Pulmonary Rehabilitation Programme: Introduction, Consent & the PR Course

Introduction

We are delighted that you are able to attend the Pulmonary Rehabilitation Programme. The programme runs for 6 weeks, twice a week., and comprises of a carefully graded exercise programme and a series of educational sessions on topics related to your chest condition.

The aim of the programme is to increase your exercise tolerance and improve your knowledge of your chest condition. This will help you to cope with its related problems. We hope to inspire you to continue the activity and advice beyond the course to help to reduce your symptoms, avoid hospital admissions and live life to the fullest.

This patient information resource is intended to give you some information about the different components of the programme. We hope that you will find it useful whilst you are completing the programme, and as an ongoing resource.

Patient Consent

By booking on this Pulmonary Rehabilitation programme, you are agreeing to:

Attending a 6 week course, consisting of twice weekly attendance for up to 90 minutes and an individual assessment again at the end of the course.

If for any reason I am unable to attend a session I will contact the team on 01234 730331 (please leave your name and group on the answerphone) or email bhn-tr.bedfordrespiratory@nhs.net

I agree not to attend if I have signs and symptoms of an untreated chest infection
I will wait 3 days after commencing antibiotics/steroids before returning
I agree not to attend if I am suffering with diarrhoea or vomiting. I must be symptom free for 48 hours prior to returning
I will carry out the exercises as I have been shown by the team. If I experience any discomfort or feel the exercises need progressing I will consult a member of staff
I will wear suitable loose clothing, flat light footwear and bring a water bottle to sessions (as this will make exercising more comfortable). Please note it is also advisable not to eat a large meal before carrying out the exercise session
I will ensure I bring the following as used:
- Reliever medicine
- Oxygen
- Reading glasses
I am aware that my partner, a carer or a family member is welcome to attend the group, and can fully participate in the educational session but will for their safety observe the exercise session only
I will respect the staff and other attendees on the programme and be supportive and maintain confidentiality of anything shared within the sessions
I will ask questions or raise any concerns I have with a member of the team
If I fail to attend more than 2 sessions without contacting the team I am aware I can be discharged from the programme and my GP will be notified

The Pulmonary Rehabilitation Exercise Session

All people, healthy or otherwise, can benefit from exercise. Indeed there are more complications that can occur from inactivity than from activity.

Exercise can:

Increase your strength
Increase your stamina
Preserve the strength of your bones
Maintain the movement you have in your joints
Help your heart stay healthy
Help your lungs expand and clear any phlegm from your chest
Help with weight control
Improve your sleep pattern
Improve your feeling of wellbeing

The exercise component of the session lasts approximately 60 minutes, and starts with a warm up, which is required for preparing the muscles for the exercises that follow. There is a cool-down at the end which involves a series of gentle stretches, to help with muscle recovery and minimise soreness.

The exercises comprise of both aerobic and strength exercises, broken down into small, manageable sections. The walking distance we ask you to aim for in the session, and the weights you will be using, will be calculated based on your pre-assessment results. An example record sheet can be requested from our staff.

We would like you to record your performance at each session. This includes the number of repetitions you achieve and how breathless you are/how hard you are working. You will use the Modified Borg scale (BORG) to decide how breathless you are for the aerobic exercises, and the rate of Perceived Exertion Score (PES) for how hard you have worked for the strength exercises. These will be familiar to you following the pre-assessment. The target to aim for when exercising is the ‘ideal’/green (in the printed version) range.

The results you record are used to see how you are managing, and the team will check these on a weekly basis to adapt/progress your programme, setting you targets for the week ahead. You may be encouraged to increase the weight you are using for some of the strength exercises and this may mean that your target repetitions go down. This will allow you to adapt to the increase in weight gradually and with better control/technique.

All the exercises prescribed and adapted are individualised for you and if you have any concerns or questions, please ask a member of the team who will be happy to help.

BORG and PES

You will use BORG and PES scales to record your own performance during the exercise:

Breathlessness score (BORG)

3-5 is ideal.

0 – Nothing at all
0.5 – Just noticeable
1 – Very slight
2 – Slight
3 – Moderate
4 – Somewhat hard
5 – Hard
6
7 – Severe
8
9 – Very, very severe
10 – Exhausted, with or without chest discomfort

Perceived exertion score (PES)

13-15 is ideal.

6 – No exertion at all
7 – Extremely light
8
9 – Very light
10
11 – Light
12 –
13 – Somewhat hard
14 –
15 – Hard (heavy)
16
17 – Very Hard
18
19 – Extremely hard
20 – Maximal exertion

Exercise at least 3 times per week

As well as attending the group exercise sessions twice a week, we would like you to complete some exercise at least once a week outside of the sessions to gain the full benefit from the programme. It is also hoped that this will start a new habit of regular exercise that will continue beyond the 6 weeks.

