Uptatonummolor - St George's Hospital



Pulmonary rehabilitation

Programme booklet

This booklet is for people who are due to start a pulmonary rehabilitation programme. It offers information about what pulmonary rehabilitation is and how it can help improve your breathing and level of exercise.

What is the pulmonary rehabilitation programme?

Pulmonary rehabilitation is a programme of exercise and education designed to help patients with chest disease become and remain as independent as possible.

Patients with chest disease may become less able to exercise or function independently because of shortness of breath. Pulmonary rehabilitation therefore aims to:

• reduce breathlessness

• increase exercise ability

• improve functional ability

• increase your knowledge and understanding of your lung condition

• decrease anxiety that may be related to your condition.

Research shows that patients who attend a pulmonary rehabilitation programme make significant improvements in:

• walking longer distances

• carrying out activities at home

• their general health.

Exercising to increase activity and function

Why do I become breathless?

If you become breathless when doing specific activities, it is likely that you will do less of this activity because your breathing is limiting you. This means that your muscles become deconditioned and unfit. You can therefore become more breathless as a result of being unfit. This is sometimes called the spiral of deconditioning.

Fig. 1 The spiral of deconditioning

Exercising at the correct level will improve your fitness and the level of activity you are able to do.

What are the benefits of exercise?

The benefits of doing exercise are felt in all areas of the body, including the heart, lungs, muscle strength and the immune system. There are also psychological benefits.

Cardiovascular benefits include an increase in the number of capillaries to the muscles and more red blood cells carrying oxygen. The heart becomes stronger and more efficient at pumping blood and oxygen around the body. This can help lower your blood pressure and help lower cholesterol, which in turn can help reduce body fat and improve weight control.

Exercising can have a positive effect on how breathless you feel. For example after a period of exercising regularly you may be able to walk the same distance but feel less breathless than before. Exercising can also help clear phlegm by increasing the amount of breath taken in.

Exercising can also be beneficial for your overall health. It can improve muscle strength by increasing the number and size of muscle fibres. This enhances functional ability and balance. Exercise also helps to prevent or limit the development of osteoporosis (brittle bones) by maintaining bone strength. Continued exercise can improve immune defence against infections.

Psychological benefits include an increase in self-belief and confidence that you can do things you did not think you could. A chemical release of endorphins after 30 minutes of exercise can also have a pain decreasing effect which can last several hours. Finally, exercise can help improve the quality and length of your sleep.

If you exercise on a regular basis the benefits will continue for a period of time. However, if you stop exercising for a prolonged period these effects will stop, so it is important to continue exercising after you complete the pulmonary rehabilitation programme.

Tips for exercising

• Dress in comfortable clothes and shoes that support your feet.

• If you have a salbutamol inhaler, use it 20 to 30 minutes before you exercise.

• If you have long-term oxygen, use this while you are exercising.

• Use music to keep you motivated and entertained.

• Keep a record of your activity and reward yourself at special milestones.

You should stop exercising and rest if:

• you feel severely short of breath or unusually short of breath

• you feel a sudden onset of chest pain

• you feel dizzy or faint

• you have muscle cramps.

Measuring your effort using the BORG Scale of Breathlessness

While exercising it is important to rate your perception (feeling) of breathlessness. The BORG scale overleaf can help you measure how breathless you are feeling at any particular point. The scale can be used during the exercise session and/or at home when exercising or doing tasks that make you work hard. We will ask you to use the BORG Scale to rate your breathlessness at the start of and during each exercise session. Think about how breathless you feel while you are exercising, then pick a number and word on the scale that best describes how your breathing feels.

Fig. 2 The BORG Scale of Breathlessness

When exercising you should feel no more than moderate to somewhat severe breathlessness (3 to 4 on the BORG scale). If your breathing feels severe or higher (5 or higher) then you are working too hard and need to slow down or stop until you recover.

