 Class 4.

Medical Rehabilitation in patients with

cardiovascular and respiratory system
diseases.
Cardiac rehabilitation (cardiac rehab) is a personalized program of education and exercise. The supervised program is
designed to improve health in those with heart disease. It's often recommended after a heart attack or heart surgery.
Cardiac rehabilitation involves exercise training, emotional support and education about a heart-healthy lifestyle.
Healthy lifestyle habits include eating a nutritious diet, managing weight and quitting smoking.
Research shows that cardiac rehabilitation can reduce the risk of future heart problems and death from heart disease.
The American Heart Association and American College of Cardiology recommend cardiac rehabilitation.
Why it's done
Cardiac rehabilitation is done to improve health in those with a heart condition or a history of heart
surgery. The goals of cardiac rehabilitation are to:
Get stronger
Reduce the risk of future heart problems
Prevent the heart condition from worsening
Improve quality of life
Cardiac rehabilitation is an option for people with many forms of heart disease. Your provider may
recommend cardiac rehab if your medical history includes:
Angioplasty and stenting
Cardiomyopathy
Certain congenital heart diseases Heart valve repair or replacemen
Chest pain (stable angina)
Coronary artery bypass surgery
Coronary artery disease
Heart attack
Heart failure
Heart or lung transplant
Who is offered cardiac rehab?
Cardiac rehab is available to people who have had:
•a heart attack
•a coronary angioplasty (balloon) and/or stent
•heart surgery including coronary artery bypass surgery, valve repair/replacement and adult congenital
heart defects
•some people who have angina or heart failure
•some people who have an implantable cardioverter defibrillator (ICD) inserted
a cardiac arrest.
What happens at cardiac rehab?
Exercise sessions
A group cardiac rehab programme should include around 10-12 weeks of structured exercise sessions
tailored to each person’s individual need, allowing them to safely return to fitness and gradually build
in strength and confidence.
A typical exercise session involves a warm up, the main exercise component, which may be circuit
based or use equipment such as stationary bikes, and a cool down. Some programmes have a
relaxation session at the end too.
The warm up prepares your heart for exercise by slightly increasing your heart rate, this will make you
slightly breathless and prepare your body and muscles to reduce the risk of injury.
The main exercise component involves working at an intensity so that you feel like you are benefitting
from the exercise and are slightly out of breath, but that you can still hold a conversation. The team will
come round and talk to you to see how you are getting on and they will check your pulse to see if you
are meeting your target heart rate.
The cool down gradually brings your heart rate and breathing back down to what it was when you
If you have a heart attack or other heart problem, cardiac rehabilitation is an important part of your
recovery. Cardiac rehabilitation can help prevent another, perhaps more serious, heart attack and can
help you build heart-healthy habits. Learn more about who needs cardiac rehabilitation and how it can
help your recovery.
About 800,000 people in the United States have a heart attack every year. About 1 in 4 of those people
already had a heart attack.1 Cardiac rehabilitation not only can help a person recover from a heart
problem but can also prevent future heart problems
hat is cardiac rehabilitation?
Cardiac rehabilitation is an important program for anyone recovering from a heart attack, heart failure,
or other heart problem that required surgery or medical care.
Cardiac rehabilitation is a supervised program that includes:
Physical activity.
Education about healthy living, including how to eat healthy, take medicine as prescribed, and quit
smoking.
Counseling to find ways to relieve stress and improve mental health.
A team of people may help you through cardiac rehabilitation, including your health care team,
exercise and nutrition specialists, physical therapists, and counselors.
Who needs cardiac rehabilitation?
Anyone who has had a heart problem, such as a heart attack, heart failure, or heart surgery, can
benefit from cardiac rehabilitation. Studies have found that cardiac rehabilitation helps men and
women, people of all ages, and people with mild, moderate, and severe heart problems. 2
However, some people are less likely to start or finish a cardiac rehabilitation program, including:
Studies show that women, especially minority women, are less likely than men to start or complete
cardiac rehabilitation.3,4 This may be because doctors may be less likely to suggest cardiac
rehabilitation to women.
How does cardiac rehabilitation help?
Cardiac rehabilitation can have many health benefits in both the short and long term, including:
•Strengthening your heart and body after a heart attack.
•Relieving symptoms of heart problems, such as chest pain.
