your lungs have been partially destroyed they will not re-grow. Other people were happy that they could walk through Marks and Spencers without panicking or leaning against a counter panting.
Your muscles will go stronger and use less oxygen and so you will experience less breathlessness. Even if you are on oxygen you can still do the course and benefit from it.
How long does the effect of this course last?
Well if you keep up with the exercises at home or in a gym then as long as the progression of your disease allows you. But if you do not then it can quickly wear off within a year. Often people lose interest and exercise less and less without supervision. Really it is up to you to put into practice what you have been taught on the course and keep it up.
Does everybody get offered P.R.?
Unfortunately not: Your GP may not know anything about it or your local hospital might not run these courses. In this case go to my page on FINDING OUT to find out how to get help and follow the instructions to find your nearest training centre.
My Pulmonary Rehab Course. David's adventures in Salisbury
Part 1. The physical side
I am an octogenarian with COPD. I had heard about the 'Rehab' course from my GP, but did not really know quite what to expect. "It will be great fun", she said.
When I arrived ten minutes early for the first session at Salisbury General I was surprised to see fourteen other candidates already seated in a circle with three gorgeous nurses in attendance. The shock was made worse by the fact that the venue was not in the expected room full of comfy armchairs for elderly patients, but in the gigantic hospital gym with hard plastic seats. Fearsome exercise machines with weights and springs and pedals stood menacingly dotted around the floor. Every flabby muscle in my body trembled at the prospect. What wicked torture have I foolishly let myself in for?
The prospectus had described the various lectures on the course and these are reviewed in Part 2, but there was not much emphasis on anything physical. In my foolish ignorance I had thought I might need to prepare by sharpening up my brain, but never my measly biceps.
Salli, the physiotherapist team leader for the first hour comes bouncing in full of enthusiasm, exuding robust good health and charm. A persuasive lady, but terrifying to a weedy intellectual whose sole energy expenditure over the past year had been finger-tapping a laptop and unloading the dishwasher.
"Now let's start with a few gentle exercises - while we are sitting down". "Help!", said my body – that's a clear threat that I would actually be expected to stand up at some stage – more butterflies in my stomach!
Here we go, alternately lifting left and right foot from the floor - up and down then raising and lowering our arms, twisting our bodies, lifting our heads and lowering them. Occasional pain, yes, but if this is what it's all about, it’s a piece of cake. Why had I bothered to worry at all? But wait !
"Now I want you to stand up. You can hold on to your chair if you need to. You are going to come on a short stroll with me, but standing still all the while. Left right, left right, left right, that's it. Keep going, keep going. Knees up, get 'em up, knees up higher. A bit faster, faster". After strolling for about five hundred miles – or so it seemed - we were allowed to sit again, breath slowly and gently and then repeat the first exercises.
Wow! I had survived the first hurdle, but from past experience of physical activity, my mind suddenly flashed forward. It will be hard to get out of bed tomorrow morning – "Ever the pessimist", says Meg, my wife. "Ever the Boy Scout", say I – "Be prepared". What I was not ready for was the sudden command that broke my forward daydream. "Come on", says Salli "Time to go walkies again". Will this old dog make it? Maybe?
After yet another 500 mile route march – this time struggling across what seemed like going uphill on Seatown's pebble beach – came a repeat of the sitting exercises and there was at last a pause. One minute to gather breath and one's thoughts? No chance – "Now you must repeat all these exercises at least three times a week at home. Off you go to your lecture and a cup of NHS coffee. See you next Monday".
I was in the kitchen next morning making the tea when suddenly I realised that I had slithered out of bed without even remembering that I was supposed to be as stiff as an arthritic old Labrador. Wow again!
Can this really be 'fun', I thought?. A real challenge? Just possible!
Each week the targets set became higher and higher – as did the level of my surprise at being able to go home in one piece. After three months, in the end all of us were happy pulling on rowing machines, lifting weights, riding on stiff bicycles and bouncing kangaroos, playing netball, treading up and down stairs. I could not believe it. Now that I am reasonably fit for my age, let's try mowing the lawn – it's a doddle! Wow again – but spare a thought for those who are not so lucky! I have two legs that work and thank my genes for that.
David Boswell
Website Created by John Kirtley, BA. Edited by Mol Smith and David Boswell B.Sc