The FITT Principle

The FITT Principle is a set of guidelines that help you set up an exercise routine to fit your goals and fitness level while helping you get the most out of your exercise program. FITT stands for:

Frequency – The aim is to be exercising between two and five times a week. You are attending the pulmonary rehabilitation group twice a week so this can be included in your amount. Try to fit in at least one more session a week in your own time.

Intensity – Using the BORG scale as a guide, you should be aiming for levels 3 to 4 (slightly breathless to moderately hard). Another way of thinking about it is to imagine you are speaking to someone whilst you are exercising – you should feel slightly breathless but able to speak in full sentences. If you are not able to speak in full sentences, it’s likely that you’re working too hard.

Time – You should be aiming to do at least 20 to 30 minutes of exercise plus a warm up of 5 to10 minutes and a cool down period of 5 minutes. For example, begin with a slower period of exercise, building up to a longer period of the main exercise, then end with a slower period of exercise and some stretches. The structure of your workout will be demonstrated to you in your exercise sessions.

Type – You should be aiming to participate in activities that use the large muscle groups, especially the leg muscles, in rhythmical, continuous movements. Such activities may include walking, cycling, and climbing the stairs.

If you are unable to exercise for 20 to 30 minutes continuously, you can divide this into shorter periods of exercise, such as 10 to 15 minutes twice a day.

Remember, any exercise is better than none!

Hard-to-breathe days

On warm or humid days, reduce your exercise and rest more often. Drink plenty of fluids to keep yourself hydrated.

On cold days, keep your airways warm and breathe through a scarf.

If air quality is poor and makes you more breathless, exercise inside.

How do I progress?

If an exercise becomes too easy and you feel you are not working hard enough, you can do the following to progress your exercises:

• Increase the time or number of repetitions you are doing in an exercise.

• Increase the distance you are walking or walk at a faster pace.

• Increase the weight you are using.

Your physiotherapist can provide you with a diary so that you can monitor your progress.

Remember to rest and recover using breathing control (see page 9) between each exercise.

Management of your breathlessness

If you are experiencing breathlessness over a continued period of time, you may have got into the habit of overusing your upper chest whilst breathing. You can reduce the effort of breathing by relaxing the upper chest and using your lower chest and your diaphragm for breathing instead.

This can be achieved using positioning and a technique called breathing control (see overleaf).

Positioning

Below are some of the best positions for using your lower chest and diaphragm for breathing.

Breathing control

Breathing control or diaphragmatic breathing can help reduce the work of breathing by re-learning to breathe in the correct pattern.

1. Begin in a sitting position and make sure that you are well supported.

2. Breathe out gently and at the same time relax your shoulders and upper chest.

3. Place a hand on your upper abdomen, breathe in, and feel a slight expansion of the lower ribs and upper abdomen. It will give you a feeling of breathing around the waist. Try and breathe in through your nose and out through your mouth.

Once you have practised breathing control in a sitting position, you can use it during activity (for example, when walking) and when you feel breathless. It will help you to gain control over your breathing.

Pursed lip breathing

This technique can make you breathe out better. You can use this technique at rest or when you are on the move and being active.

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Controlling your breathing during exercise and activities of daily living

Use your breathing control by breathing from your diaphragm during activity and when you are recovering from activity.

When performing tasks, concentrate on keeping your breathing even and rhythmical. Breathing out as you are doing an activity can help to control your breathing. This is sometimes called 'blow as you go'.

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Remember:

• Pace yourself – break tasks up into smaller steps.

• Positioning – if you can do an activity sitting but not standing, use a chair so that you feel more supported.

Managing an exacerbation

What is an exacerbation?

An exacerbation is a worsening of your respiratory symptoms, such as:

• an increase in your shortness of breath

• a change in your sputum volume compared to normal

• a change in the stickiness of your sputum which may make it more difficult to clear.

Do I have an infection?