•Building healthier habits such as getting more physical activity, quitting smoking, and eating a heart-
healthy diet. A nutritionist or dietitian may work with you to help you limit foods with unhealthy fats
and eat more fruits and vegetables that are high in vitamins, minerals, and fiber.
•Reducing stress.
•Improving your mood. People are more likely to feel depressed after a heart attack. Cardiac
rehabilitation can help prevent or lessen depression.6
•Increasing your energy and strength to make daily activities like carrying groceries and climbing stairs
easier.
•Making you more likely to take your prescribed medicines that help lower your risk for future heart
problems.6
•Preventing future illness and death from heart disease. Studies have found that cardiac rehabilitation
decreases the chance that you will die in the 5 years following a heart attack or bypass surgery by
about 35%.6
What is Cardiac Rehab?
Cardiac rehab is a comprehensive, medically supervised recovery program, specifically designed for
patients with heart disease. Typically, a cardiac rehab program will begin with a careful analysis of a patient's condition
and needs, followed by a supervised, progressive exercise regime, combined with education on a heart-healthy
lifestyle and medications. Cardiac rehab may be beneficial for patients with any kind of heart condition, including
coronary artery disease, angina, heart failure, heart attack, or heart surgery.
A cardiac rehabilitation program will likely progress through the four main phases:
Phase 1: Acute, In Hospital Patient Period
Patients with acute heart conditions, such as those recovering from heart surgery or a heart attack, may be referred
to a cardiac rehab team while still in hospital. This phase will likely last between 2 and 5 days, depending on your
physical condition.
What happens?
1. Assessment
During this phase, you will be visited by cardiac rehab specialists, who will begin by providing you with support and
information as you begin recovery. Your cardiac rehab team may run the following tests:
•Heart rate
•Blood pressure
•Oxygen saturation
•Upper extremity function, including strength and range of motion (ROM)
•Lower extremity strength
•Functional mobility such as walking and self-care tasks
They will also take a full medical history, to identify any particular risk areas or comorbidities (other diseases that
might complicate your recovery).
2. Education
You may begin to receive education and training on:
The cardiac event itself
Specific aspects of your diagnosis and condition
Managing your psychological reactions to the event
Managing cardiac pain or other symptoms
Monitoring
You will be closely monitored to make sure that you don’t experience any worsening of your
symptoms or risk another cardiac event.
Goals for Phase 1:
The main goal for the first phase of cardiac rehabilitation is to enable you to leave the hospital and return home as
quickly and safely as possible. You will work with doctors, nurses, and physical therapists or other specialists to design
a safe and appropriate discharge plan. By the end of this phase, you should have:
1.A safe, limited exercise plan that you can follow at home
2.A clear understanding of your condition and your cardiac rehabilitation program
3.Knowledge about self-care for your wounds (if you have had open heart surgery)
4.An assistive device, such as a cane or walker, if needed
5.Access to home oxygen therapy, if needed
By the end of Phase 1, you should have recovered sufficiently to return home and begin the second phase of cardiac
rehab.
Phase 2: Subacute Outpatient Care (Post-discharge, Pre-Exercise Period)
Phase 2 takes place after you leave the hospital, at an outpatient care facility. This second phase will last between
three and six weeks.

A cardiac rehab program combines:

Exercise training.
Cardiac risk factor changes.
Heart health education.
Diet and nutrition counseling.
Emotional support.
What are the three phases of cardiac rehab?
Cardiac rehab begins before the hospital discharges you and should continue long-term. Cardiac rehab
phases are:
Phase 1: Inpatient (starting while you’re in the hospital).
Can I do cardiac rehabilitation at home?
You may be able to do cardiac rehab at home, but check with your insurance company to see if they cover it.
The first phase of your cardiac rehab will happen during your hospital stay. In most cases, your healthcare provider will tell
you to start cardiac rehab shortly after you leave the hospital. In addition to hospitals, other medical centers offer cardiac
rehab programs.
What conditions are treated/managed with cardiac rehab?
Cardiac rehab is important for people who’ve had some kind of heart or blood vessel issue, such as:
•Heart attack.
•Heart failure.
•Use of a ventricular assist device.
•Stable angina.
•Heart or heart-lung transplant.
•Heart valve repair or replacement.
•Coronary artery bypass grafting (CABG).
•Coronary artery angioplasty with or without a stent.
•Peripheral artery disease.
Your healthcare provider can give you a referral to a cardiac rehab program.
How common is cardiac rehab?
