EHR519 Lecture Notes - Lecture 14: Exercise Prescription, Shortness Of Breath, Chronic Obstructive Pulmonary Disease
1. Week 14 – Exercise Training Prescription for
Pulmonary Disease Clients
Exercise Prescription and Pulmonary Disease
The primary symptom of pulmonary disease, dyspnea, should occupy the key central focus of exercise
prescription.
Clients with pulmonary disease often present in a state that illustrates that they are anxious, scared,
frustrated and depressed.
Dyspnea and any recent exacerbations of their disease often precede their referral and are
present/limiting in initial EP interaction and adherence.
Reducing stress and appropriate pharmacological management are critical in encouraging a pulmonary
disease client to take the first steps in their “new” approach to exercise.
You need to know current (or very recent) FEV1.0, FVC and PEFR data as this will assist intensity and work:
rest interval parameters.
You must ensure that you know their pharmacological treatment history and current details when
prescribing exercise. This includes:
SABA, LABA, LAMA or ICS usage (may be useful to know when performing split sessions)
Dose-and-response (i.e. are they responding to applied dosages; how long turn-around)
Reversibility/irreversibility (i.e. extent of my indicate optimal times to exercise)
Timing in relation to daily activities and planned exercise (help plan out ExRx and ADLs)
Pharmacological Intervention: COPD
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Pharmacological Intervention
COPD: symptoms (cough, wheezing, sputum) are treated accordingly with pharma; often comorbid with
CVD; diuretic used for excess fluid from pulmonary congestion;
Asthma: SABA (albuterol) and LABA (salmeterol) are prescribed isolated + combined;
ILD: atrovent (ipratropium), Spiriva (tiotropium), “open” airways may relieve bronchospasm.
Bronchiectasis: any bronchodilator use may help “open” airways and loosen sputum plug
Dyspnea Assessment
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Exercise Prescription in COPD and ILD
END:
Modality: walking, cycling, rowing, cross-training are options. In the order listed (easiest to
hardest), these modalities promote challenge, but also dyspnea.
Given often weak respiratory musculature, upper extremity exercise (i.e. cross-trainer, arm
ergometry, circuit-type exercise) may exacerbate dyspnea.
Frequency: 3-5 days per week, depending upon level of conditioning, exacerbations,
accompanying modalities (i.e. RES or ROM exercise).
Duration: minimum of 20 mins, focus on working up to this and then beyond (45 – 60 mins may
be ceiling/optimal with results unlikely to be better beyond).
Intensity: HR is underestimated in COPD clients; HR zones may be erroneous.
Intensity (Option 1): >50% VO2peak equates to dyspnea (Borg) scale reading of 3. Dyspnea
reading of 6 usually equates to 85% VO2peak; most clients will have a metabolic threshold well
below healthy individuals (e.g. 40-60% VO2peak), so aiming to have them exercise at a scale
reading of 3-4 will likely be achievable.
Intensity (Option 2): train at near-maximal or maximal levels (relative to stress test results); due
to low condition, any exercise at upper intensities will assist. CV system is usually not limiting in
COPD; thus aim to challenge respiratory system.
You have a client with pulmonary fibrosis who has a resting dyspnea rating of 3. Which of the below initial
exercise prescriptions is appropriate for endurance exercise?
10 cycles of walking for 1 minute at 3 km/h with 1 minute rest intervals between
10 cycles of walking for 1 minutes at 3 km/h with 2 minute rest intervals between OR
10 cycles of walking for 1 minute at 5 km/h with 1 minute rest intervals between
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Document Summary
Week 14 exercise training prescription for. The primary symptom of pulmonary disease, dyspnea, should occupy the key central focus of exercise prescription. Clients with pulmonary disease often present in a state that illustrates that they are anxious, scared, frustrated and depressed. Dyspnea and any recent exacerbations of their disease often precede their referral and are present/limiting in initial ep interaction and adherence. Reducing stress and appropriate pharmacological management are critical in encouraging a pulmonary disease client to take the first steps in their new approach to exercise. You need to know current (or very recent) fev1. 0, fvc and pefr data as this will assist intensity and work: rest interval parameters. You must ensure that you know their pharmacological treatment history and current details when prescribing exercise. Saba, laba, lama or ics usage (may be useful to know when performing split sessions) Dose-and-response (i. e. are they responding to applied dosages; how long turn-around)
