Exercise and Pulmonary Rehabilitation

1. Exercise and Pulmonary Rehabilitation Lynn Sieben RPFT Pulmonary Rehabilitation Program University of Minnesota

3. Physical Activity“Lifestyle Exercise” Any activity that requires bodily movement. Some activity is better than none, more is better than some. The surgeon general’s report recommends that we accumulate a minimum of 30 minutes of moderate intensity activity on most if not all days of the week. Physical activity is any activity that requires bodily movement. There is no right or wrong way to be physically active. Some activity is better than none and more activity is better than some. In fact, the improvement seen most is with those people who are not at all active and then begin to increase activity. The surgeon general’s report recommends that we accumulate a minimum of 30 minutes of moderate intensity activity on most if not all days of the week. Physical activity is any activity that requires bodily movement. There is no right or wrong way to be physically active. Some activity is better than none and more activity is better than some. In fact, the improvement seen most is with those people who are not at all active and then begin to increase activity. The surgeon general’s report recommends that we accumulate a minimum of 30 minutes of moderate intensity activity on most if not all days of the week.

4. Be Active and Stay Active Go for a walk Take the stairs instead of the elevator Follow a small child or toddler Park the car further from the door These are some activity suggestions to be active and stay active. This is not a complete list, so be creative in finding ways to incorporate more activity into your life. (Encourage participants to add any other ideas to the list.)These are some activity suggestions to be active and stay active. This is not a complete list, so be creative in finding ways to incorporate more activity into your life. (Encourage participants to add any other ideas to the list.)

5. Be Active and Stay Active Do yard work or gardening Walk the dog Clean out storage areas or the basement Go golfing, shopping, or dancing These are some activity suggestions to be active and stay active. This is not a complete list, so be creative in finding ways to incorporate more activity into your life. (Encourage participants to add any other ideas to the list.)These are some activity suggestions to be active and stay active. This is not a complete list, so be creative in finding ways to incorporate more activity into your life. (Encourage participants to add any other ideas to the list.)

6. How Many Steps Should I be Taking? 2,000 –4,000 steps/day indicate sedentary lifestyle. 4,000 – 7,000 steps/day indicate moderate activity level. 7,000 – 10,000 steps/day indicate active lifestyle. One way to measure physical activity is by wearing a pedometer. A pedometer records the number of steps you take in one day with everyday activity. Use this as feedback to establish your inactivity and your progress. Keep in mind these numbers were established for people in good health. 2,000-4,000 steps indicate sedentary lifestyle. 4,000-7,000 steps indicate moderate activity and 7,000-10,000 steps indicate active lifestyle. If you fall in the inactive category, use this tool as a stepping stone to increase your level of activity. One way to measure physical activity is by wearing a pedometer. A pedometer records the number of steps you take in one day with everyday activity. Use this as feedback to establish your inactivity and your progress. Keep in mind these numbers were established for people in good health. 2,000-4,000 steps indicate sedentary lifestyle. 4,000-7,000 steps indicate moderate activity and 7,000-10,000 steps indicate active lifestyle. If you fall in the inactive category, use this tool as a stepping stone to increase your level of activity.

7. Aerobic Exercise is… Continuous, rhythmic, repetitive exercise that uses large muscles of the body. Some examples are biking, walking, swimming, dancing, rowing or cross country skiing. Recommended 3 to 6 days per week for the rest of your life. Now let us talk about aerobic exercise. Aerobic exercise is continuous, rhythmic, repetitive exercise that uses large muscles of the body. Some examples may be: biking, walking, swimming, dancing, rowing or cross country skiing. It should be done 3 to 6 days per week for the rest of your life.Now let us talk about aerobic exercise. Aerobic exercise is continuous, rhythmic, repetitive exercise that uses large muscles of the body. Some examples may be: biking, walking, swimming, dancing, rowing or cross country skiing. It should be done 3 to 6 days per week for the rest of your life.

8. Aerobic Exercise…. How long and how hard? It is recommended to reach a goal of 20-60 minutes. Initially this may need to be done in shorter bouts several times per day. It is recommended that you exercise between 20 – 60 minutes. Initially you may need to do 2-3 exercise bouts for 10 minutes each or even possibly 4-5 bouts for 5 minutes each to reach your goal of 20-60 minutes. There are a few ways to help you monitor how hard to work. First and foremost use common sense and listen to your body. A few more measurable ways is to keep your shortness of breath rating no higher than a 4 and the RPE scale between a 3 and a 4. It is also important to keep your oxygen levels > 88%. The goal is to try to remember what you felt like during your sessions here and to be able to adjust your activity levels accordingly.It is recommended that you exercise between 20 – 60 minutes. Initially you may need to do 2-3 exercise bouts for 10 minutes each or even possibly 4-5 bouts for 5 minutes each to reach your goal of 20-60 minutes. There are a few ways to help you monitor how hard to work. First and foremost use common sense and listen to your body. A few more measurable ways is to keep your shortness of breath rating no higher than a 4 and the RPE scale between a 3 and a 4. It is also important to keep your oxygen levels > 88%. The goal is to try to remember what you felt like during your sessions here and to be able to adjust your activity levels accordingly.