Cardiac rehab isn’t as common as it should be. Each year, about 800,000 Americans have a heart attack. For 25% of them, it’s
not their first one. Cardiac rehab can help prevent a second heart attack and decrease the risk of death over one to three
years after taking part in the program. However, only 20% to 30% of those eligible each year enroll in a cardiac rehab
program.
The American Heart Association and the American College of Cardiology endorse cardiac rehab for people with the heart
conditions listed above
What exercises do you do at cardiac rehab?
Cardiac rehab exercises can vary depending on the fitness level and risk factors you started with. Exercises may include:
•Aerobic exercises, like walking, riding a stationary bike or using an elliptical or step trainer.
•Activities to strengthen your muscles, like lifting free weights or using cable machines and resistance bands.
What does cardiac rehab consist of?
In addition to exercise, cardiac rehab helps you with:
•Eating heart-healthy.
•Learning how to manage stress.
•Getting to and staying at a healthy weight.
•Stopping the use of tobacco products and/or other substances.
•Taking and managing your medicines.
•Managing your blood pressure, cholesterol and blood sugar levels.
How long is cardiac rehab?
Most insurance companies (and Medicare) cover a 12-week cardiac rehab program with a total of 36 sessions. That works out
to three one-hour sessions a week.
What are the potential benefits of cardiac rehab?
Completing a cardiac rehab program can add up to five years to your life expectancy, according to studies. Cardiac rehab is
good for you in many ways. It can:
•Help you recover and get stronger after a heart attack, heart surgery or another heart issue.
•Get your body moving so your everyday activities are easier.
•Improve your daily quality of life.
•Help lower your risk of having another heart attack.
•Decrease your risk of becoming very ill or dying from heart disease in the coming years.
•Help you manage mental health and possible feelings of depression and anxiety after a heart attack.
•Show you ways to ease stress.
•Help you manage your weight.
•Teach you healthier lifestyle habits, such as heart-healthy eating, not using tobacco products, sitting less and exercising more.
•Help with your chest pain and shortness of breath.
Cardiac rehab helps people who’ve had a heart attack or other heart problems recover. It creates a personal plan for safely
improving physical health and managing other risk factors.
Having a heart attack or other heart issue can also be scary and make you feel depressed. Cardiac rehabilitation stresses the
importance of mental health and quality of life. It provides holistic support for every part of rehab so you’re not alone in
reaching your goals.
How successful is cardiac rehab?
Several studies have found cardiac rehab helps people in various ways.
Researchers found cardiac rehab reduced:
•Cardiovascular death risk by 58%.
•Heart attack risk by 30%.
•The risk of stroke by 60%.
Depression symptoms by 63%.
What are the risks or complications of cardiac rehab?
In very rare cases, exercise during cardiac rehab can cause an injury or a dangerous heart rhythm. If
this happens, the cardiac rehab staff will have you stop exercising so they can treat you right away. If
needed, the cardiac rehab staff will also talk with your cardiologist or primary healthcare provider. They
may want to examine you or order more testing before you return to cardiac rehab.
•Coronary artery disease (CAD) is a leading cause of disease burden worldwide. Referral to cardiac
rehabilitation (CR) is a class I recommendation for all patients with CAD based on findings that
participation can reduce cardiovascular and all-cause mortality, as well as improve functional capacity
and quality of life. However, programme uptake remains low, systematic progression through the
traditional CR phases is often lacking, and communication between health care providers is frequently
suboptimal, resulting in fragmented care. Only 30% to 50% of eligible patients are typically referred to
outpatient CR and fewer still complete the programme. In contemporary models of CR, patients are no
longer treated by a single practitioner, but rather by an array of health professionals, across multiples
specialities and health care settings. The risk of fragmented care in CR may be great, and a concerted
approach is required to achieve continuity and optimise patient outcomes. ‘Continuity of care’ has
been described as the delivery of services in a coherent, logical, and timely fashion and which entails 3
specific domains: informational, management, and relational continuity. This is examined in the context
Indications for Cardiac Rehab
•A medical examination is completed at the initial consultation to determine the needs and limitations
of the patient.
•The results of the exam are interpreted, the team creates a rehab program and sets goals for
treatment.
•Treatment typically consists of a physical activity program in a group setting where vital signs can
consistently be monitored. As the program progresses, the patient is taught how to monitor their own
vitals and progresses to more challenging aerobic activities.
•Cycle Ergometer Use in the post-operative period following cardiac surgery is a safe choice for patient
rehabilitation[7].
