Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 13 Resistance-Training...

Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Chapter 13

Resistance-Training Strategies for Individuals with Chronic Obstructive

Pulmonary Disease


COPD

• Main term for group of respiratory diseases, including:– Asthma

– Emphysema

– Chronic bronchitis

• Progressive diseases


COPD

• Impairment quantified by measuring forced expiratory volume in one second (FEV1)

• Refer to Table 13.1


COPD Characteristics

• Gradual loss of lung function

• Airflow obstruction

• Dyspnea with exertion

• Weight loss associated with muscle wasting

• Recurrent bronchial infections


COPD Characteristics

• Chronic disability

• Reduced quality of life

• Downward spiral of inactivity, social isolation, and disability


Greater Risk for Comorbidities

• Congestive heart failure

• Osteoporosis

• Diabetes

• Depression and anxiety


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


Prevalence of Asthma

• 11 million adults

• 9 million children

• More than 8 million males

• More than 11 million females


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


Etiology of Asthma

• Airway hypersensitivity to allergens (triggers)

• Causes airway inflammation, asthmatic episode (bronchospasm), and mucosal edema


Etiology of Asthma

• Leads to decreased ventilation, lung perfusion, and respiratory failure

• Lung obstruction usually reduced by pharmacological management


Signs of Asthma

• Coughing– Includes frequent throat clearing

• Wheezing– Hoarse whistling sound on exhalation

• Shortness of breath

• Chest tightness


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


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


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


Etiology of Bronchitis

• Results in:– Decreased exercise tolerance

– Wheezing

– Shortness of breath

– Frequent, productive cough

– Frequent respiratory infections

– Hypoventilation

– Right-sided heart failure


Benefits of Resistance Training

• Increased muscular strength

• Trabecular bone content

• Glucose tolerance and lean body tissue

• Decreased falls


Benefits of Resistance Training

• Enhanced ability to handle orthostatic challenges

• Improvements in performing activities of daily living


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


Research Supports Resistance Training

• Safety depends on proper exercise selection, training volumes, and intensities

• Refer to Table 13.2


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


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


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


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


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


Increased Risk for Anxiety and Depression

• Include screening as part of initial assessment

• Requires beginning exercise at lower intensity/duration than individual can tolerate


Increased Risk for Anxiety and Depression

• Mild to moderate levels may improve with pulmonary rehabilitation

• Individuals with significant psychiatric disease require appropriate professional care

Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 13 Resistance-Training...

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