9. Aerobic Exercise…. How long and how hard? To exercise comfortably you should: Keep your “shortness of breath” rating no higher than a 4. Keep RPE scale between 3 and 4. Keep your oxygen level > 88%. It is recommended that you exercise between 20 – 60 minutes. Initially you may need to do 2-3 exercise bouts for 10 minutes each or even possibly 4-5 bouts for 5 minutes each to reach your goal of 20-60 minutes. There are a few ways to help you monitor how hard to work. First and foremost use common sense and listen to your body. A few more measurable ways is to keep your shortness of breath rating no higher than a 4 and the RPE scale between a 3 and a 4. It is also important to keep your oxygen levels > 88%. The goal is to try to remember what you felt like during your sessions here and to be able to adjust your activity levels accordingly.It is recommended that you exercise between 20 – 60 minutes. Initially you may need to do 2-3 exercise bouts for 10 minutes each or even possibly 4-5 bouts for 5 minutes each to reach your goal of 20-60 minutes. There are a few ways to help you monitor how hard to work. First and foremost use common sense and listen to your body. A few more measurable ways is to keep your shortness of breath rating no higher than a 4 and the RPE scale between a 3 and a 4. It is also important to keep your oxygen levels > 88%. The goal is to try to remember what you felt like during your sessions here and to be able to adjust your activity levels accordingly.

10. Other Important Tips If you use a fast acting inhaler be sure to take it before exercise. You may need to use oxygen during exercise. Oxygen will help your muscles work more efficiently. If you use a fast acting inhaler be sure to take it before you exercise. Follow the guidelines recommended to you by your Respiratory Care Practitioner. You may also need to use oxygen during exercise. This will help your muscles work more efficiently. Your oxygen will be adjusted to make sure your saturations remain higher than 88%. Your oxygen is a drug and should only be adjusted by a trained professional. To help with anxiety and feeling short of breath it is important to use pursed lipped breathing and diaphragmatic breathing. We will be reviewing the proper technique throughout your rehab sessions. For some of you, it might be to your advantange to use a wheeled walker, wheel chair or shopping cart. If this allows you to be more active, certainly use it.If you use a fast acting inhaler be sure to take it before you exercise. Follow the guidelines recommended to you by your Respiratory Care Practitioner. You may also need to use oxygen during exercise. This will help your muscles work more efficiently. Your oxygen will be adjusted to make sure your saturations remain higher than 88%. Your oxygen is a drug and should only be adjusted by a trained professional. To help with anxiety and feeling short of breath it is important to use pursed lipped breathing and diaphragmatic breathing. We will be reviewing the proper technique throughout your rehab sessions. For some of you, it might be to your advantange to use a wheeled walker, wheel chair or shopping cart. If this allows you to be more active, certainly use it.

11. Other Important Tips To help with anxiety and breathlessness use pursed lip breathing and diaphragmatic breathing. You are encouraged to use a walker, shopping cart or wheel chair if it allows you to be more active. If you use a fast acting inhaler be sure to take it before you exercise. Follow the guidelines recommended to you by your Respiratory Care Practitioner. You may also need to use oxygen during exercise. This will help your muscles work more efficiently. Your oxygen will be adjusted to make sure your saturations remain higher than 88%. Your oxygen is a drug and should only be adjusted by a trained professional. To help with anxiety and feeling short of breath it is important to use pursed lipped breathing and diaphragmatic breathing. We will be reviewing the proper technique throughout your rehab sessions. For some of you, it might be to your advantange to use a wheeled walker, wheel chair or shopping cart. If this allows you to be more active, certainly use it.If you use a fast acting inhaler be sure to take it before you exercise. Follow the guidelines recommended to you by your Respiratory Care Practitioner. You may also need to use oxygen during exercise. This will help your muscles work more efficiently. Your oxygen will be adjusted to make sure your saturations remain higher than 88%. Your oxygen is a drug and should only be adjusted by a trained professional. To help with anxiety and feeling short of breath it is important to use pursed lipped breathing and diaphragmatic breathing. We will be reviewing the proper technique throughout your rehab sessions. For some of you, it might be to your advantange to use a wheeled walker, wheel chair or shopping cart. If this allows you to be more active, certainly use it.

