The Importance of Pulmonary Rehabilitation

by John R. Goodman BS, RRT, FAARC

In the 1940s hospitals began to develop “cardiac work evaluation units” to evaluate a person’s ability to go back to work. It evolved into our Cardiac Reha- bilitation programs. During and following WW II, manpower needs spurred cardiol- ogists to review the need for absolute bed rest following cardiac events. Well designed studies proved that long-term bed rest de- creased functional capacity, sapped morale, and caused its own set of complications.

A big breakthrough came with the heart attack of President Eisenhower in 1955. His cardiologist prescribed graded exercise to include swimming, walking and golf. At first it was considered dangerous and reckless, but it was so successful it led to the creation of the President’s Fitness Council.

A Short History of Pulmonary Rehab

People in pulmonary rehab tend to be far more diverse and complex, requiring much more individualized professional attention than those in cardiac rehab. In the begin- ning, it was thought that since dyspnea (shortness of breath) on exertion was the major troubling symptom, avoiding dys- pnea was the appropriate way to manage. This would preclude the introduction of any sort of graduated exercise program. It wasn’t until the 1950s that one of the true pioneers of pulmonary medicine, Dr. Alvan Barach, offered a different opinion. He understood the significance of the increased work of breathing people with COPD had to contend with and sought ways to lessen their burden.

An insight into Dr. Barach’s under- standing of the physiology of COPD can be appreciated in this quote from his 1952 paper, “In two patients with pulmonary emphysema in whom dyspnea on exertion was relieved during the inhalation of oxy- gen, an exercise program was instituted with subsequent improvement in capacity to exercise without oxygen.” Dr. Thomas Petty put all the separate components of pulmonary rehabilitation together to establish the modern Pulmonary Rehab De- partment. Dr. Petty published his landmark paper titled, A Comprehensive Care Pro- gram for Chronic Airway Obstruction, in 1969. The program offered individualized education about disease, bronchial hygiene techniques, breathing retraining, physical reconditioning, individualized medication instruction, and the use of oxygen therapy whenever indicated. By 1974 Dr. Petty’s program became the model approved by the American College of Chest Physicians, and in 1980 the American Thoracic Society endorsed pulmonary rehabilitation, defining exercise as an essential component.

The 1980s saw a number of papers pub- lished doubting the value of rehabilitative exercise. It was pointed out that pulmonary rehab could not be shown to improve lung function. Several papers looked for biologic markers that would show improvement in “muscle training” such as may be seen in athletes. No markers could be found and, in the view of some, pulmonary rehab was labeled more of a “touchy-feely” therapy rather than scientifically driven. The 1990s saw a number of investigators doing better targeted studies looking at what  could be measured following completion of a pulmonary rehab program. We now know that pulmonary rehab has both direct and indirect positive effects on people with a variety of pulmonary disease. Pulmonary rehab can be easily defended to show an improvement in dyspnea, exercise tolerance and improvement in health-related quality of life.

Pulmonary rehab is aimed at improving quality of life. What are some of the very realistic expectations a person entering a pulmonary rehab program can expect?

  1. Decreasing respiratory symptoms and their complications;
  2. Encouraging you to self-manage your disease and exert more control over day-to-day functioning;
  3. Improving overall physical condi- tioning and exercise performance;
  4. Improving emotional well-being; and
  5. Reducing hospitalizations for

How Might Pulmonary Rehab Help You?

By attending education classes you will learn many things about your lungs, how they normally work, and how your disease process interferes with the normal working of the lung. Classes on your medications, how to correctly use your inhalers, drug interactions, and when to call your doctor are all normally covered. One of the most important component of pulmonary rehab is the effect of the group dynamic. During group meetings you will meet with other people who have breathing problems. Shar- ing common concerns or asking questions of those who have already “walked a mile in your moccasins” shows all participants that they are in the same boat together. Exercise classes will teach you methods of breathing that will allow you to be more active and less short of breath. Most rehab units look like a well equipped gym. Equip- ment will be utilized to build both your strength and endurance. Exercise classes help you feel better and become stronger by helping you get in shape. This helps with self-image – important to all of us!

In pulmonary rehab you will be taught energy conserving techniques, breathing strategies, and nutritional counseling that will teach you what foods to avoid for eas- ier breathing. Most programs will help you control anxiety or depression, and even help with some of the more personal questions such as your sex life. Pulmonary rehab can’t cure your underlying lung disease, or completely relieve your breathing problems, but it is one of the most important parts of a complete pulmonary program. Ask your family physician or pulmonologist if there is such a program at the hospital where he or she practices. Remember it is important to set realistic goals. A little bit faster on the treadmill each week, and just a little bit farther than the week before. Like losing weight, the hard part is actually starting the program. Once you begin to see and feel the results of your efforts, especially on your breathing, staying with the program becomes easier and easier. In the case of pulmonary rehab, the old maxim “use it or lose it” is most definitely the operative phrase.

Happy and healthy holidays to everyone!

image122-2John R. Goodman, BS, RRT, FAARC,

retired Respiratory Therapist Extra- ordinaire, is enjoying his grandchildren and still helping people with lung problems!