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Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Chapter 13
Resistance-Training Strategies for Individuals with Chronic Obstructive
Pulmonary Disease
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
COPD
• Main term for group of respiratory diseases, including:– Asthma
– Emphysema
– Chronic bronchitis
• Progressive diseases
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
COPD
• Impairment quantified by measuring forced expiratory volume in one second (FEV1)
• Refer to Table 13.1
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
COPD Characteristics
• Gradual loss of lung function
• Airflow obstruction
• Dyspnea with exertion
• Weight loss associated with muscle wasting
• Recurrent bronchial infections
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
COPD Characteristics
• Chronic disability
• Reduced quality of life
• Downward spiral of inactivity, social isolation, and disability
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Greater Risk for Comorbidities
• Congestive heart failure
• Osteoporosis
• Diabetes
• Depression and anxiety
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Prevalence of COPD
• Almost 10 million adults have emphysema and/or chronic bronchitis– 3 million men
– 6 million women
• People over age 50 likely to be disabled
• Younger individuals still significantly contribute to economic impact of COPD
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Prevalence of Asthma
• 11 million adults
• 9 million children
• More than 8 million males
• More than 11 million females
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Economic Impact of COPD
• Third major cause of lost work days
• Fourth most common noncommunicable cause of disability
• More than 32 billion dollars spent on associated medical costs
• Costs likely higher due to under-diagnosis
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Etiology of Asthma
• Airway hypersensitivity to allergens (triggers)
• Causes airway inflammation, asthmatic episode (bronchospasm), and mucosal edema
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Etiology of Asthma
• Leads to decreased ventilation, lung perfusion, and respiratory failure
• Lung obstruction usually reduced by pharmacological management
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Signs of Asthma
• Coughing– Includes frequent throat clearing
• Wheezing– Hoarse whistling sound on exhalation
• Shortness of breath
• Chest tightness
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Etiology of Emphysema
• Destruction of alveolar walls and permanent enlargement of airspaces distal to terminal bronchioles, resulting in:– Airflow limitations
– Impaired gas exchange efficiency
– Loss of lung elastic recoil
– Intraluminal pressure
– Loss of small airway patency
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Etiology of Emphysema
• Caused by smoking, occupational exposures, or air pollution
• In early stages, dyspnea during activity
• As disease progresses, dyspnea at rest
• Hypoxia can ultimately cause respiratory failure
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Etiology of Bronchitis
• Hypersecretion of mucus and chronic productive cough– Continues for at least three months per year for two
consecutive years
• Exacerbated by pollution and cigarette smoke
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Etiology of Bronchitis
• Results in:– Decreased exercise tolerance
– Wheezing
– Shortness of breath
– Frequent, productive cough
– Frequent respiratory infections
– Hypoventilation
– Right-sided heart failure
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Benefits of Resistance Training
• Increased muscular strength
• Trabecular bone content
• Glucose tolerance and lean body tissue
• Decreased falls
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Benefits of Resistance Training
• Enhanced ability to handle orthostatic challenges
• Improvements in performing activities of daily living
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Research Supports Resistance Training
• Major theme:– Resistance training is safe, effective modality to
increase strength and improve quality of life
• Individuals can tolerate maximal testing and high-intensity resistance training
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Research Supports Resistance Training
• Safety depends on proper exercise selection, training volumes, and intensities
• Refer to Table 13.2
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Program Design Considerations
• Obtain physician clearance
• Review medical history and medications
• Perform physical assessment with baseline physiological measures:– Heart rate
– Blood pressure
– Body composition
– Oxygen saturation
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Program Design Considerations
• May require supplemental oxygen, oxygen delivery devices, or pulse oximeter
• Record heart rate, blood pressure, and oxygen saturation at rest/during exercise for clients with moderate to severe COPD
• Document goals for rehabilitation and participation
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Exercise Testing Considerations
• 1 RM assessment safe to use– Even on severely deconditioned clients
• Cardiopulmonary responses during 1 RM testing significantly lower than during aerobic exercise at sub-maximal level
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Program Components
• Goal:– Achieve maximal physiologic training effects
• May require modification due to disease severity, limitations, comorbidities, or motivation level
• Include 2 to 4 sets of 6 to 12 repetitions
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Program Components
• Intensities range from 50 to 85 percent of 1 RM
• Exercises should mimic actual movements
• Interval training an appropriate exercise modality
• See sample 24-Week Program
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Increased Risk for Anxiety and Depression
• Include screening as part of initial assessment
• Requires beginning exercise at lower intensity/duration than individual can tolerate
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Increased Risk for Anxiety and Depression
• Mild to moderate levels may improve with pulmonary rehabilitation
• Individuals with significant psychiatric disease require appropriate professional care