Your condition can be exacerbated by illness, such as an infection. Below are some signs and symptoms of a chest infection. You may experience some or all of these symptoms:

• General feeling of being unwell

• Lethargy

• Increased sputum production (change in amount)

• Thicker sputum

• Darker sputum (change in colour)

• Increased shortness of breath

• Increased temperature

• Any of the above following an upper respiratory tract infection (flu, sore throat, sinus infection, runny nose)

If you think you may have an infection, contact your GP or your respiratory nurse for an appointment so that they can review your symptoms and provide appropriate treatment. This may include antibiotics or a course of steroids.

If you are severely unwell and short of breath, you should call 999 for an ambulance.

Top tips for visits to the doctor or chest clinic

• Always prepare a list of subjects that you want to discuss. Keep it to two or three vital ones.

• Before your visit, think through all the information you believe your doctor needs to know. This may include:

o when the symptoms started,

o how they have changed

o how they are affecting your life

o how you actually feel.

• Take a friend or relative with you if this will make you feel more comfortable.

• Take a copy of your prescription with you to each appointment, so that the doctor will know all of your medications and what doses you take.

• Listen to what the doctor says. If you do not understand, or you feel they have not answered your questions, ask.

• Note down all the points in writing, or ask for a copy of any letters to be forwarded to you so you have a record of your appointments.

• Check your list of questions at the end to make sure all the points have been covered.

• Remember, do not be afraid to say how you really feel – after all, you are the only person who knows!

Medications to help with your breathing

Inhalers

If an inhaler is prescribed for you, your GP, practice nurse or pharmacist will explain how to use it.

In the treatment of COPD, the drugs inside inhalers can be grouped as follows:

• short-acting bronchodilators

• long-acting bronchodilators

• steroids

There are different brands of some types of inhaler made by different companies, which may be a little confusing. Also, for some drugs there are different inhaler devices that deliver the same drug.

Short-acting bronchodilator inhalers – Short-acting bronchodilator inhalers deliver a small dose of medicine directly to your lungs, causing the muscles in your airways to relax and open up (bronchodilate). They also prevent hyperinflation (overexpansion) of your lungs.

There are two types of short-acting bronchodilator inhalers:

• beta-2 agonist inhalers, such as salbutamol and terbutaline

• anticholinergic inhalers, such as ipratropium and oxitropium

For people with mild COPD symptoms, one bronchodilator inhaler used as and when you feel breathless may be enough to relieve the symptoms.

For other people, it may be necessary to use one of each type of bronchodilator.

Long-acting bronchodilator inhalers – If a short-acting bronchodilator inhaler does not help to relieve your symptoms, your GP or respiratory nurse may recommend a long-acting bronchodilator inhaler. These work in a similar way to the short-acting bronchodilators, but each dose lasts for at least 12 hours.

There are two types of long-acting bronchodilator inhalers:

• beta-2 agonist inhalers, such as salmeterol and formoterol

• anticholinergic inhalers, such as tiotropium

Steroid inhalers – A steroid inhaler may help in addition to a bronchodilator inhaler if you have more severe COPD or regular flare-ups (exacerbations) of symptoms. Steroids reduce inflammation. There are several brands of steroid inhaler. A steroid inhaler may not have much effect on your 'usual' symptoms, but may help to prevent flare-ups.

Medicines

Mucolytic tablets or capsules – Mucolytics, such as carbocysteine, make the mucus and phlegm in your chest thinner and easier to cough up. They are particularly beneficial for people with moderate and severe COPD, who have frequent or bad flare-ups.

Antibiotics and steroid tablets – If you have a chest infection, your GP may prescribe a short course of antibiotics. If you have a bad flare-up, a short course of steroid tablets may also be prescribed for one or two weeks. They work best if they are taken as the flare-up starts, so your GP may give you a course to keep at home.

Remember, if you are taking medications and you do not know what they are for, discuss this with your GP or pharmacist.

Inhaler technique

Aerosol inhalers (metered dose inhaler)

The drug is in a metal canister where it is mixed with a liquid propellant. Each time the canister is pushed down, a set dose of the drug is dispensed in a fine mist which the patient breathes in. It requires good coordination and a good technique. They are most effective when used with a spacer device, which makes the inhaler easier to use.

