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May 1

Breathe better: Understanding pulmonary rehab – Foster’s Daily Democrat

Exercise Programs Comments Off on Breathe better: Understanding pulmonary rehab – Foster’s Daily Democrat

By Dr. Mark Windt

As easy as breathing... is a phrase we frequently hear, but for many of my patients, breathing does not come easy.

As a pulmonologist, I have spent the better part of my career working to find methods and treatments that will improve lung function for my patients and allow them to breathe easier. One treatment that has proven to have remarkable success, with patients suffering from asthma, COPD, and other illnesses, is pulmonary rehab. However, the benefits of targeted, clinically overseen exercise and its success in treating and improving lung conditions, is not widely known. Not that long ago, patients with lung conditions were encouraged to rest and not exert themselves. Now, research shows that lung function can be improved thanks to exercise. Lets talk about the origins and benefits of pulmonary rehab.

A brief history of pulmonary rehab

Up until the 1950s, the prevailing school of thought was that those with lung diseases should rest and save their breath. Children with asthma were advised not to run or play; adults with lung disease were encouraged to rest and live quietly. Exertion can trigger difficulty breathing with some conditions, but not exercising at all has also proven to be harmful. In 1952, Dr. Alvan Barach, a leader in oxygen therapy and a faculty member at Columbia University College of Physicians and Surgeons, was conducting research on COPD and first noted the benefits of an exercise program that was geared to markedly improve the capacity to exercise without oxygen. He likened this program to the training efforts undergone by athletes to improve lung function.

Another 10 years would pass before the first pulmonary rehab program would get underway.

In 1969, Dr. Thomas Petty, an international authority on respiratory disease and professor of medicine at the University of Colorado Health Sciences Center in Denver, launched a program that provided patients with sessions geared toward walking exercise, bronchial hygiene techniques, supplemental oxygen therapy and breathing techniques. The sessions were aided by a personal instruction manual that patients took with them.

What conditions can pulmonary rehab treat?

Currently, pulmonary rehab is being used to successfully treat asthma, COPD, pulmonary fibrosis, interstitial lung disease, lung volume reduction, pulmonary hypertension and bronchiectasis, a condition where the bronchial tubes become permanently damaged, thickened and widened, often because of infection. Pulmonary rehab is also an important tool in aiding people who have had lung cancer or a lung transplant. And, it is being used more and more in the treatment of obstructive sleep apnea more on that later.

In addition, it is important to note that pulmonary rehab can be helpful to people of any age. It does not matter with adults how old or young you are. I have seen successful treatment with many senior patients. People with COPD or pulmonary fibrosis who qualify for rehab can see improvement even if they are in their eighties. No one should give up on trying to improve their ability to breathe better due to age. Pulmonary rehab also works well for patients who have asthma, are fairly healthy, but want to improve lung function. Some asthma patients may already be active, but targeted breathing exercises, such as those found in a rehab program, can improve their breathing and allow them to be even more active.

What are the benefits of pulmonary rehab? As early as Dr. Pettys time, the benefits were clear: Reduced hospitalization, improved exercise tolerance and a faster time frame in returning to work after illness or flare-up. We also notice improved activity levels, better quality of life and greater independence among our patients who have undergone rehab.

Patients with specific conditions also see specific gains. For example, for patients with COPD, exercise strengthens the heart as well as the muscles used for breathing so this can help alleviate shortness of breath. People with COPD tend to limit physical activity because they are fearful of becoming short of breath, but inactivity causes muscle strength and heart health to decline. Pulmonary rehab helps patients maintain physical fitness and regain control of their breathing. They can then pursue activities to the full extent of their abilities.

For patients with asthma, the goal is to help them keep an active lifestyle. Regular exercise can help them maintain control of their asthma symptoms, and reduce the risk of flare-ups, as well as the use of medication. It also boosts the immune system (it is important for asthmatics to avoid flu and other respiratory illness), aids in weight management (being overweight increases the strain on your cardiovascular system), and improves the bodys oxygen efficiency, which leads to improved cardiopulmonary fitness.

