East Cheshire Physiotherapy Service

What is Pulmonary Rehabilitation?

When you have a long term lung problem you can find it difficult to move around or do your normal activities without getting breathless. Pulmonary rehabilitation is designed to help you cope with your breathlessness and feel stronger and fitter at the same time.

Due to the current pandemic, you may be unable to attend a face to face pulmonary rehabilitation programme, so this is an online resource that you can use.
It includes a series of educational topics and a guide to a six week course of a gentle exercise programme for you to follow. There are also links to reputable websites with advice on lung health and how to cope with breathlessness and helping to clear your lungs.

Pulmonary Rehabilitation is about helping you take control of your condition. It is not a cure but you will feel better and in more control. Using the information provided you can increase your awareness of your condition and what can help alongside improving your ability to exercise.

The exercises are carefully designed for people with chest problems. It includes exercise at 3 levels, included in the British Lung Foundation video. There is step-by-step aerobic and strength training exercises, as well as how to warmup before you start, and cool down at the end.

It is advisable to follow the programme in order starting with week 1 and each week viewing the educational component of the programme followed by guided exercise. The exercises should be completed daily.

Week 1 – The Benefits of Exercise & Breathlessness Management 

This week the information provided takes you through the benefits of exercise & breathlessness management.

Education: Benefits of exercise & breathlessness management

The BORG scale relates to how breathless you should be feeling on exercise

This useful link guides you through 4 videos on breathlessness & panic.
www.stchristophers.org.uk/videos/managing-breathlessness

The breathing rectangle is a useful tool to use to try and control your breathing when you are breathless.

Week 1 Exercise
There are two options for the exercise component. East Cheshire NHS Trust have an exercise programme that is followed as part of the face to face sessions, which are in the format of pictures or alternatively can access The British Lung Foundation website exercise video which will take you through a series of exercises including a warm up and cool down.

You can choose to complete level 1,2 or 3 based on your ability.

Take some time to look through or watch the exercises within this section before commencing them.

It is important that you use the BORG scale to monitor the level you are working at and to take rests as needed between the exercises.
To get the most benefit from this, the exercises should be completed daily.

Week 2 – How The Lungs Work and lung conditions

This week the information provided takes you through how the lungs work and explains COPD and other respiratory conditions

The information provided on the British Lung Foundation website covers the below topics.

About your lungs

Why do you breathe

Oxygen and blood

What else the lungs do?

Respiratory Conditions

COPD:

  • COPD is an Umbrella term which incorporates chronic bronchitis, emphysema & asthma. This is a group of lung conditions that can make it difficult to empty air out of the lungs.
  • It is diagnosed by spirometry. You should have yearly assessments to monitor your condition by a health professional.
  • Common symptoms are shortness of breath, wheeze & cough, due to narrowed airways.
  • Patients will most likely be over the age of 35 and will or have been a smoker, but also occupational exposure to asbestos, car fumes & chemicals & genetic history can contribute.

The different conditions:

  • Chronic bronchitis – persistent cough producing sputum for at least 3 months per year for 2 consecutive years. There is an increase in the size and number of goblet cells which produce mucus. Smoking can reduce the cilia, small hairs that line your breathing tubes, affecting the clearance of this mucus. Patients can produce thick blobby sputum.
  • Emphysema – affects the alveoli. The alveoli can breakdown causing a reduced surface area for gas exchange. Associated with a dry cough.
  • Chronic Asthma – allergies like hayfever, dust, pets, perfume. Narrowing of the airways which cause increased turbulence of air creating a wheeze. Often clear stringy sputum.
  • Pulmonary Fibrosis - pulmonary fibrosis (PF) means scarring in the lungs. But, pulmonary fibrosis is more serious than just having a scar in your lung. In PF, the scar tissue builds up in the walls of the air sacs of the lungs, and eventually the scar tissue makes it hard for oxygen to get into your blood. Low oxygen levels (and the stiff scar tissue itself) can cause you to feel short of breath, particularly when walking and exercising.
  • Bronchiectasis – chronic dilation of one or more bronchi, persistent cough and sputum may be a problem.


Week 2 Exercise
Please continue with your exercises this week, as you did in week 1, accessed via the below resources.

East Cheshire NHS Trust have an exercise programme that is followed as part of the face to face sessions, which are in the format of pictures or alternatively can access The British Lung Foundation website exercise video which will take you through a series of exercises including a warm up and cool down. You can choose to complete level 1,2 or 3 based on your ability.

It is important that you continue to use the BORG scale to monitor the level you are working at and to take rests as needed between the exercises.
To get the most benefit from this, the exercises should be completed daily.

Week 3 – Chest Clearance Techniques

This week, the information provided explains different techniques to help chest clearance and the importance of clearing your chest. 

Sputum Clearance
Sputum or phlegm as some may know it is what you cough up from your chest.

One of the symptoms of COPD is that you may produce more sputum/phlegm than usual and this can result in increased coughing. This is the body’s way of trying to clear the sputum/phlegm from your lungs.

It will be more difficult to clear phlegm if you are:

  • Dehydrated
  • If you have an infection (This can lead to increased thick, sticky secretions/phlegm)
  • If you have a poor or ineffective cough.

So what might aid sputum clearance?