•Along with physical activity, patient education is also a very important part of cardiac rehab. Patients
may work with a dietician or be given advice on how to stop smoking if necessary.
According to the American Heart Association, the benefits of cardiac rehab include:
•Regular physical activity helps your heart and the rest of your body get stronger and work better.
Physical activity improves your energy level and lifts your spirits. It also reduces your chances of future
heart problems, including heart attack.
•Counseling and education can help you quit smoking, eat right, lose weight, and lower your blood
pressure and cholesterol levels. Counseling may also help you learn to manage stress and to feel better
about your health.
You have the advice and close supervision of healthcare professionals to help you improve your health
and lower your risk of future problems. These professionals can also communicate with your primary
care doctor or cardiologist
Prevention
Evidence based interventions for secondary prevention include the use of aspirin, beta-blockers,
angiotensin converting enzyme inhibitors; lipid lowering drugs and other anti- hypertensives, as well as
Hypertension, also known as high blood pressure, is a common condition in which the long-term force of the
blood against your artery walls is high enough that it may eventually cause health problems, such as heart
disease.
Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to
blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your
blood pressure. (Source)
Rehab Therapy can help improve the symptoms related to hypertension:
1.Maximizing patient safety with all activities and mobility.
2.Education for the patient for improved levels of endurance with stable vitals for a healthy lifestyle.
3.Maximize safety and independence with all activities and mobility.
These physical therapy tactics can help improve hypertension:
•Exercise prescription through aerobics and strengthening, increasing activity levels and endurance
•Facilitation of weight loss through exercise and activity levels
•Patient and caregiver education
These occupational therapy tactics can help improve hypertension:
•ADL training with energy conservation and pacing
•Adaptive equipment
•Environmental adaptation
•Increasing activity levels through exercise
Pulmonary rehabilitation is the use of supervised exercise, education, support, and
behavioral intervention to improve how people with chronic lung disease function in daily
life and to enhance their quality of life.
Pulmonary rehabilitation is a program designed for people who have chronic lung disease. Its primary
goal is to enable people to achieve and maintain their maximum level of independence and
functioning. Although most pulmonary rehabilitation programs focus on people who have
chronic obstructive pulmonary disease (COPD), pulmonary rehabilitation may also benefit people with
other types of lung disease, including
•Asthma
•Bronchiectasis
•COVID-19
•Cystic fibrosis
•Interstitial lung disease
•Lung cancer
•Neuromuscular disorders
•Pulmonary hypertension
•Sarcoidosis
Pulmonary rehabilitation programs may improve quality of life by
•Reducing shortness of breath
•Increasing exercise tolerance
•Promoting a sense of well-being
•Decreasing the number of hospitalizations
However, there is no clear evidence these programs significantly lengthen survival.
Pulmonary rehabilitation both before and after surgery may be beneficial for people with cancer
undergoing lung resection, people with chronic obstructive pulmonary disease undergoing
lung volume reduction surgery, and people with severe lung disease undergoing lung transplantation.
Pulmonary rehabilitation programs are usually conducted in an outpatient setting (in other words, the
person has regular appointments in an office or clinic) or in the person’s home. However, telemedicine
and web-based programs are being used more often.
Pulmonary rehabilitation programs may be used before a person's lung disease becomes severe. Even
people with less severe disease may benefit from therapy to reduce shortness of breath and increase
the ability to exercise. Sometimes pulmonary rehabilitation is combined with cardiac rehabilitation.
The most successful rehabilitation programs are those in which services are provided by a respiratory or
physical therapist, a nurse, a doctor, a psychologist or social worker, and a dietitian working as the
pulmonary rehabilitation team to coordinate complex medical services. Most people are enrolled in
these programs for 8 to 12 weeks. However, the techniques learned during the program have to be
continued at home after the rehabilitation program ends or the gains made will be lost.
Supportive respiratory therapy, which includes oxygen therapy and chest physical therapy, can be used
in conjunction with pulmonary rehabilitation. Supportive therapy can also be used for people not
enrolled in these programs but who have chronic lung disorders (such as cystic fibrosis or bronchiectasis
) or acute lung conditions (such as pneumonia).
 pulmonary rehabilitation program has several components, including
•Exercise training
•Inspiratory muscle training
•Neuromuscular electrical stimulation
•Psychosocial counseling
•Nutritional evaluation and counseling
•Education, including on proper use of prescribed drugs
Exercise training
Exercise training is the most important component of pulmonary rehabilitation. It reduces the effects of
inactivity and deconditioning, resulting in less shortness of breath and an increased ability to exercise.
