For someone with chronic lung disease, pulmonary rehabilitation offers an opportunity to reach—and keep—the best possible level of functioning and independence.

Rehabilitation programs are designed to help people who are recovering from an illness or injury to regain as much function as possible. Most individuals who are referred for pulmonary rehabilitation have chronic obstructive pulmonary disease (COPD), a group of conditions that involve the lungs and airways leading to the lungs, including chronic bronchitis and emphysema. However, individuals with other types of lung disease may also profit from rehab.

A program for body and mind

While the lungs may be the primary target for pulmonary rehab, respiratory diseases usually cause problems in other parts of the body as well, such as the heart and the muscles—particularly muscles in the arms and legs. In addition, the person’s nutrition may suffer, and psychological or social problems may be associated with the illness.

A pulmonary rehabilitation program can help relieve symptoms and improve general functioning and participation in life activities. People in these programs undergo exercise training and receive nutritional guidance. They also learn self-management skills and get psychosocial support.

This may sound like a tall order, but a number of healthcare professionals work together to make it all happen. In most successful pulmonary programs, the rehab team includes a respiratory or physical therapist, a dietitian, a social worker or psychologist, a nurse, and a doctor.

Pulmonary rehabilitation may take place in an inpatient setting (generally when people are recuperating following a hospital stay), an outpatient setting, or at home. Such programs tend to last 8 to 12 weeks.

Exercise training: The root of all pulmonary rehab

Shortness of breath, with or without fatigue, is what limits the ability of most people with COPD to engage in exercise. Other physical problems may contribute to exercise intolerance as well—some linked with the respiratory system, some not. That’s where exercise training comes in.

Exercise training is widely considered the foundation of pulmonary rehab. It’s ideal for people with COPD who suffer from a decreased endurance level, shortness of breath when exercising, fatigue, or other problems that restrict their daily activity.

Exercise training programs have been shown to be the best way to improve muscle function in people with COPD. Ideally, the person should exercise at least 3 times a week. The best results have been seen in people who participate in programs that have at least 20 sessions. A combination of endurance and strength training usually works best. Although much pulmonary rehab emphasizes strength training for the legs, increasing arm strength is critical for many activities of daily living.

Shortness of breath, the hallmark of COPD, is frightening. It can make a person anxious or fearful, feelings that may lead to depression or other psychological disturbances. Pulmonary rehab can help a person manage the physical problem and overcome the negative feelings associated with it.

Weight control is part of the program

People with moderate to severe COPD are often underweight, and it’s not uncommon for them to have a loss of muscle tissue due to disease or because they don’t use the muscle (called muscle wasting). The loss of body mass and muscle tone can significantly reduce quality of life.

A high-calorie diet can help restore weight and compensate for the increased energy expenditure that COPD requires. It appears that exercise training is also needed for adequate weight gain.

On the other side of the coin are people with COPD who are severely overweight (obese). Obesity carries its own set of problems when it comes to breathing and exercise tolerance. Pulmonary rehabilitation provides an opportunity to learn about proper nutrition and healthful meal planning.

Pulmonary rehab is a key part of the COPD care plan. It helps people learn important self-management techniques to improve their quality of life.

From American Journal of Respiratory and Critical Care Medicine and The Merck Manual of Medical Information