Pulmonary Rehabilitation

Before you get started and after you’ve completed your program, your healthcare provider will assess your:

• Symptoms.
• Oxygen needs.
• Exercise capacity.
• Medical history, including other health conditions (comorbidities).
• Mental health.

They might assess you with questionnaires or tests like stress tests or pulmonary function tests. They’ll also talk to you about your goals. This might include what would improve your quality of life and what kinds of activities you’d like to be able to do (visit family, get back to hobbies, take short walks and more).

Physical activity is the main component of pulmonary rehabilitation. You’ll have exercise sessions two to three days a week. A provider will be there to guide and help you through. They’ll select physical activities that you can safely perform.

You’ll probably start out with short exercises and build strength over time. Each exercise might last a minute or two, or they might be up to 30 minutes, depending on what’s comfortable for you. During any exercise, your provider will make sure you’re managing the level of physical activity and might ask you to rate your level of effort or breathlessness.

Pulmonary rehab exercises might include:

• Warm-up and cool down.
• Flexibility training (stretching exercises).
• Respiratory muscle training. This might involve breathing in or out forcefully through a handheld device.
• Endurance or interval training. This might be cycling, walking or using a machine like a sitting elliptical.
• Resistance/weight training. You can do this with light weights, resistance bands or weight machines.
• Transcutaneous neuromuscular electrical stimulation (NMES). This contracts your muscles with small amounts of electricity.

A provider will help you feel prepared to manage parts of your life affected by lung disease. This might include:

• Managing shortness of breath and other symptoms.
• Understanding medications. This includes when and how to use specific medications and their side effects.
• Understanding oxygen. This includes how to monitor your oxygen level and when to use supplemental oxygen.
• Preventing and treating flares and infections.
• Learning how to use at-home medical equipment.

A provider will help you learn to adapt to and manage breathlessness during your daily life. This can help make performing daily tasks like housework and navigating stairs feel more manageable. Techniques might include:

• Controlled breathing techniques (like diaphragmatic breathing or pursed lip breathing).
• Relaxation techniques.
• Positions that help relieve shortness of breath (like tripod/orthopneic position).

If you have a condition that causes a lot of mucus in your lungs and airways, chest physiotherapy and airway clearance might be part of your pulmonary rehab program. Providers can teach you how to use techniques or devices to clear mucus, including:

• Coughing and breathing techniques. A provider can teach you techniques that open your airways and loosen mucus. For instance, huff cough.
• Positive expiratory pressure (PEP). PEP devices provide resistance so you have to work harder to breathe out, holding your airways open and forcing out mucus. Oscillating PEP devices (Flutter®, Acapella®, AerobikA®, RC-Cornet®) are specific types of PEP that also vibrate to loosen mucus.
• Airway clearance vests. An airway clearance vest, or high-frequency chest wall oscillation device, is an inflatable vest that vibrates to loosen mucus.
• Postural drainage and percussion. This is a type of physical therapy where you move into certain positions so that your lungs can drain. Another person claps their hand on your chest and/or your back to help loosen the mucus.

It can be stressful to live with a chronic health condition. Your care team can help you manage anxiety, depression, stress and other mental health concerns with:

• Relaxation and distraction techniques.
• Counseling.
• Support groups.
• Medications.

Depending on your underlying lung condition, your provider might make nutritional recommendations to help you gain muscle mass. This might mean eating a certain amount of protein, limiting certain foods or eating smaller but more frequent meals. If you’re at a higher risk of aspiration, your provider may also teach you swallowing techniques to reduce your risk.