However, physical limitations may restrict the types of exercise training that can be used.
Aerobic exercise and strength training are both important components of exercise training in people with
lung disorders.
Exercise of the legs is the cornerstone of training. Because walking is necessary for most activities of
daily living, many rehabilitation programs use walking (sometimes on a treadmill) as the preferred mode
of training. Some people may prefer exercising on a stationary bicycle. Choosing an exercise that is
comfortable and satisfying for the person enhances willingness to participate long-term.
Exercise training of the arms is also beneficial for people with chronic lung diseases who have shortness
of breath or other symptoms during their normal activities of daily living, such as washing their hair or
shaving. Such training is needed because chronic lung disease can cause muscle loss, and some of the
shoulder muscles are used in breathing as well as in moving the arms. Activities involving arm work can
quickly overexert these muscles.
Inspiratory muscle training
Inspiratory muscle training (IMT) is often a component of pulmonary rehabilitation. With IMT, the person
uses breathing exercises and devices to strengthen the muscles involved in breathing. IMT is usually
Neuromuscular electrical stimulation
Neuromuscular electrical stimulation (NMES) uses a device that applies electrical impulses through the
skin to selected muscles to stimulate contraction. NMES can be effective in people with severe lung
and/or heart disease because it does not cause the shortness of breath that often prevents these
people from participating in typical exercise training.
Psychosocial counseling
Depression and anxiety are common reactions to the life changes a person with lung disease
experiences. In addition, shortness of breath itself may cause anxiety and depression, interfere with
sexual activity, and cause difficulty managing stress and relaxing. Through counseling, group therapy,
and, when needed, drug treatment, people may be able to better cope with these psychosocial
problems. Sometimes family members participate in counseling to help them cope with the stress
involved in caring for a person with lung disease.
Nutritional evaluation and counseling
People who have lung disease often need nutritional evaluation and counseling. For example, those
with the most severe chronic obstructive pulmonary disease often experience weight loss. Pulmonary
rehabilitation programs help people avoid weight loss and maintain muscle mass. People must be
taught to eat in such a way that they maintain adequate caloric intake while avoiding becoming too
full, which can interfere with breathing. Alternatively, some people gain weight because of a reduced
activity level. In this case, breathing places a greater demand on an already taxed respiratory system.
Weight reduction benefits such people.
Some people with chronic lung disease need only a brief period of oxygen therapy during an acute flare
up (exacerbation) of their lung disease. (See also Pulmonary Rehabilitation.) Others, in whom oxygen
levels in the blood are consistently low (such as some people with severe COPD), may require oxygen
therapy all the time.
In people with severely low oxygen levels, long-term oxygen therapy increases survival time. The more
hours a day the oxygen is used, the better the result. People survive longer when 12 hours of oxygen
are used than when no oxygen is used. People survive even longer when oxygen is used continuously
(24 hours per day). However, in people with moderate or slightly low oxygen levels due to chronic lung
disease, long term-term oxygen use does not decrease risk of death. Regardless of the effects on
mortality, long-term oxygen use may decrease shortness of breath and reduces the strain on the heart
that lung disease causes. Both sleep quality and the ability to exercise tend to improve
Some people with chronic lung disease have low levels of oxygen only when they physically exert
themselves. These people can limit their oxygen use to periods of exertion. Other people have low
oxygen levels only when they are sleeping. These people can limit their oxygen use to overnight hours.
Oxygen delivery systems
Oxygen for long-term home use is available from three different delivery systems:
Oxygen concentrators
Liquid oxygen systems
Compressed gas systems
An oxygen concentrator is an electrically powered device that separates the oxygen from the
nitrogen in the air, allowing a person with lung disease to receive purified oxygen. Because the system
pulls oxygen from the room air, the person does not need to receive deliveries of oxygen. Although
many of the devices also operate by battery as well, people should have a supply of oxygen available in
case of a power or battery failure.
.
Hyptonia is a common diagnosis, that is widely misunderstood. In this post I hope to highlight the
meaning of Congenital Hypotonia, providing helpful information to families and caregivers of
children with hypotonia as well as the medical providers who work with them.
