When you begin pulmonary rehabilitation, your healthcare team will do a few tests to see how well your lungs are doing. For example, an exercise stress test measures your oxygen level, heart rate, and other vital signs to inform your team how well your lungs work. Another test — the six-minute walk test — measures how far you can walk in six minutes, informing your health team how much exercise you can tolerate.
Pulmonary rehabilitation can take place at home, in a hospital, or in a clinic. You can work on your own with a clinician, or in a group setting. But wherever you go for pulmonary rehabilitation, your program will include education, exercise, and possibly dietary advice and mental health counseling.
Education
The program will teach you breathing techniques and ways to help you avoid lung exacerbations and get your breathing back on track if it gets too hard.
Lung Function You will learn more about your condition, its symptoms, and how to take your medications, spot flare-ups, quit smoking, and manage your daily tasks.
Oxygen Monitoring If you use oxygen at home, your provider will teach you how to monitor your oxygen levels and use your oxygen tank or concentrator (a machine that transforms the air around you into concentrated oxygen).
Breathing Techniques Certain breathing methods can help you control your breaths and breathe easier. These include pursed-lip breathing, box breathing, and diaphragmatic breathing.
You may also learn techniques to keep your airways clear, like using the “huff cough” method, a coughing technique in which you cough with less force, keeping mucus from getting trapped.
Knowing how to loosen mucus with a positive expiratory pressure (PEP) device or vibrating vest or by moving into a position that helps your lungs drain can help prevent and treat flare-ups.
Counseling
Mental health issues like depression and anxiety can sometimes occur in people with long-term lung disease. For example, people with COPD and mental health disorders experience more acute exacerbations, more frequent readmissions to the hospital, and a higher risk of mortality than those without these conditions. As a part of pulmonary rehabilitation, counseling can help you work through these issues and manage your stress.
Nutritional Support
When it’s harder to breathe, your body may burn up to 10 times more calories than someone with healthy lungs.
Because of this, your nutritionist may recommend increasing or limiting certain foods. If you’re underweight, you can add calories to your diet by adding healthy fats like peanut butter to meals and snacks or stirring a spoonful of olive oil into your hot foods. If you’re overweight, your nutritionist may recommend eating fewer calories each day and adding more exercise to your routine.
In general, they may also suggest consuming more protein and fewer carbohydrates, and eating smaller meals, to help you gain muscle mass.
Exercise
Your healthcare provider will guide you through exercises that will help you build strength over time. Aerobic and strengthening exercises are generally part of the program, as are positioning and flexibility. For example, some positions can help relieve shortness of breath, like the tripod position, in which you sit with your knees apart and lean forward with a hand on each knee.
Depending on your needs and activity level, your provider may help you:
- Do stretching exercises
- Train your respiratory muscles with a breathing device
- Use a stationary bike or treadmill
- Strengthen your upper body and abdominal muscles using weights or resistance bands
Most pulmonary rehabilitation programs prescribe two to three sessions a week for 4 to 12 weeks.
Your healthcare team will monitor your breathing throughout and make adjustments to the frequency and length of your program.