People with obstructive sleep apnea share many of the same symptoms and complaints as those diagnosed with COPD and/or asthma. Participants with OSA see an improvement in their capacity for exercise and the activities of daily life. Their balance improves, and they have increased strength in the muscles they use for breathing. An increased ability to exercise, along with a healthy diet, may lead to weight reduction, which is a goal for many with OSA.

How does such a program work? Each exercise program is customized to the participant, providing them with specific exercises based on their individual abilities and personal goals. All participants undergo a cardiovascular fitness assessment, cholesterol evaluation, body composition measurement, and testing of their strength and balance; they also provide a comprehensive medical history and complete lifestyle and fitness questionnaires. These tests are important as they provide a good baseline as to the patients overall health prior to starting rehab.

The program is then designed by a pulmonologist and exercise physiologist, and held in a controlled setting. The Pulmonary Rehabilitation Programs at the Center for Asthma, Allergies and Respiratory Disease run for 90 minutes once a week for eight consecutive weeks. Each session focuses on a different topic, such as balance and mobility, fitness and strength, nutrition, controlled breathing techniques and stress management tools.

All exercise therapy is overseen by a masters degree exercise physiologist who monitors each patients oxygen level, heart rate and blood pressure. In addition to the educational component, each week includes a cardiovascular session with activities such as walking on a treadmill or riding an upright bike. Strength training may include working with lightweight dumbbells or resistance bands. Poor balance is a medical issue affecting numerous people and the pulmonary rehab program specifically addresses this issue with exercise and instruction. Balance training may use stability balls, chair and wall support, and dynamic body movements. If someone is arthritic or has an orthopedic condition or other infirmity, those are taken into account and exercises are modified to accommodate their needs.

What are some of the challenges?

One of the challenges facing pulmonary rehab is getting patients to continue with the program once they graduate. Joining a medically-affiliated fitness center can help, as can online support groups. Telemedicine may also be a good tool. Being able to access instruction and advice via computer allows people to exercise in their homes but still be able to check in with a professional if they have questions or need encouragement. Telemedicine is also a good way to help people in rural areas maintain their programs.

Another challenge is the educational factor. We still need to make more people aware that pulmonary rehab can potentially help their conditions, and also make more doctors aware so that they can refer patients for pulmonary rehab.

Where is pulmonary rehab headed?

I think you are going to see the benefits of pulmonary rehab continue to expand. I started my pulmonary rehab program at CAARD seven years ago. It was designed as an outpatient program to improve health benefits for COPD patients, asthmatics, and those with obstructive sleep apnea. A few years later, the American Thoracic Society recommended asthma as a condition that would benefit from pulmonary rehab (previously, it had only looked at COPD). Ive been doing research on the benefits of pulmonary rehab to those with OSA for some time, and am hoping that with the publication of that research, the ATS will add OSA as another condition where pulmonary rehab can make a difference.

I think it's important to remember that the body likes to be active. There are few conditions that do not improve if the body is allowed to be active in some fashion. In fact, studies have shown that one of the key markers of longevity is how physically active you are. You may be battling a serious illness or condition, but if you are still able to be up and about and get in some form of exercise, then you have a greater chance at maintaining quality of life and living longer.

If you are interested in learning more about pulmonary rehab and whether it might help you or a family member, contact CAARD at 964-3392 for a consultation.

Dr. Mark R. Windt is an allergist, immunologist and pulmonologist who has been treating allergies, including food allergies and respiratory illnesses, for more than 30 years. He is the medical director for the Center for Asthma, Allergy and Respiratory Disease in North Hampton, NH, a facility he started in 1985. Dr. Windt is also an adjunct professor at the University of New Hampshire's School of Nutrition and founder of the Probiotic Cheese Company (www.theprobioticcheesecompany.com). For information, visit http://www.caard.com or call 964-3392.

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Breathe better: Understanding pulmonary rehab - Foster's Daily Democrat

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