1998 OPEN FORUM Abstracts
'DEVELOP THE EXERCISE PRESCRIPTION'
Julien M. Roy, BA, RRT
Exercising patients with chronic obstructive pulmonary diseases (COPD) has always been the subject of controversies in the past years. The importance of an exercise training program cannot be overemphasized in any pulmonary rehabilitation program. But before a safe program can be established, a thorough assessment needs to be done to dedect exercise hypoxemia, to assess the need for supplemental oxygen during training, and to evaluate cardiac function. The well-documented benefits of exercise training include increased tolerance for dyspnea, improved appetite, increased physical capability, and an improved quality of life. Exercise is one of the essential components of a comprehensive pulmonary rehabilitation program.
A variety of training methods have been used successfully in pulmonary rehabilitation. Emphasis on improving endurance through progressive training to symptom limits. It is important to start severely disabled patients at relatively low exercise levels and increase them as tolerated in small increments to build the patient's confidence and endurance.
In determining the proper exercise prescription for the patient with hypoxemia, an accurate evaluation of oxygen needs is necessary. The basic components of an exercise program are:
* Duration * Frequency * Intensity * Mode
The duration of an endurance exercise session is typically set at a goal of 30 to 40 minutes of continuous activity plus warm-up and cool-down periods, including stretching. Many patients start training for shorter periods and progress as tolerated. This allows them to gain confidence, improve their self-efficacy, and work toward their goals.
Exercise frequency should be a minimum of 3 days per week, for a training effect to be reached and maintained. During exacerbations, patients should be instructed to reduce their exercise program as tolerated until they recover.
Pulmonary rehabilitation programs have used different approaches to intensity for exercise training. Some use a target heart rate (THR), other use symptom-limited targets(e.g., a target level of perceived breathlessness). During exercise training sessions, minimum routine patient monitoring should consist of heart rate and dyspnea level. Oximetry and blood pressure should also be monitored.
A variety of exercise training modalities have been used successfully in pulmonary rehabilitation. The most common are walking, treadmill, cycling, upper body ergometer, and weight training. One of the greatest benefits of exercise conditioning is to allow patients to do more work for any given oxygen consumption, patients become more efficient, while increased muscular strength and endurance enable them to accomplish more. As a great result, patients can better tolerate activities of daily living.
The 44th International Respiratory Congress Abstracts-On-Disk®, November 7 - 10, 1998, Atlanta, Georgia.