How to use a metered dose inhaler

1. Remove the cap and shake the inhaler.

2. Breathe out gently.

3. Put the mouthpiece in your mouth, breathe in slowly and press the canister down as you continue to inhale deeply.

4. Hold your breath for 10 seconds, or as long as possible, then breathe out slowly.

5. Wait for 30 seconds before repeating steps 2 to 4.

How to use a spacer device (such as Volumatic)

There are two key techniques for using a spacer – the multiple breath technique and the single breath technique.

Multiple breath technique

1. Remove the cap of the inhaler, shake well and insert into the spacer device.

2. Put the mouthpiece of the spacer in your mouth.

3. Start breathing in and out slowly and gently. This will make a clicking sound as the valve opens and closes.

4. Once a breathing pattern is well established, press the canister down and leave the device in same position as you continue to breathe (tidal breathing) several more times.

5. Remove the device from your mouth.

6. Wait about 30 seconds before repeating steps 1 to 5.

Single breath technique

1. Remove the cap of the inhaler, shake well and insert into the spacer device.

2. Put the mouthpiece of the spacer in your mouth.

3. Press the canister once to release a dose of the drug.

4. Breath in slowly and deeply.

5. Hold your breath for about 10 seconds, and then breathe out through the mouthpiece.

6. Breathe in again, but do not press the canister.

7. Remove the device from your mouth and breathe out.

8. Wait about 30 seconds before repeating steps 2 to 7.

How to use the Aerochamber

1. Remove the cap of the inhaler.

2. Shake the inhaler and insert into the back of the Aerochamber

3. Place the mouthpiece of the Aeroinhaler in your mouth (or the mask over your mouth and nose)

4. Press the canister once to release a dose of the drug.

5. Breath in slowly and deeply (if you hear a whistling sound, you are breathing in too quickly).

6. Hold your breath for about ten seconds, and then breathe out through the mouthpiece.

7. Breathe in again but do not press canister.

8. Remove the mouthpiece from your mouth and breathe out.

9. Wait 30 seconds before repeating steps 2 to 8.

Breath-activated inhalers

Breath-activated inhalers are inhalers that automatically release a spray of medication when the person begins to inhale.

How to use the Easi-breathe

1. Shake the inhaler.

2. Hold the inhaler upright and open the cap.

3. Breathe out gently, and keeping the inhaler upright, put the mouthpiece in your mouth and close your lips and teeth around it (the air holes on the top must not be blocked by the hand).

4. Breathe in steadily through the mouthpiece. Do not stop breathing when the inhaler puffs and continue taking a really deep breath.

5. Hold your breath for about ten seconds and then exhale.

6. After use, hold the inhaler upright and immediately close the cap.

7. For a second dose, wait 30 seconds before repeating steps 1 to 6.

Dry powder devices (Accuhaler, Turbohaler, Diskhaler, Rotahaler)

These inhalers contain no propellant. The medication is in dry powder form inside a small capsule, disk or a compartment inside the inhaler. Dry powder devices are easy to use, although some people find that loading the capsules can be a bit fiddly.

Some devices contain a set number of doses inside the device and a counter indicating the number of doses left.

How to use the Accuhaler

1. Open the Accuhaler using the thumb grip.

2. Holding it horizontally, load the dose by sliding the lever until it clicks.

3. Breathe out gently away from mouthpiece, then place the mouthpiece in your mouth and seal your lips before breathing in steadily and deeply.

4. Hold your breath for about 10 seconds or for as long as is comfortable.

5. While holding your breath, remove the inhaler from your mouth. Breathe out gently away from the mouthpiece. Close the cover to click shut.

6. For a second dose, wait 30 seconds before repeating steps 1 to 5.

How to use the Turbohaler

1. Unscrew and lift off the white cover. Hold the Turbohaler upright and twist the grip forwards and backwards as far as it will go. You should hear a click.

2. Breathe out gently, put the mouthpiece between your lips and breathe in as deeply as possible. Even when a full dose is taken there may be no taste.