The following are some ideas for the additional exercise session:

Repeat the aerobic exercises you are doing in the group sessions (and the strength exercises if you have the appropriate equipment)
Attend a local exercise class/gym (staff can provide you with more information)
Complete the Asthma and Lung UK Keep Active Programme, via a video online or downloadable exercise sheets
Complete the Bedford Pulmonary Rehabilitation exercise video available using the links below (please ensure you watch part 1 prior to completing part 2)
- Part 1- https://youtu.be/xZnnkEd7cRY
- Part 2- https://youtu.be/6XVhD4HDZOE
Please use the previous scores for evaluating how hard you are working and stop if any of the exercises cause you pain/worsen symptoms and ask a member of the team if you require advice about alternatives

Walking is excellent exercise

In addition to your pulmonary rehabilitation exercise sessions, we would like you to try to walk at least twice a week. Walk on the level, avoiding slopes and stairs. If the weather is too cold or windy, it is better for you to walk indoors instead. Walk at your steady pace, but do stop before your shortness of breath prevents you from being able to talk. You should be able to speak a few words at a time. When you are walking, please take your inhalers with you.

Don’t worry if you can’t manage far to begin with. The more you do, the easier it gets! Gradually increase your distance as you feel able.

You could keep a record of your home exercise and walking sessions. Staff can provide you with a home record sheet or you can use a diary or calendar to track your progress.

Exercise advice

Most athletes when training to become fitter would expect to get breathless doing exercise and you will also find that breathlessness is a feature of your exercise programme. The breathlessness that comes from exercising is a useful sort of breathlessness and if you can think about it in a positive way, it will help with your training. For more information on exercising and its benefits see the Exercise section.

Do

Make time for exercise – treat yourself, don’t rush it
Use your oxygen/inhaler if you need it
Start your walk/exercise feeling relaxed and in control of your breathing

Don’t

Walk/exercise if you feel unwell
Walk/exercise straight after a meal

When you have finished your continual walking or exercises

Expect to feel breathless – you have just done some exercise!
Adopt a good position to aid breathing (Breathlessness section)
Don’t think about slowing your breathing down just yet, but let the air flow in and out through your mouth and nose
When your breathing sounds quieter and feels easier, try some of your breathing control techniques (Breathlessness section)
Let your shoulders relax
Keep control of your breathing – you’re in charge!

1. Elbow Bends – Breathe OUT when you are bending your elbow

In standing with hand down to the side. Holding a weight in your hand, bend your arm up to your shoulder and straight back down.
- More difficult- increase weight
- Less difficult – reduce weight
For 1 minute

2. Sit to Stand – Breathe OUT when you stand up

Stand up and sit down without using your hands. Have feet shoulder width apart for balance.
- More difficult- use a weight or do squats
- Less difficult- use your hands to push up from chair or marching in chair.
For 1 minute

3. Push Offs – Breathe OUT when you push away from the wall

Stand with feet slightly apart and arms length away from the wall. Place your hands on the wall at shoulder height. Bend
and straighten your arms. Keep your body in a straight line.
- More Difficult- feet further away from wall
- Less difficult- complete movement with arms in sitting or standing
For 1 minute

4. Heel raisers – Breathe OUT when you go up onto your toes

In standing push up onto your toes and then go back down. Try not to rock back onto your heels.
- More difficult- not holding or holding weights.
- Less difficult- can be completed in sitting.
For 1 minute

5. Arm Stretch – Breathe OUT when you lift your arm up

Start with weight at shoulder height reach up to ceiling. Control the movement on the way up and the way down.
- More Difficult- heavier weight.
- Less Difficult- no weight or reach forwards and backwards.
For 1 minute

6. Leg Swings – Breathe OUT when take your leg out to the side

Stand with the support of the wall; take one leg out to the side, keeping your standing leg straight. Don’t let your body move.
- Less difficult – Step your foot out to side and back or in sitting lift your leg straight up in front of you and back down again
For 1 minute

7. Forward Lean – Breathe OUT when you go back to sitting up

Bring your bottom to the front of the chair, feet wide apart, hands on your forehead, keep back straight.
Bend forward and back up.
- Less difficult- Reach arms forward and up.
For 1 minute

8. Step Ups – Breathe OUT when you are stepping up

Step up and back down, with alternate legs or same leg or you can change halfway. Hold onto handrail if you need to.
- More difficult- hold a weight.
- Less difficult- marching in sitting
For 1 minute

9. Side Bends – Breathe OUT when you are coming back up

Standing with feet shoulder width apart with equal weight in hands. Down to the side and back to middle. Go down alternate sides. Back to straight and as far as is comfortable.
- Less difficult- no weight or in sitting
For 1 minute

10. Walk – Breathe IN through your nose and OUT through your mouth

Find a safe area or route where you can walk. Use your walking aid if you use one. Or march on the spot.
For 3 minutes

Pulmonary Rehabilitation education

One of the aims of the Pulmonary Rehabilitation Programme is to increase your knowledge of various aspects of your condition. This is done so that you have the information to be able to manage your chest condition and to help you cope with some of the related problems.

At the end of the exercise sessions there will be a short talk and opportunity for discussion on a particular topic. You should be informed by staff as to the topic for the next week. We would encourage you to read through the relevant information in these online resources or watch the video presentation. This will enable you to be able to ask any questions and be involved in relevant topic discussions.

The talks

You may access the online presentations on the main Pulmonary Rehabilitation Service web page under the Bedford Hospital tab – click on the link to the topic you wish to watch.

Please ask a member of staff if you would like all the direct presentation links emailed to you.