The diagnosis of Hypotonia or Low Muscle Tone is often used as a “catch all”. Hypotonia may be
the presenting sign of both benign and serious conditions that affect motor control. Recognizing
hypotonia, even in early infancy, is usually relatively straightforward, but diagnosing the underlying
cause can be quite arduous.
The long term effects of hypotonia on a child’s development depend primarily on the severity of the
hypotonia, as well as the nature of the underlying etiology. Some of these disorders have a
specific medical treatment, but the principal treatment for most children with congenital hypotonia is
in fact Physical and Occupational Therapy.
Signs and Symptoms of Hypotonia
•Difficulty maintaining head control
•Difficulty sitting upright without significant lean or support
•Slow to attain motor milestones
•Difficulty transitioning in and out of positions
•Clumsy or inefficient movement patterns
•Global Developmental delay
•Difficulty with hand eye coordination
•Prefer to observe rather than participate
•Low frustration tolerance with physically challenging tasks
Hypotonia is the medical term for decreased muscle tone. Hypotonia is a symptom rather than a
condition. It can be caused by a number of different underlying health problems, many of which are
inherited.
Neurological conditions that affect the Central Nervous System and can cause central hypotonia
include:
•Cerebral Palsy
•Brain and Spinal Cord Injury – including bleeding in the brain
Serious Infections – such as Meningitis (an infection of the outside membrane of the brain) and
Encephalitis (an infection of the brain itself)
Treatment plan will/may include:
Hydrotherapy
Improve Muscle strength and endurance
Gait Analysis and Training
Help with balance and co-ordination.
Vestibular rehabilitation
Posture management.
Wheelchair assessment
Splints/Orthosis referral to appropriate department.
Personalised home exercise programs.
Recommendation to other services.
Valvular disease is the second indication of cardiac rehabilitation (CR) after coronary artery disease.
Patients suffering valvular disease are addressed to CR after valvular repair, and are usually old.
Valvular replacement are the most frequent, and more and more patients being treated by TAVI are
addressed to CR. CR takes place on two phases: From the seventh (day 7) to the fifteenth (day 15) day:
management of complications, respiratory physio, and help to autonomy if necessary. From the fifteenth
day (day 15): rehabilitation to exercise after an exercise stress test with or without MVO2 measurement.
Because the patients are taking anticoagulants and are at risk of endocarditis, therapeutic education
takes an important place during the stage. CR of patients suffering valvular disease has demonstrated
its usefulness with: An increase of exercise capacity in all kind of valvular disease; A reduction of left
ventricular hypertrophy in patients with aortic valve stenosis. No serious complication was observed in
all studies regarding CR in patients with valvular disease.
How long does it take to recover after heart valve surgery?
Recovering from valve surgery usually takes most people between 4 and 8 weeks. If you had minimally
invasive surgery, you may recover even sooner.
Before you leave hospital, you’ll be given detailed instructions for exercise, medications, ongoing wound
care and resuming normal activities.You’ll also be encouraged to book a cardiac rehabilitation program,
which is a dedicated program that helps to support you, every step of the way, as you heal, recover and
get back to your everyday routine.
What should I eat after heart valve surgery?
After your valve surgery, you’ll need to focus on eating a healthy diet. This will help your body to heal and reduce your
risk of complications and enable you to recover well.
You may notice that you have a poor appetite and find that food has lost its flavour. Your sense of smell may change
and you may also experience a strange metallic taste in your mouth. This can be caused by the operation or your
medication and can take 3 months to fully recover. Try to eat small amounts of food often.
Many studies have shown that a diet rich in fruits, vegetables, wholegrains, nuts and seeds can reduce your risk of
heart disease. A healthy diet provides your body with plenty of heart-protective nutrients - like vitamins, minerals,
antioxidants and dietary fibre.
Ideally, your diet should include:
•Meat - and/or meat alternatives such as eggs, tofu, legumes and nuts
•Fish - 2 serves of oily fish per week such as salmon, mackerel or sardines will help you get plenty of heart healthy
omega-3 fats
•Wholegrains - good wholegrain choices include wholemeal or wholegrain bread or crackers, brown rice, wholemeal
pasta, quinoa, freekah, barley, rye, rolled oats, polenta and couscous
•Dairy - preferably low fat
•Healthy fats - a small amount of healthy fats and oils from nuts, seeds, avocado and oily fish
•Water - avoid sugary soft drinks and drink alcohol only in moderation
Aim to consume 2 serves of fruit, 5 serves of vegetables and 4 or more serves of wholegrains - depending on your
energy needs. Some other tips to help you eat well include:
•Reduce your salt intake - use as little salt as possible when cooking as this will help to lower your blood pressure and
help prevent fluid retention
•Avoid sugary foods
Pulmonary rehabilitation
Pulmonary rehabilitation is a specialised programme of exercise and education designed to help people
with lung problems such as COPD.
