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Exercise Prescription for COPD

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... Inspiratory reserve volume Tidal volume Expiratory reserve volume Vital capacity Functional residual capacity VT EELV EILV IRV ERV Mild COPD Healthy ... – PowerPoint PPT presentation

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Title: Exercise Prescription for COPD


1
Exercise Prescription for COPD Asthma
  • Dr. Roland Leung
  • MBBS MD FRACP FCCP FHKCP FHKAM(Medicine)
  • Specialist in Respiratory Medicine

2
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100
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FEV1??(??25????)
75
45???
???COPD??
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0
50
75
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12
Airflow Limitation in COPD Hyperinflation and
Exercise
13
Review of Terminology
Total lung capacity
Residual volume
14
Tidal Volume at rest
Breathing frequency at rest 12 15 / min
Inspiration
IRV
EILV
VT
Healthy
Mild COPD
Severe COPD
EELV
ERV
Healthy subjects breathing rest time
Expiration
COPD patients less breathing rest time
15
Dynamic Hyperinflation
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To the COPD patient, this is a breathtaking view.
18
Clinical Course of COPD
COPD
Expiratory Flow Limitation
Air Trapping
Hyperinflation
Breathlessness
Inactivity
Deconditioning
Reduced Exercise Capacity
Poor Health-Related Quality of Life
Disability
Disease progression
Death
19
Effect of Exercise on Dyspnea
Dyspnea Intensity (Borg Scale) Very
severe Severe Somewhat severe Moderate Slight Ver
y slight None at all
End-exercise
Exercise Stops
Exercise time
Isotime
Pre-exercise
20
Relieves patients breathlessness during
physically demanding exercise
SPIRIVA reduces activity-induced breathlessness
by 19 (Plt0.001)
21
SPIRIVA increases exercise endurance time
Exhibited 42 difference in mean exercise
endurance time
22
Pulmonary Rehabilitation
  • This is the process of maximising the patients
    physical , mental and social wellbeing by an
    individualised program of exercises and education

23
Why PR?
  • All COPD patients benefit from exercise training
    programs.
  • Improvement in both exercise tolerance and
    symptoms of dyspnoea and fatigue.
  • Evidence to show reduce exacerbations and
    hospital admissions.

BTS GOLD
24
Pulmonary Rehabilitation
  • Ideally Comprises of
  • Exercise
  • Empowerment
  • Diet
  • Psychological well-being

25
PR Exercise
  • Supervised training 2 - 5 times per week
  • Minimum 20 - 30 minutes each time (may take a
    time to reach this level)
  • Course duration of 4 - 12 weeks
  • It should involve both upper lower limb
    exercises both for endurance and strength

26
Components of Exercise Prescription
  • Mode (Type of exercise)
  • Intensity
  • Duration
  • Frequency
  • Progression of Exercise Programme

27
PR Exercise
  • STRETCHING of the major muscle groups of both
    upper and lower extremities.
  • AEROBIC EXERCISES e.g. walking, cycling, rowing,
    swimming, etc.
  • FREQUENCY - is 2 to 5 times per week with aim of
    daily routine.
  • INTENSITY- maximum limit tolerated by symptoms
    or to 60 to 75 of maximal heart rate
  • DURATION - 20 to 30 min of continuous exercise OR
    if this is not possible, interval training two
    to three min of high-intensity training
    alternating with equal periods of rest.

28
PR Diet
  • COPD can be adversely affected if the patient is
    malnourished or overweight. The former leads to
    muscle bulk loss (diaphragm accessory muscles
    of respiration) and the latter an extra burden on
    the cardio-respiratory system

29
SPIRIVA demonstrates superior improvements in
breathlessness post rehab
Combined rehab with SPIRIVA results in extended,
superior outcomes in breathlessness compared with
rehab alone
Casaburi, et al Chest 2005
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35
EIA in Children Scope of the Problem
Children with asthma About 20 have asthma
symptoms only during exercise
More than 80 have EIB
  • EIB may interfere with physical activity and
    personal morale.

Adapted from American Lung Association. Available
at http//www.lungusa.org/site/pp.asp?cdvLUK9O0E
b22782 Randolph C Curr Probl Pediatr
1997275377.
36
Diagnostic Criteria for EIA
Coughing, wheezing, or shortness of breath with
exercise
10 to 20 decrease in FEV1
Relief of airway obstruction with exercise after
use of inhaled beta2-agonist
After 5 minutes of exercise at 8590 of
maximum Adapted from Gotshall RW Drugs
20026217251739.
37
Possible Role of Cysteinyl Leukotrienes in EIA
Exercise/activity andother triggers
  • Mast cell mediators
  • Leukotrienes
  • Histamine
  • Prostaglandins

Bronchospasm
Inflammation
Airway obstruction
Adapted from Gotshall RW Drugs 20026217251739
Randolph C Curr Probl Pediatr 1997275377.
38
Possible Therapeutic Options for EIA
Agents Effective in EIB No development of tolerance Dosing notrequired immediately before exercise
Inhaled SABAs ? X X
LABAs ? X ?
ICS ? ? ?
LTRAs ? ? ?
SABAs short-acting beta2-agonists LABAs
long-acting beta2-agonists ICS inhaled
corticosteroids LTRAs leukotriene receptor
antagonists May require combination
therapy Adapted from Gotshall RW Drugs
20026217251739 Hancox RJ et al Am J Respir
Crit Care Med 200216510681070.
39
Exercise Prescription for Asthmatics
  • Make sure the underlying asthma is
    well-controlled
  • exercise is not recommended during exacerbation
  • Pre-medication before exercise is essential
  • confidence
  • self assurance
  • Adequate warm-up
  • Educate the parents and caregivers
  • anxiety
  • Exercise most suitable for asthmatics
  • swimming
  • slow jogging

40
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