3. Remove the turbohaler from your mouth and hold your breath for about 10 seconds. Replace the white cover.

How to use the Handihaler

1. Open the dust cap by pulling it upwards. Then open the mouthpiece.

2. Remove a Spiriva capsule from the blister (only immediately before use) and place the Spiriva capsule in the centre chamber. It does not matter which way the capsule is placed in the chamber.

3. Close the mouthpiece firmly until you hear a click, leaving the dust cap open.

4. Hold the Handihaler with the mouthpiece upwards. Press down firmly on the green piercing button and then release.

5. Breathe out completely (you should avoid breathing into the mouthpiece at anytime).

6. Raise the Handihaler to your mouth and close your lips tightly around the mouthpiece. Keep your head in an upright position and breathe in slowly and deeply but quickly enough to hear the capsule vibrate. Breathe in until your lungs are full, then hold your breath for as long as is comfortable, taking the Handihaler out of your mouth at the same time.

7. Resume normal breathing.

8. Repeat steps 5 and 6 once more – this will empty the capsule completely.

9. Open the mouthpiece again. Tip out the used capsule and dispose.

Remember, if you are unsure of how to use your inhaler or are having problems with coordination, please discuss this with your doctor, pharmacist or respiratory nurse. There may be a different inhaler type which would be more suitable for you.

Clearing your chest

Due to the damage to your lungs, you may produce more mucus and may have difficulty clearing the phlegm from your chest. If you do not clear this phlegm, you are more likely to have recurrent chest infections.

Breathing exercises can assist in clearing this phlegm, which can reduce the number of chest infections you have.

Breathing exercises

There is no set position for completing your breathing exercises. You will initially be taught how to do them in a sitting position but your position can be modified to whatever best assists you in clearing the phlegm.

The length of time and frequency for which you need to do your breathing exercises will also vary. It depends on how easily you can clear secretions, the amount of secretions present, and the time of day when you have secretions.

This is covered in more depth during the education sessions, however if you want to ask any questions individually, please discuss these with your physiotherapist.

Stress and relaxation

What is stress?

Moderate anxiety or stress levels are normal. Stress is a fact of living in society today. It is essential for coping with the sudden demands that we face. It also helps us to respond to challenges.

Stress affects the way we behave, feel and perform. Everyone is affected in different ways depending on their view of the situation.

Stress becomes a problem when it is so excessive or prolonged that it becomes a way of life. It can lead to mental, emotional and physical fatigue.

Being aware of the things that make us stressed is essential for managing our stress. We all need to develop a way of relaxing and coping with stress. Some people find that regular exercise, getting absorbed in a hobby or listening to music can help.

How relaxation works

Most people are more tense than they realise. Real relaxation, both mental and physical, means more than simply sitting down and taking it easy for a moment.

Research has shown that some forms of relaxation will reduce respiratory rate, heart rate and can reduce blood pressure, which is why it can be used in people with many medical problems.

Relaxation works by enabling people to remain physically and mentally detached in stressful circumstances. Relaxation is a skill that can be learnt. It is essentially about teaching the body to use areas that can be controlled to affect those that cannot (for example, teaching muscles to relax can affect deeper systems of the body such as the digestion). This then becomes a natural way of being.

Techniques

1. Relaxation checklist - if you look relaxed, you feel relaxed. Try working through the following:

• Feet… resting with toes lying free

• Hands… fingers gently curled

• Body… without movement

• Shoulders… dropped and level

• Head… still and facing forwards

• Mouth… teeth separated, lips unpursed

• Throat… loose

• Breathing… slow and gentle

• Voice… no sound

2. The panic hand

• Recognise that you are feeling increasingly stressed

• Sigh out

• Breath in gently

• Breath out gently for a little longer

• Stretch fingers and wrist fully then let them relax

3. Breathing control

By consciously slowing your breathing rate down it is possible to reduce the sense of panic and stress.

In a comfortable position and in a quiet place, spend 10 minutes practicing breathing control:

• Let your attention focus on your abdomen (tummy).

