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Overview of Chronic Obstructive Pulmonary Disease

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This condition refers to disorders that affect movement of air into and out of the lungs, with emphysema and chronic bronchitis being the most common disorders. Clients develop limitations of the pulmonary and cardiovascular systems, skeletal muscle dysfunctions, nutritional impairments, and increasing levels of anxiety or fear. Treatment combines medical therapies, medications, oxygen therapy, and rehabilitation programs to control the client's symptoms and to limit progression of the disease. Clients experience dyspnea, leg fatigue, and discomfort with physical exertions, which result in a decrease in activities as the disease progresses. Dyspnea is created by the client's inability to expire air from the lungs.

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Comorbidities to Consider

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  • Clients in advanced stages have signs of deconditioning, respiratory muscle shortening, and lower extremity muscle weakness.1

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Client Examination

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Keys to Examination of Clients

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  • Assess the results of pulmonary function testing to determine levels of airflow limitations; use the reduction of forced expiratory volume as a key measurement for monitoring changes in the disease process.

  • Measure clients' level of dyspnea by using a 0–5 scale.2

  • Before starting exercise testing, assess clients' trunk and rib cage mobility and tolerance for sitting positions.

  • Before starting exercise testing, assess the use of pursed-lip breathing and medications.

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Recommended Baseline Testing of Fitness Levels

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  • A cycle ergometry endurance test is the most common method for assessing cardiopulmonary response to exercises. A 6-minute walk test and treadmill walking have also been used to assess endurance.

  • Strength testing, especially for the quadriceps muscle group, can be assessed with one repetition maximum test using a hand or isokinetic dynamometer.3

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Exercise Prescription

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Type: Cycle ergometer, treadmill walking

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Intensity: Start at low intensities of 50%–60% of work maximums

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Duration: Start at 10–20 minutes

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Frequency: Three times per week

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Getting Started

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Clients with uncontrolled dyspnea will be restricted from participating in an exercise program. Clients with chronically high levels of CO2 (hypercapnia) may respond poorly to exercise activities. Clients with severe congestive heart failure and pulmonary hypertension are not permitted to engage in exercise programs. If a client develops excessive anxiety or mental instability with increasing levels of dyspnea, restrict the client from participating in the exercise program until efforts to control these problems are successful.1 Progress exercise sessions to 30 minutes of continuous exercise.3 Interval training has been used to improve tolerance to physical activities by alternating short bouts of 30–60 seconds of high-intensity cycling, followed by rest of similar length.1 Strength training using low-intensity workloads have used two to four sets of 20 repetitions to improve muscle strength and tolerance to physical activities.2,4 Breathing exercises using hyperventilation while rebreathing CO2...

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