  • Hydrate – recommendation is to drink 2 litres of water a day.
  • Humidify – steam inhalation i.e. bowl of steaming water with towel over your head. Inhaling warm water particles can be helpful.
  • Nebulise – Saline nebs. Not recommended to use regularly at home as this will be what the hospital will use on admission with an acute exacerbation. However your GP surgeries or the Integrated Respiratory team might loan one out to you if you are unwell to prevent hospital admission.
  • Medication – carbocisteine/mucodyne (if you have a chronic productive cough it may be worth an 8 week trial). You can discuss this with your GP.
  • Exercise/movement/mobility/positional changes. Will all help to aid mucus clearance.

Active Cycle of Breathing Techniques (ACBT)
Is a very useful breathing exercise to aid clearance of secretions.  Please click here for guidance on this procedure.


Other aids for sputum clearance
Some GP’s may prescribe or you may have to self-purchase.

  • Flutter – creates vibrations in the airways. Could try with a straw and glass of water, blowing bubbles! Bubble PEP information is attached. (Positive Expiratory Pressure).
  • PEP – forces air through collateral channels and behind the secretions. You could practise blowing up a balloon.
  • Acapella – Provides a combination of the two.
  • Postural drainage – Using gravity to aid drainage of secretions. Can be used in conjunction with ACBT.

How to recognise an acute exacerbation:

Do you have a change in your normal symptoms?

  • Symptoms are usually an increase in coughing, change in the colour of sputum & increase in breathlessness.

Do you have a sputum pot at home? Send sample ASAP. Rescue pack of antibiotics and steroids at home can be helpful, to start treatment early. 


Week 3 Exercise
Please continue with your exercises this week, as you did in week 2, accessed via the below resources.

East Cheshire NHS Trust have an exercise programme that is followed as part of the face to face sessions, which are in the format of pictures or alternatively can access The British Lung Foundation website exercise video which will take you through a series of exercises including a warm up and cool down. You can choose to complete level 1,2 or 3 based on your ability.

It is important that you continue to use the BORG scale to monitor the level you are working at and to take rests as needed between the exercises.

To get the most benefit from this, the exercises should be completed daily.

Week 4 – Energy Conservation & Relaxation

The week, the information provided explains about energy conservation and relaxation and how this can help you manage your condition and symptoms.

Energy Conservation
What do we mean by energy conservation?  Simply put it is a need to balance exercise with conserving energy. We all have a certain amount of energy for the day. We can make sure we have enough by following some simple advice.

The three P's:

  • Planning (break tasks down into smaller tasks)
  • Prioritising (doing the most important job first, delegating other tasks if able to)
  • Pacing (rate at which we work. To ensure we stay in control of our breathing)

Posture & positioning will play a part too.

For example a perching stool to allow you to sit down to perform tasks will save energy.

It is useful to recap on the relaxation positions discussed in week one and remember to use breathing control & the breathing rectangle..

Relaxation
Finding space and time to practise relaxation can be helpful for chronic respiratory conditions. It can be useful to practise when calm and may help if you become breathless or panicky.

There are different types of relaxation.

Click here for a short guided relaxation exercise www.stchristophers.org.uk/video-exercise-relaxation


Week 4 Exercise
Please continue with your exercises this week, as you did in week 3, accessed via the below resources.

East Cheshire NHS Trust have an exercise programme that is followed as part of the face to face sessions, which are in the format of pictures or alternatively can access The British Lung Foundation website exercise video which will take you through a series of exercises including a warm up and cool down. You can choose to complete level 1,2 or 3 based on your ability.

It is important that you continue to use the BORG scale to monitor the level you are working at and to take rests as needed between the exercises.

To get the most benefit from this, the exercises should be completed daily.

Week 5 – Nutrition for COPD

This week provides information about the importance of your diet if you have a chronic respiratory condition.

What we eat affects our health. Good nutrition is important for everyone, and it’s especially important if you have COPD. Food is the fuel your body needs in order to perform all activities, including breathing.

Click here for further information.

Week 5 Exercise
Please continue with your exercises this week, as you did in week 4, accessed via the below resources.

East Cheshire NHS Trust have an exercise programme that is followed as part of the face to face sessions, which are in the format of pictures or alternatively can access The British Lung Foundation website exercise video which will take you through a series of exercises including a warm up and cool down. You can choose to complete level 1,2 or 3 based on your ability.

It is important that you continue to use the BORG scale to monitor the level you are working at and to take rests as needed between the exercises.

To get the most benefit from this, the exercises should be completed daily.

Week 6 – Moving on

As you have now completed the five week program, you will hopefully have more information to help you in managing your condition.

To see continued benefit and sustained improvements it is important to carry on with your exercises and the skills learnt throughout the last 5 weeks.

Your health professional can refer you onto your local Everybody Leisure Centre where you can access specialist COPD gym classes.  Or you can continue with the exercise video & home exercise sheet if you wish.

Week 6 Exercise
Please continue with your exercises this week, as you did in week 3, accessed via the below resources.

East Cheshire NHS Trust have an exercise programme that is followed as part of the face to face sessions, which are in the format of pictures or alternatively can access The British Lung Foundation website exercise video which will take you through a series of exercises including a warm up and cool down. You can choose to complete level 1,2 or 3 based on your ability.

It is important that you continue to use the BORG scale to monitor the level you are working at and to take rests as needed between the exercises.

To get the most benefit from this, the exercises should be completed daily.