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Waiting to Inhale: Exercising to Reduce Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program Coordinator of Cardiovascular and Pulmonary Clinical Residency Department Of Rehabilitation Services, Brigham & Women’s Hospital Clinical Instructor or Adjunct Faculty: Northeastern University, Boston, MA, University Of Massachusetts Lowell, Lowell,MA, Springfield College, Springfield, MA.

Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

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Page 1: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

Waiting to Inhale: Exercising to Reduce Shortness of Breath

Paul Ricard, PT, DPT, CCS

Clinical SpecialistLead Therapist Pulmonary Thoracic Team

Program Coordinator of Cardiovascular and Pulmonary Clinical Residency

Department Of Rehabilitation Services, Brigham & Women’s Hospital

Clinical Instructor or Adjunct Faculty:Northeastern University, Boston, MA,

University Of Massachusetts Lowell, Lowell,MA, Springfield College, Springfield, MA.

Page 2: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 3: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

IS HE CRAZY?!

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 4: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

Exercise “freak”

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 5: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

But I Can’t Train/Exercise…

It’s boringI’m too short of breathI’m not seeing any improvementI don’t know what I’m doingI don’t have time______________

Fill In The Blank

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 6: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

START TRAINING FOR LIFE!!

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 7: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

Metabolic Equivalence

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 8: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

Remember it is not the years of your life that matter but the life in your years. This is what I train for.

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 9: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

Is It Magic?

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 10: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

Three Forms of Training Your Body

AEROBIC

STRENGTHENING

STRETCHING

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 11: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

Aerobic Training

Regular performance of exercise that involves the large muscle groups on a rhythmic and repetitive basis 20 to 30 minutes a day for three times a week.

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 12: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

What are Aerobic Exercises

WalkingRowingSwimmingJumping RopeDancingJogging

HikingLine DancingBicyclingCross Country SkiingMowing the lawn

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 13: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

What are Not Aerobic Exercises?

Surfing the net.Watching the T.V.Walking to the refrigerator.Riding a golf cart.Heavy lifting. Hitting balls at the driving range.

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 14: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

No Time to Train?

Think in intervalsThose who exercised a total of 30 minutes a day but in 10 or 15 minutes at a time reaped the same benefits as one who exercised 30 minutes all at once.

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 15: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

Self Monitoring Aerobic Training

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 16: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

Strength Training

But I don’t want to get too big…

http://zaiworld.wordpress.com/2011/06/22/Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 17: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

But Why Strength Training?

Aerobic training alone has revealed only modest exercise and activity tolerance. Strength training is a useful method for improving oxygen consumption.

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 18: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

Furthermore…

Exercise limitations have been shown to originate from skeletal muscle dysfunction rather than from the cardiopulmonary system.

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 19: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

What Does Strength Training Look Like?

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 20: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

But Stretching Is Beneficial Too You Say?

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 21: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

Stretch to Increase Range of Motion

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 22: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

Stretching Is Not…

http://kodjoworkout.com/2012/01/the-health-benefits-of-yoga/

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 23: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

Stretching Is Also

http://preservebristol.blogspot.com/2011/01/chair-yoga-for-seniors-on-fridays-at.html

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 24: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

Questions?

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 25: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

Breathing Can Be Relaxing Too

Diaphragmatic breathing

http://www.lung.ca/diseases-maladies/copd-mpoc/breathing-respiration/index_e.php

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 26: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

Respiratory MusclesPaul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 27: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

Breathe

Action of the Respiratory Muscles

Stabilize Trunk

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 28: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

Stretch to Increase Range of Motion

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 29: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

Muscles Help You Breathe In

Personal photograph donated by Dr. Sean Collins 2010

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 30: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

And We Can Train Them Too!

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-86502007000200004

http://www.thegearcaster.com/the_gearcaster/2009/10/powerbreathe-kinetic-inspiratory-muscle-training.html

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 31: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

But This Training Thing Is Still Boring

Mix it upVarying the mode of exercise during the week has been shown to improve adherence to exercise programs.

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 32: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

When Can I Stop Having To Train Myself?

Without ongoing exercise training and maintenance, function and quality of life will decline.

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 33: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

Lifelong Friends, Lifelong Practice

Pulmonary rehabilitation should, therefore, be lifelong and be supported and promoted by all members of the health care team.

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 34: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

And for those of you who say it’s an age thing…

French cyclist breaks age group record for The Hour - three months after his 100th birthday

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012

Page 35: Waiting to Inhale: Exercising to Reduce Shortness of Breath€¦ · Shortness of Breath Paul Ricard, PT, DPT, CCS Clinical Specialist Lead Therapist Pulmonary Thoracic Team Program

Thank You & Questions

Paul Ricard, PT,DPT,CCS

[email protected]

www.brighamandwomens.org/rehabilitationservices

Paul Ricard, PT, DPT, CCSBrigham and Women’s Hospital, 2012