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Exercise Prescription Table

Summary of Exercise Prescription

This table provides details for the initial prescription for a patient with COPD.

See relevant sections in the toolkit for examples of the exercises (i.e. mode) and details for exercise progression

 

 

Mode


Intensity


Protocol


Duration


Frequency


Lower limb


1) endurance training


Ground walking


Treadmill walking


Stationary Cycle


or a combination of the above with a total duration of 30 minutes



2) strength training


Walking training


Ground-based


80% average speed on 6MWT


75% peak speed on ISWT


Dyspnoea rating of 3 (moderate)


Continuous or interval


30 minutes


4 or 5 times a week that includes 2 or 3 supervised sessions and home exercise training


Walking training


Treadmill


As for ground-based walking training but reduce speed by 0.5 to 1 kph until familiar with treadmill


Continuous or interval


30 minutes


4 or 5 days a week that includes 2 or 3 supervised sessions and home exercise training


Stationary cycle training (if possible)


Dyspnoea rating of 3 (moderate)


Continuous or interval


30 minutes


4 or 5 days a week that includes 2 or 3 supervised sessions and home exercise training


See relevant section for examples of strength exercises


 

10 RM (repetition maximum)


10 repetitions (1 set)


2 or 3 times a week with at least 1 day rest between sessions


Upper limb


 1) endurance training


See relevant section for examples of exercises


Determine the weight that the patient can only lift 15 times


Dyspnoea rating of 2 or 3 (slight or moderate)


 

15 repetitions (1 set)


4 or 5 times a week that includes 2 or 3 supervised sessions and home exercise training


2) strength training


See relevant section for examples of exercises


10 RM (repetition maximum)


 

10 repetitions (1 set)


2 or 3 times a week with at least 1 day rest between sessions


See text below for exercise considerations specific to other chronic lung disease.

Bronchiectasis

Bronchiectasis is the term used for the permanent abnormal dilatation of one or more bronchi.  The main causes of permanent abnormal dilatation are damage to the airways due to severe lower respiratory tract infections such as pneumonia, whooping cough, measles (usually in childhood), gastric aspiration, primary ciliary dyskinesia.  Bronchiectasis may also a secondary manifestation of COPD, sarciodosis and bronchiolitis obliterans. However, often the underlying cause of bronchiectasis is not identified.

Bronchiectasis is characterised by repeated episodes of acute bronchial infection with increased cough and mucus production.

Pulmonary rehabilitation has been shown to be effective in improving exercise capacity and health-related quality of life of people with bronchiectasis.1 However, all trials of PR for bronchiectasis have included airway clearance techniques, which may not be a standard component of all PR programs. Therefore, those PR programs that include people with bronchiectasis should ensure that there are staff (physiotherapists) skilled in airway clearance techniques.

Interstitial lung diseases

Interstitial lung diseases (ILDs) are a group of over 200 conditions which are characterised by varying degrees of interstitial inflammation and fibrosis. People with ILD experience distressing breathlessness on exertion and fatigue, reduced health-related quality of life, and anxiety and depression.

Pulmonary rehabilitation has been shown to be effective in improving exercise capacity and health-related quality of life and reducing breathlessness of people with ILD.1 However, since many patients with ILD experience significant exercise-induced desaturation, programs that provide PR for people with ILD should ensure that supplemental oxygen is available during training if necessary.

Pulmonary Hypertension

Pulmonary hypertension (PH) is defined as an increase in the resting mean pulmonary arterial pressure to at least 25 mm Hg on right heart catheterization. People with PH usually experience breathlessness on exertion and may have other symptoms such as fatigue, dizziness, chest discomfort, chest pain, palpitations, cough, pre-syncope, syncope, lower limb oedema and abdominal distension.

Pulmonary rehabilitation has been shown to be effective in improving exercise capacity and health-related quality of life of people with PH.1 However, people with PH should be stable on pharmacotherapy prior to undertaking an exercise training programme and PR programs should be delivered in centres experienced in managing people with PH.