• Feel it swell as you breathe in and sink as you breathe out (try placing your hands on your tummy to feel).

• Keep the breathing as gentle and slow as you can.

If you feel that stress is affecting your life and you are not able to cope please speak to your physiotherapist, your respiratory nurse or your GP for further help or advice.

Energy conservation and pacing

Why is energy conservation important?

In people with COPD the lungs are less efficient in meeting the body’s demand for oxygen. As a result, the body’s energy supplies become more limited, meaning that a person with COPD can become more tired or short of breath with normal activity. By learning to conserve energy, you will be able to perform many activities with less effort and shortness of breath.

Top tips for energy conservation

1. Organise your daily routine and activities:

• Plan a daily activity schedule alternating with heavy and light tasks. Also eliminate unnecessary steps of a task where possible.

• Gather and arrange any necessary supplies or tools for daily activities before you start.

• Have sufficient rest after completing a task and before moving onto the next one.

2. Use appropriate tools to simplify activities:

• Use modern household utensils or electric appliances to save energy. This may include non-stick kitchenware, electric can openers, a microwave oven and so on.

• Use assistive devices, such as long-handled grabbers to minimise the need to stoop or bend over when retrieving objects from the floor.

• Use wheeled trolleys to assist pushing and carrying heavy objects.

3. Pace yourself:

• Allow ample time to finish an activity, keep a slow and steady pace and do not rush.

• Pay attention to how your body feels – rest before you are exhausted.

4. Avoid tiring yourself out and awkward posture that may impair breathing:

• Sit down for your activities whenever possible.

• Avoid tasks that required prolonged standing, squatting or stooping.

5. Use proper body mechanics:

• Keep your body straight while performing a task. Poor posture consumes more energy.

• Keep your arms straight and close to your body while carrying objects and spread the load between both arms at the same time.

• Support your elbows on a table or a firm surface while performing task such as shaving or peeling vegetables. This will help you to avoid positions that make you tired.

Your GP may be able to refer you to the community occupational therapy service for help obtaining energy conservation equipment.

Continence and COPD

Why do you need to know about incontinence?

Incontinence (being unable to hold your urine/faeces) and other complaints of a weak pelvic floor are a common problem for many people with COPD and other chronic lung conditions.

What is the pelvic floor?

The pelvic floor is made up of layers of muscle and other tissues.

The pelvic floor holds up and supports the organs in the pelvis, including the bladder, the bowel, the uterus (womb) in women and the prostate in men. Its purpose is to control bladder and bowel function. When the pelvic floor muscles contract, they protect the bladder, the bowel and the uterus during daily activities and from the pressures of coughing and sneezing.

Contraction of the pelvic floor muscles is important in preventing urgency (the urgent need to go to the toilet), incontinence (the leakage of urine or faeces) and constipation. The pelvic floor muscles also contribute towards good posture.

There are a number of things that can make the pelvic floor muscles weak, including:

• chronic coughing

• pregnancy and childbirth

• continual straining to empty bowels (constipation)

• heavy lifting

• being overweight

• being unfit

• changes in hormone levels at menopause.

What are the symptoms of a weak pelvic floor?

If you suffer from any of the following complaints, you may have a weak pelvic floor:

• Urgency (a sudden and urgent need to go to the toilet and an inability to ‘hold on’)

• Incontinence (a leakage of urine or faeces from the bladder or bowel)

• Stress incontinence (a small leakage of urine from the bladder when the pelvic floor is stressed by activity, such as coughing, laughing, sneezing, straining, lifting, jumping, running or doing exercise)

• Constipation or straining (the inability to defecate without great effort)

• Frequency (the need to go to the toilet frequently, which indicates an inability to ‘hold on’)

• Other symptoms (such as vaginal wind or an inability to keep tampons in place)

What can I do to strengthen my pelvic floor?

A weak pelvic floor cannot do its job properly. Research has shown that the pelvic floor responds to regular exercise. In fact, the sooner you start pelvic floor exercises, the better your chance of preventing or overcoming many of the problems associated with a weak pelvic floor.