It can help improve how much exercise you're able to do before you feel out of breath, as well as your
symptoms, self-confidence and emotional wellbeing.
Pulmonary rehabilitation programmes usually involve 2 or more group sessions a week for at least 6
weeks.
A typical programme includes:
•physical exercise training tailored to your needs and ability – such as walking, cycling and strength
exercises
•education about your condition for you and your family
•dietary advice
psychological and emotional support
Lifestyle factors for COPD
If you have COPD it can help to make a number of important lifestyle changes, including:
quitting smoking – techniques can include ‘cold turkey’, counselling, nicotine replacement therapy
and medications that work on brain receptors. Evidence shows that counselling, together with medical
therapy, is most effective
being as physically active as possible. If possible, attend pulmonary rehabilitation
following a COPD action plan
eating a healthy diet
making adjustments to your lifestyle and home environment to ensure plenty of rest
keeping adequately hydrated to help keep the mucus in your lungs runny and easier to cough up
avoiding smoky or dusty environments
Treatment for COPD
There is no cure for COPD, and the damaged lung tissue doesn’t repair itself. However, there are things
you can do to slow the progression of the disease, improve your symptoms, stay out of hospital and live
longer.

Treatment may include:

•bronchodilator medication – to open the airways. This medication is best administered by a puffer
•corticosteroids – medication to reduce inflammation and swelling of lung tissue. This is usually given by
a puffer to minimise the risk of side effects
•expectorants – medication to loosen the phlegm and make it easier to cough up
•oxygen therapy – is prescribed for many people with chronic lung disease who have low blood oxygen
levels. The body can tolerate low levels of oxygen for short periods of time, but low levels of oxygen for
long periods of time can cause problems in your vital organs. Home oxygen therapy helps return your
blood oxygen levels to normal, reducing the damage to your vital organs. Oxygen therapy is usually
prescribed to prolong life and it may also improve quality of life. While the use of oxygen may relieve
shortness of breath, in many cases, it does not
•treatment for chest infections – such as antibiotics to treat existing infections, and pneumonia and flu
vaccinations to reduce the risk of infections in the future
•pulmonary rehabilitation – these programs consist of an individual assessment followed by supervised
exercise training and education. Programs usually run for about eight weeks and at the end of the
program, there is normally re-assessment and referral to an ongoing maintenance exercise program
such as Lungs in Action (where available)
•surgery – a technique called lung volume reduction surgery is a possible option for a small number of
people with COPD. Affected portions of diseased lung tissue are surgically removed, which allows the
Your post-operation timeline may suggest:
•Within 1 to 3 days after surgery - Within 1 to 3 days after surgery, you will likely be released from
the hospital. Depending on the type of surgery that you had, your doctor may recommend that you
begin moving or completing simple strengthening exercises at the hospital or immediately after release.

•Within one week after surgery - Your surgeon should schedule your first post-operative visit within
one week after surgery. At this visit, you may discuss the next steps in your recovery process, including
starting a more rigorous physical therapy routine.
•Within one month after surgery - Again, depending on the type of surgery, you may be able to start
returning to normal activities. You should be well into your physical therapy at this point and continuing
it for the next several weeks or months.
The vast majority of surgeons are now recommending starting a physical therapy regimen soon after
your operation. Beginning these strengthening exercises on schedule and continuing them can prove
vital to your recovery.
Why Physical Therapy Is Crucial to Your Recovery
After surgery, a person’s muscles can begin to weaken with fatigue losing strength and range of motion.
Physical therapy not only helps you to regain that strength and improve the range of motion, but it also
has several other less obvious benefits.
Benefits of physical therapy after surgery:
•Heal faster - By starting physical therapy immediately after surgery, it can help you heal faster. It is
not only the area where the surgery was completed that can deteriorate; the surrounding muscles can
weaken because of nonuse. Physical therapy works to improve the core, increase stability, mobility,
flexibility, balance, and strength.

•Minimize scar tissue buildup - Scar tissue can quickly form after an injury or because of the surgery