Home based pulmonary rehab improves physical conditioning, emotional well being and shortness of breath among COPD patients

For COPD patients, proactive self-management is likely the most important success factor in limiting the impact of lung disease symptoms over the long-term. One proven method for improving shortness of breath, physical conditioning and quality of life/sense of well being among COPD patients is a treatment option known as pulmonary rehabilitation. Pulmonary rehabilitation involves guided aerobic and strength training exercise, learning/practicing breathing techniques that are helpful when exerting yourself or managing a shortness of breath event, and nutrition counseling among other activities. Of these elements, the guided exercise is considered the centerpiece of such a program.

However, pulmonary rehab is prescribed to an excruciatingly small slice of the COPD population (1-2%) and is typically only offered for a modest period of time (6-12weeks) before insurance/Medicare reimbursement ceases. At that point, COPD patients who were lucky enough to gain entry to such a program are on their own to self-manage their condition for the rest of their lives. For COPD patients who never gain entry to pulmonary rehab, there are few self-management guidance/support offered to help improve how they feel and slow the progression of lung disease.

We are convinced that COPD patients can employ many of the principles and practices of pulmonary rehabilitation at home or at a local fitness center. It’s the main reason we created our Breathe Better for Life guide and companion CD-ROM (http://www.breathebetterforlife.com/). We examined many pulmonary rehab studies, visited several pulmonary rehab facilities, spoke with a slew of leading pulmonary rehab practitioners & researchers, and reviewed the pulmonary rehab program guidelines established by the two main thoracic medicine societies. From these resources, we constructed an at-home better breathing program that incorporates the key successful elements of pulmonary rehabilitation. Whether you follow our program or one your doctor recommends, we would encourage any COPD patient who either can’t gain access to a hospital based rehab program in their area or who has been discharged from a rehab program to consider implementing a home based or fitness center based pulmonary rehab-style exercise program for the long-term.

For an example of the power of a home-based pulmonary rehab program, we direct your attention to an Egyptian study published earlier this year in the Annals of Thoracic Medicine that showed the dramatic benefits achieved through a home based pulmonary rehab program.

This particular study involved moderate to severe COPD patients who had recently been admitted to a hospital due to an acute exacerbation (doctor-speak for a shortness of breath attack intense enough to require a hospital admission). The researchers split the study subjects into two groups after their medical treatment and discharge from the hospital. One group received what the researchers call “usual standard of care” which typically means patients are sent home with some basic materials and instruction to take better care of themselves and are advised to visit their pulmonologist for periodic follow up visits. The second group was given in-hospital instruction on aerobic & strength training exercises as well as breathing techniques and then asked to self-manage their own at-home pulmonary rehab program every other day over a two month period. The patients in the pulmonary rehab group were not supervised in their at-home programs.

In our view the results were dramatic. In the researcher’s view the results were deemed clinically significant (such a designation means that the degree of observed improvement is large enough to demonstrate efficacy of the studied approach).

After two months, the home-based pulmonary rehab group experienced a 60% improvement in the distance walked in 6 minutes (a standard evaluation measure for assessing COPD patient physical conditioning) while the usual care group experienced a 18% decline in distance walked in 6 minutes. The home-based pulmonary rehab group reported a 66% improvement in perceived shortness of breath while the usual care group reported an 8% improvement. Self-reported improvement in fatigue, energy levels, and emotional well being for the home-based pulmonary rehab group ranged from 48-77% while the usual care group reported 7-13% improvements on the same measures. (Ghanem M, et al. Home-based pulmonary rehabilitation program: Effect on exercise tolerance and quality of life in chronic obstructive pulmonary disease patients. Ann Thorac Med. 2010 Jan; 5(1):18-25)

In our view, this study points out that with some level of instruction/information, a COPD patient can successfully implement a pulmonary rehab program at home. Other, earlier studies have reached similar conclusions.

For COPD patients who do proactively practice self-management techniques such as pulmonary rehab, the health benefits are substantial as another recent study noted, “Current estimates indicate that 70–80% of older individuals living with a chronic condition can reduce disease burden and preventable hospital admissions through the implementation of appropriate self-management. For instance, older adults who have participated in self-management programs experience significantly less dyspnea (shortness of breath attacks) and a 36% reduction in the chance of a hospital admission relating to COPD.” (Warwick M, et al. Self-management and symptom monitoring among older adults with chronic obstructive pulmonary disease. Journal of Advanced Nursing. 2010: 66(4), 784–793)

Therefore, we would encourage you to consider asking your doctor to refer you for admission to a pulmonary rehab program in your area to learn the principles and practices of this valuable therapy option that you can in turn practice for a lifetime.

If you can’t gain admission to a program in your area, ask your doctor to at least recommend an at-home pulmonary rehab-style exercise & nutrition program suited for your particular circumstance. If they can’t help design a program for you, consider visiting a local fitness center and ask to speak to a fitness instructor who is certified in designing exercise programs for people with chronic health conditions. They can not only design a program well suited for your condition, they can also guide you regarding how to do the specific exercises.

To educate yourself more about pulmonary rehab and/or to review our recommended at-home exercise program, consider purchasing our Breathe Better for Life guide and companion CD-ROM by visiting http://www.breathebetterforlife.com/ for ordering information.