With practice, pelvic floor exercises can be done anywhere, but you may find is easier to learn the exercises in the following position:

1. Sit on a chair, toilet seat or toilet lid with your feet flat on the floor and your legs slightly apart. Lean forwards, resting your elbows on your knees.

2. Close and draw up the muscles around your back passage, as if you are trying to stop passing wind. Make sure that you do not contract your buttock muscles while you do this.

3. Now close and draw up the muscles around your vagina and urethra, as though you are trying to stop the flow of urine.

4. Hold for a count of five, trying to breathe normally. Then slowly relax and let go.

5. Repeat five times in total.

What are good bladder and bowel habits?

Going to the toilet between four and six times a day and no more than twice at night is normal.

Some simple steps to keep your bladder and bowel healthy

• Try to drink at least six to eight cups (one and a half litres) of fluid a day, unless advised otherwise by your doctor).

• Limit the amount of caffeine (for example, coffee, cola and tea) and alcohol you drink as these drinks irritate the bladder.

• Try to go to the toilet only when your bladder is full and you need to go (emptying your bladder before going to bed is fine).

• Take your time when urinating so that your bladder can empty completely.

• Keep your bowels regular and avoid constipation.

• Keep your pelvic floor muscles in good condition.

If you are worried about incontinence, speak to your GP or continence advisor who may be able to refer you to an appropriate service.

Life after pulmonary rehabilitation

So what happens after pulmonary rehabilitation?

After you complete your course of pulmonary rehabilitation, you should be feeling fitter, less short of breath on exertion or just better at managing your breathlessness. Hopefully you will have a better idea of your exercise abilities and know when you are able to push yourself a bit further.

If you are not feeling these benefits just yet, don’t give up! It may be that you need to continue for a while longer before you begin to feel some improvements.

In order to maintain the benefits you need to continue exercising on a regular basis.

Many boroughs offer further exercise classes within local leisure centres, which can be accessed at a reduced cost. These can be especially good if you need some additional motivation to continue exercising.

Other people prefer to exercise independently, either continuing the exercises learnt in the class or with regular walks, which can be done through an organised group such as “Walk for Life” or on your own. There are many areas nearby that are easily accessible to all and where you can walk whatever distance you can manage.

Remember, everyone can do some exercise, however little that may be!

Notes

Contact us

If you have any further questions or concerns, please speak to the community respiratory physiotherapist on 020 8725 3016.

Additional services

Patient Advice and Liaison Service (PALS)

PALS can offer you on-the-spot advice and information when you have comments or concerns about our services or the care you have received. You can visit the PALS office between 9am and 5pm, Monday to Friday in the main corridor between Grosvenor and Lanesborough Wing (near the lift foyer).

Tel: 020 8725 2453 Email: pals@stgeorges.nhs.uk

NHS Choices

NHS Choices provides online information and guidance on all aspects of health and healthcare, to help you make decisions about your health.

Web: nhs.uk

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Muscles become unfit & decondition

Breathlessness increases

Become less active

Less unfit

Breathless

Less activity

Muscles become unfit and deconditioned

Breathlessness increases

Become less active

More unfit

0 Nothing at all

0.5 Very, very slight (just noticeable)

1 Very slight

2 Slight

3 Moderate

4 Somewhat severe

5. Severe

6.

7 Very severe

8

9 Very, very severe (almost maximal)

10 Maximal

Leaning forwards onto your knees or onto a table when seated

Leaning forwards onto a window ledge or back of a chair

Leaning backwards against a wall

Normal/relaxed breathing (10–30 seconds)

[pic]

Take a deep breath and hold for four seconds

(Repeat three or four times)

[pic]

Normal/relaxed breathing (10–30 seconds)

[pic]

Take a deep breath and hold for four seconds

(Repeat three or four times)

[pic]

Normal/relaxed breathing (10–30 seconds)

[pic]

One or two huffs

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Cough (only if phlegm is ready to come up)

Reference: THE_PRE_01 Published: July 2015 Review date: July 2017

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