Author Archives: Jackie Aim

What happens when the programme ends?

Community fitness class for older people

The best way to get the most from pulmonary rehabilitation is to maintain or improve your fitness after the programme of sessions have finished.

We know that people who stop exercising after pulmonary rehab can lose the benefits they had gained.

The only way to maintain your improved way of life is to carry on with exercise.

If you have just recovered from an exacerbation you should gradually build up your levels of exercise and activity. You should not expect to just pick up the same exercise level you had before you were unwell. Step back and take your time to regain your activity level.

Ask about:

Chest Heart & Stroke Scotland affiliated groups.
BLF breatheasy groups.
Council or leisure centre classes.
Local activities within your community such as walking groups, Tai Chi, aqua fit and many others.
A personal exercise plan to do at home.
Singing and COPD groups to help with breathing, confidence and as a social outlet.

For more information please contact the Chest Heart & Stroke Scotland Advice Line on 0808 801 0899.

How will I get there?

Group of older ladies waiting for a bus at the bus stop

Many pulmonary rehabilitation classes are based in the community to make them easier to get to.

However, if you are unable to get there yourself, ask the programme organiser if they can arrange transport. Not all pulmonary rehab programmes will be able to offer this. However, there may be other local schemes that you can use such as Dial a Ride, Taxi Cards or Volunteer Car Schemes.

You may find that at first you need to take a taxi to the venue but after the first few weeks as your energy levels and fitness improves you can use public transport or even walk part or all of the way, especially if it is close to where you live.

If you have difficulty arranging transport please contact the CHSS Advice Line nurses for help on free phone 0808 801 0899.

How can I join a pulmonary rehabilitation course?

Most health care professionals can refer you to pulmonary rehabilitation so make sure you ask them about it if you think this could help you. If you have an MRC score of 3 or above you can benefit from pulmonary rehabilitation (see below). Do not go to the gym until after you have been to pulmonary rehab so you will know how to manage your chest condition in the gym environment.

The MRC scale
1	2	3	4	5

You are not troubled by breathlessness except on strenuous exercise.	You are short of breath when hurrying on the level or walking up a slight hill.	You walk slower than most people on the level, stop after a mile or so, or stop after 15 minutes walking at own pace.	You stop for breath after walking about 100 yards (60 metres) or after a few minutes on level ground.	You are too breathless to leave the house, or breathless when dressing or undressing.

If you have an MRC score of 1 or 2 ask about the exercise and activity you can do at home or at your local gym.

If there is a waiting list, ask your health care professional what activities you can do in the meantime (see our section on Physical activity and exercise for more information). Ask your nurse, GP or other health care professional about what is available in your area. Sometimes you can get reduced rates at leisure centres or gyms if you are referred by a health care professional.

As well as benefiting people who find that their breathlessness is starting to affect their lifestyle, pulmonary rehabilitation can also help people who have just recovered from an exacerbation. If you have been in hospital with an exacerbation of COPD ask about referral to pulmonary rehabilitation. This can help you to recover and help you to stay out of hospital. The only time you should not exercise is while you are unwell or having an exacerbation or flare up.

What patients say about pulmonary rehab

“I wish I had done these classes years ago”.
“I’ve now got the upper hand when it comes to my breathlessness”.
“When I get breathless, I don’t make it worse by panicking like I used to do”.
“I feel like I’ve got my life back”.
“It is not an exercise class really, it is a rest class interrupted by some exercise”.
“It was the pacing which really helped me and meeting people like me”.
“The best thing that I did was the pulmonary rehabilitation class”. “I must admit I wasn’t keen on it when they asked me”. “I have to say it was definitely the best thing I did”. “I think it helped give more confidence that I could control the COPD and not let it control me”.

Quote from the pulmonary rehabilitation team:

“Our patients feel fitter, stronger and more able to do things for themselves.” “They have made new friends – ones who understand how they feel – and feel more in control of their breathing”.

Information and education sessions

Information and education topics are tailored to the needs of the group.
Topics that the information sessions may cover are:

How the lungs work.
How to live well with your lung problem.
How to manage a flare-up or exacerbation.
How to clear your chest.
Medicines and inhalers.
Help to stop smoking.
How to control your breathing.
The benefits of exercise.
Exercise after Pulmonary Rehabilitation.
Advice about your diet.
Pacing yourself.
Managing anxiety.
Relaxation.
Relationships and sex.
Sources of ongoing support.
State benefits available to you.
Planning for the future.

Self management tip

You will be able to ask any questions during these sessions to help you to manage your COPD better.
There is often time to share experiences and advice with other members of the group. It is also a great way to meet people with COPD who understand what it is like. This is great for social contacts and support.

I don’t think pulmonary rehabilitation is for me

Female therapist laughing with 2 male members of the pulmonary rehabilitation class

You will never be made to go to pulmonary rehabilitation if you don’t want to.
If you are not sure whether it is for you, ask if you can go along to a local class for a ‘taster’, or see our video clip.
Ask a healthcare professional what other things you can do to be active, either at home or with another group (see our section on Physical activity and exercise for more information).
You should be reassured that the exercise can be adapted to suit any level of fitness and ability. You will always be closely supervised and monitored by the pulmonary rehabilitation team.
The only time you should not go to pulmonary rehabilitation sessions are if you have an exacerbation, flare up or infection and you have an acute illness.

I don’t think I’m fit enough?

A male healthcare professional in the gym with a female patient who is riding a stationary bike

Please don’t worry! Pulmonary Rehabilitation can be adapted to suit almost anyone. It is especially useful if you have recently had an exacerbation or flare up and you are recovering.

One of the main aims of pulmonary rehabilitation is to teach you how to manage your breathlessness and be active.

Before you start the class, you will be assessed by a Physiotherapist. This will involve an individual appointment face to face with the physiotherapist.
You will need to answer some questions which will help your physiotherapist understand how your condition affects you and what things you would like to be able to do after completing the course.
You will also do a walking test or an exercise bike test. This will let your physiotherapist assess your fitness.
This will mean that the exercises you do will suit your own abilities, fitness and goals.
People who use portable oxygen can attend pulmonary rehabilitation.

Using Pulmonary Rehabilitation to break the cycle of inactivity

This diagram shows the cycle of inactivity in red. By being more active and going to pulmonary rehabilitation you will start to change the cycle to the green pathway.

Cycle of inactivity - Symptoms - Fear/Confidence - Activity - Fitter

What will the exercise sessions be like?

There will be a warm up with stretches.
A gentle exercise session will strengthen your muscles.
This will improve fitness and will help you to do more before feeling breathless.
You will feel less worried by your breathlessness.
A circuit of exercises at your own pace.
A cool down with stretches.

Exercises in the circuit may include:

Static bike.
Arm exercises with light weights.
Leg exercises with light weights.
Treadmill walking.
These exercises will work on different muscles in different parts of your body.

By selecting groups of muscles for one exercise you can then work this group harder. At the end of the programme the whole body has had an exercise session which could improve some of the following:

Breathing control.
Muscle endurance.
Muscle strength.
Balance.
Confidence.
Stamina.
Walking distance.

To make you feel better, the exercises need to be done at least 3 times a week, so you will be given similar exercises to do at home. It is important to get into the habit of walking and taking rests to build up endurance for doing activities. This is called pacing.

What should I bring?

If you have a reliever inhaler remember to take it with you.
If you have any other medicine which you have been advised to carry with you, take them too, for example a GTN (glycerol trinitrate) angina spray.
If you normally use a walking aid then bring that with you too.
If you use a hand held fan to help with your breathlessness at home, bring that along.
You may want to bring along a bottle of water or a cold drink.