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What Is Pulmonary Rehabilitation?
When you have a lung condition like chronic obstructive pulmonary disease, or COPD, performing daily activities such as walking or climbing stairs can be challenging. Following a pulmonary rehabilitation program may improve your symptoms and quality of life. COPD is a group of progressive lung diseases that includes emphysema and chronic bronchitis, and it is the sixth leading cause of death in the United States.
When you have COPD, air gets trapped in your lungs, causing symptoms like difficulty breathing, a chronic cough, wheezing, and fatigue. Participating in a pulmonary rehabilitation program can reduce symptoms of breathlessness, improve your physical function, and reduce hospitalizations over time.
Pulmonary rehabilitation is a therapeutic medical program that uses exercise, education, and specialized techniques to improve breathing and quality of life in someone with a chronic lung disease.
The program helps you build strength in the muscles you use to breathe, so you can breathe easier. You’ll also receive guidance on how to adopt lifestyle habits and find support for your mental health through counseling and support groups. Your healthcare team may include doctors, nurses, physical and respiratory therapists, and dietitians, all of whom tailor your pulmonary rehabilitation program to your preferences, symptoms, and abilities.
Anyone with a chronic lung disease can benefit from pulmonary rehabilitation. Those with the following lung conditions are often referred to a program:
While pulmonary rehabilitation was first developed for people with late-stage lung disease, it is now considered beneficial for people at any stage of chronic lung disease — mild, moderate, or advanced. Sometimes healthcare providers also recommend pulmonary rehabilitation before and after lung surgery or transplantation to strengthen the lungs in preparation for surgical recovery and to aid in recovery through chest expansion, keeping the lungs clear through effective coughing, and training the muscles around your ribcage to pull in air efficiently.
When you have a chronic lung disease, the muscles you use to breathe, such as your diaphragm and intercostal muscles (the muscles between your ribs), can get weak, which makes it hard to breathe and move around. This lack of activity makes your muscles even weaker, which perpetuates a cycle that can worsen your symptoms.
Pulmonary rehabilitation helps to reverse this cycle by gradually increasing your muscle strength, allowing you to take deeper breaths and participate in more daily physical activity.
When you begin pulmonary rehabilitation, your healthcare team will do a few tests to see how well your lungs are doing. For example, an exercise stress test measures your oxygen level, heart rate, and other vital signs to inform your team how well your lungs work. Another test — the six-minute walk test — measures how far you can walk in six minutes, informing your health team how much exercise you can tolerate.
Pulmonary rehabilitation can take place at home, in a hospital, or in a clinic. You can work on your own with a clinician, or in a group setting. But wherever you go for pulmonary rehabilitation, your program will include education, exercise, and possibly dietary advice and mental health counseling.
Education
The program will teach you breathing techniques and ways to help you avoid lung exacerbations and get your breathing back on track if it gets too hard.
Lung Function You will learn more about your condition, its symptoms, and how to take your medications, spot flare-ups, quit smoking, and manage your daily tasks.
Oxygen Monitoring If you use oxygen at home, your provider will teach you how to monitor your oxygen levels and use your oxygen tank or concentrator (a machine that transforms the air around you into concentrated oxygen).
Breathing Techniques Certain breathing methods can help you control your breaths and breathe easier. These include pursed-lip breathing, box breathing, and diaphragmatic breathing. You may also learn techniques to keep your airways clear, like using the “huff cough” method, a coughing technique in which you cough with less force, keeping mucus from getting trapped.
Knowing how to loosen mucus with a positive expiratory pressure (PEP) device or vibrating vest or by moving into a position that helps your lungs drain can help prevent and treat flare-ups.
Counseling
Mental health issues like depression and anxiety can sometimes occur in people with long-term lung disease. For example, people with COPD and mental health disorders experience more acute exacerbations, more frequent readmissions to the hospital, and a higher risk of mortality than those without these conditions. As a part of pulmonary rehabilitation, counseling can help you work through these issues and manage your stress.
Nutritional Support
When it’s harder to breathe, your body may burn up to 10 times more calories than someone with healthy lungs. Because of this, your nutritionist may recommend increasing or limiting certain foods. If you’re underweight, you can add calories to your diet by adding healthy fats like peanut butter to meals and snacks or stirring a spoonful of olive oil into your hot foods. If you’re overweight, your nutritionist may recommend eating fewer calories each day and adding more exercise to your routine.
In general, they may also suggest consuming more protein and fewer carbohydrates, and eating smaller meals, to help you gain muscle mass.
Exercise
Your healthcare provider will guide you through exercises that will help you build strength over time. Aerobic and strengthening exercises are generally part of the program, as are positioning and flexibility. For example, some positions can help relieve shortness of breath, like the tripod position, in which you sit with your knees apart and lean forward with a hand on each knee. Depending on your needs and activity level, your provider may help you:
- Do stretching exercises
- Train your respiratory muscles with a breathing device
- Use a stationary bike or treadmill
- Strengthen your upper body and abdominal muscles using weights or resistance bands
Most pulmonary rehabilitation programs prescribe two to three sessions a week for 4 to 12 weeks. Your healthcare team will monitor your breathing throughout and make adjustments to the frequency and length of your program.
Pulmonary rehabilitation offers a long list of benefits for anyone with chronic lung disease. For instance, research shows that people who started pulmonary rehabilitation within three months of hospital discharge for COPD had a much lower risk of mortality after a year.
When you follow the long-term plan laid out for you by your healthcare team, you may notice:
- Breathing comes easier
- Increased strength
- Fewer symptoms of anxiety or depression
- More energy
- Fewer flares and hospitalizations
- Better ability to participate in hobbies and interests
- The ability to walk longer and further
After you’ve finished the program, you may see the best results if you continue doing the exercises and make them a part of your normal routine.
Pulmonary rehabilitation can pose a few risks, although they are very rare. If you’re feeling weak, you could be at risk of falling or muscle injury during physical activity. If you have a heart condition, exercise can prompt cardiac issues like arrhythmias. But complications like this are rare because each pulmonary rehabilitation program is designed around your specific health issues and abilities. In addition, all exercise is highly monitored, so if your breathing gets worse during a session or any other complications arise, your rehabilitation team will stop and address the problem immediately.
If your breathing worsens at home, or you feel you have injured yourself, stop what you’re doing and call your healthcare provider.
To enroll in a pulmonary rehabilitation program, talk to your healthcare provider. They can direct you to a specialist as needed or refer you to a program.
To find a program near you, contact the American Lung Association or the American Association for Cardiovascular and Pulmonary Rehabilitation (AACVPR). Make sure that any programs you consider are run by healthcare providers with experience in chronic lung conditions.
Cost can vary greatly depending on where you live, but many insurance providers at least partially cover pulmonary rehabilitation. Medicare covers the cost of the program for COPD if you meet certain criteria and may cover it for other lung conditions, depending on where you live. You or someone from your healthcare provider’s office can contact your insurance provider for more details.
Pulmonary rehabilitation is a provider-led program that uses exercise, education, and specialized techniques to help people with chronic lung disease breathe easier and improve their quality of life. The program can help people improve breathing and increase strength, as well as reduce fatigue, exacerbations, and number of hospital admissions. If you have any questions about starting a program, talk with your doctor.
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