12. It is important to: Warm-up Prepares the body for exercise Cool-down Prevents muscle soreness and stiffness Less chance of lightheadedness and irregular heart beats Reduces bronchospasm The purpose of a warm-up is to prepare the body for exercise. At rest, most of the blood supply is in your internal organs. During exercise, 80% of your blood goes to your exercising muscles. Warming up allows this process to take place gradually rather than putting a sudden demand on the circulatory system. The warm-up should last between 3-5 min. Some examples may include performing calisthenics, biking or walking at slower pace. The purpose of a cool-down is to help prevent muscle soreness and stiffness, possible irregular heart beats, lightheadedness caused by blood pooling in the legs. This can also help reduce and prevent bronchospasm. Cool-down should last between 3-5 minutes. Some examples may include stretching, walking or biking at slow pace.The purpose of a warm-up is to prepare the body for exercise. At rest, most of the blood supply is in your internal organs. During exercise, 80% of your blood goes to your exercising muscles. Warming up allows this process to take place gradually rather than putting a sudden demand on the circulatory system. The warm-up should last between 3-5 min. Some examples may include performing calisthenics, biking or walking at slower pace. The purpose of a cool-down is to help prevent muscle soreness and stiffness, possible irregular heart beats, lightheadedness caused by blood pooling in the legs. This can also help reduce and prevent bronchospasm. Cool-down should last between 3-5 minutes. Some examples may include stretching, walking or biking at slow pace.

13. Also important…. Stretching Muscle Conditioning Stretching is helpful in the prevention of injury and muscle soreness. It also improves ROM and flexibility. Stretching can be a part of the warm-up and cool-down of your aerobic exercise program. It is best to stretch daily or at least 3 times per week. Stretches should involve slow, steady, movement followed by holding for 10-30 seconds. Stretch all major muscle groups around the joints (hip, back, shoulders, upper trunk and neck regions) Muscle conditioning is important because it helps to improve and maintain muscle strength for everyday activities. Recent research suggests that muscle conditioning starting as low as 1-3# weights are beneficial for men and women of all ages. Exercises are preformed to strengthen all major muscle groups. The goal is to do one set of each exercise for 12-15 repetitions. Muscle conditioning should be done 2-3 days per week.Stretching is helpful in the prevention of injury and muscle soreness. It also improves ROM and flexibility. Stretching can be a part of the warm-up and cool-down of your aerobic exercise program. It is best to stretch daily or at least 3 times per week. Stretches should involve slow, steady, movement followed by holding for 10-30 seconds. Stretch all major muscle groups around the joints (hip, back, shoulders, upper trunk and neck regions) Muscle conditioning is important because it helps to improve and maintain muscle strength for everyday activities. Recent research suggests that muscle conditioning starting as low as 1-3# weights are beneficial for men and women of all ages. Exercises are preformed to strengthen all major muscle groups. The goal is to do one set of each exercise for 12-15 repetitions. Muscle conditioning should be done 2-3 days per week.

14. Indications of Exercise Intolerance Extreme fatigue Lightheadedness/Dizziness Severe muscle cramping Chest pain or pressure Severe joint pain Coughing Excessive or sudden onset of sweating or nausea Some signs to watch for are Extreme fatigue, lightheadedness or dizziness, severe muscle cramping, chest pain or pressure, severe joint pain, coughing, or excessive and/or sudden onset of sweating or nausea. These signs indicate an abnormal response to exercise. If any of these should occur, decrease your workload or stop exercise. For persistent signs, do not hesitate to call your doctor.Some signs to watch for are Extreme fatigue, lightheadedness or dizziness, severe muscle cramping, chest pain or pressure, severe joint pain, coughing, or excessive and/or sudden onset of sweating or nausea. These signs indicate an abnormal response to exercise. If any of these should occur, decrease your workload or stop exercise. For persistent signs, do not hesitate to call your doctor.

15. Aerobic Exercise Facts It takes 2 to 3 weeks to begin improving your fitness level. It takes 6 weeks to 3 months to achieve significant improvement. It takes 3 to 6 months to achieve maximum fitness. In only 2 days of inactivity, you start losing endurance. Much of the exercise benefit will be lost within 2 weeks of inactivity. Here are some interesting facts about aerobic exercise. Read above.Here are some interesting facts about aerobic exercise. Read above.

16. Staying on Track Look for ways to increase activity and exercise. Set specific and measurable short and long term goals. Think of possible barriers and make a plan. Seek help from others. Be creative and have fun! People vary in their readiness to include more physical activity and/or exercise into their lives. Any successful change involves planning and requires skills to overcome obstacles and setbacks. Making a lifestyle change does not happen overnight. At times you may find that you take two steps forward, then one step back. The key to overcoming barriers involves having a plan to help you stay on track and stay motivated. Some suggestions are: (see next page for outline)People vary in their readiness to include more physical activity and/or exercise into their lives. Any successful change involves planning and requires skills to overcome obstacles and setbacks. Making a lifestyle change does not happen overnight. At times you may find that you take two steps forward, then one step back. The key to overcoming barriers involves having a plan to help you stay on track and stay motivated. Some suggestions are: (see next page for outline)