Assignment- Indications for Cardiopulmonary Exercise

Learning Objectives Covered

1. Explain the rationale for exercise conditioning and psychosocial support of patients with chronic pulmonary diseases
2. List and describe the indications for cardiopulmonary exercise testing for evaluation of hypoxemia and desaturation
3. Identify and interpret parameters measured during cardiopulmonary exercise testing

Background

Medical therapy is important in alleviating symptoms of chronic obstructive pulmonary disease (COPD), particularly the frightening symptom of dyspnea (breathing that is labored making it difficult). However, patients are still left to cope with the consequences of a chronic, irreversible condition. These individuals who are often: dyspneic, depressed, dysfunctional, disabled, desperate, and difficult to deal with often visit physician's offices, emergency departments and hospitals in part because of their inability to cope with their distressing symptoms. Pulmonary rehabilitation programs must incorporate a program with physical and psychological components to assist the patient in returning to the highest level of independent function.

Psychological, emotional and social issues are common among patients with chronic lung disease as they struggle to deal with symptoms that are often poorly understood. Those diagnosed with chronic lung disease often experience depression, fear, anxiety, and dependency. Dyspnea is a frightening symptom! When experiencing dyspnea upon exertion, many patients prefer to reduce their exercise, which leads to more anxiety, which aggravates the dyspnea, and the patient becomes caught in a cycle. In extreme cases, the patient can become housebound.

Subsequent hospital visits follow patients who do not have social support. Therefore, when assessing a patient for cardiopulmonary rehabilitation we must include an assessment of the patient's: psychological state, cognition, family and social support, activities of daily living and employment history. Identifying key support individuals is paramount. Many programs also measure baseline dyspnea and health-related quality of life at the time of enrollment and at the time of follow-up.

Common Goals of a Pulmonary Rehabilitation Program

• Controls of respiratory infections
• Basic airway management
• Improvement of ventilation and cardiac status
• Improvement in ambulation and other types of physical activity
• Reduction of overall medical cost
• Reduction of hospitalization
• Psychosocial retaining and replacement
• Family education, counseling and support
• Patient education, counseling and support

Program Design Format

• Opened ended design-this format allows patients to enter the program and progress through until predetermined objectives are met. This format is best suited for self-directed patients or patients with scheduling difficulties. Major drawback is the lack of group support and involvement.

• Closed designed-this format is more traditional with a set time period to cover content of the program. A typical program run 6-16 weeks, with classes meeting 1-3 times a week. All sessions are formal and group support and involved are encouraged. A major drawback to this format is that the schedule and not objectives determines program completion.

Content

The program will combine physical reconditioning and educational content. The education portion of the program is necessary and an especially important part of the pulmonary rehabilitation program. There are twelve typical education topics for a program.

• Introduction and welcome
• Respiratory structure, function, and pathology*
• Breathing control methods*
• Relaxation and stress management
• Proper exercise techniques and personal routines*
• Methods to aid secretion clearance (bronchial hygiene)*
• Home oxygen and aerosol therapy*
• Medications
• Use of MDI's and spacers*
• Dietary Guidelines
• Recreation and vocational counseling
• Planning for the future

The educational topics with an * are typically taught by a registered respiratory therapist.

Physical Reconditioning

The physical reconditioning will consist of an exercise prescription with a target heart rate based on the initial exercise evaluation. The prescription usually includes:

• Lower extremity (leg) aerobic exercises
• Time walking (6 or 12 minute walk)
• Upper extremity (arm) aerobic exercises
• Ventilator muscle training

Program Implementation

• Staffing-should be multidisciplinary involving various health care professionals involved in the planning, implementation, and evaluation of the program. It is recommended that staff members be certified in basic life support or advance cardiac life support.

• Facilities- the quality and location of the program is directly related to patient's attendance. Patients are more likely to attend if they have access to public transportation and parking arrangement.

• Scheduling-timely scheduling of the session, usually three times a week for 1-2 hours. The length of the program is often projected by insurance coverage.

• Class size-the ideal size of a group should range from 3-10 participants.

Watch the video below on Pulmonary Rehabilitation and Exercise (Total time 38:17 minutes). This video will provide you with an understanding of how patients are instructed on exercise and fitness to promote a healthier life with pulmonary disorders.

Youtube Video: "Pulmonary Rehab: Daily Fitness & Exercise"

Prompt

Choose three of the asterisked rehabilitation education topics above. These topics are based on the information covered during a 12-week rehabilitation program as outlined in your reading. Based on the program outlined in your reading, explain how you would teach the information to a patient participating in the pulmonary rehabilitation program. Be creative!

Submit your answers in at least 500 words on a Word document. You must cite at least three references in APA format to defend and support your position.

Proceed to the remaining item for week two when you are ready.