Pulmonary System and Exercise

Cough Wheeze Sputum Shortness of Breath History of exposure to smoking,

pollution, etc Spirometry impairment

INSPIRATION AND EXPIRATION

Pulmonary Diffusion

Respiration

INTERNAL Respiration — Gas exchange between the blood and tissues

Pulmonary diffusion — exchange of oxygen and carbon dioxide between the lungs and the blood

Pulmonary ventilation — inflow and outflow of air between the lugs and atmosphere

EXTERNAL Respiration

Any disease or disorder where lung function is impaired.

1. Obstructive Lung Disease -- a narrowing or blockage of the airways a decrease exhaled air flow- asthma, emphysema, and chronic bronchitis.

2. Restrictive lung disease -- a loss of lung compliance / elasticity of the lungs themselves or problem expanding decrease in the total lungs volume- Pneumonia, Cancer

3. Vascular Defect – decrease ability lung tissue to move oxygen to blood

Chronic Obstructive Pulmonary Disease (COPD)

Disease Cause

Asthma Constriction airways

Bronchitis secretion Excess mucus

Emphysema Destruction of alveoli

Causes of COPDCauses of COPDNOXIOUS AGENT

(tobacco smoke, pollutants, occupational agent)

Inflammation

Airway inflammation

Airway remodeling

COPD

Genetic factors

Respiratory infection

Other

Asthma• Airway narrowing due to inflammation (bronchial hyperresponsiveness) airflow obstruction “ bronchoconstriction”

Less Constricted More constricted

Bronchitis•Inflammation or thickened bronchial walls within the lungs due to secretion of fluids

•acute: infection•Chronic: +3 months to year

EMPHYSEMA

Loss of elasticity in the aveoli

Associated with exposure to toxic chemicals & long-term exposure to tobacco smoke.

RESTRICTIVE DISEASE

Disease Cause

Scoliosis Skeletal Origins

Pulmonary Edema Plural

Paralysis Neuromuscular

Pneumonia Alveolar blockage

Cancer or Fibrotic  Lung Scarring or loss of tissue function  

Reversible Accumulation of inflammatory cells, mucus,

in bronchi Smooth muscle contraction in airways Increase functioning with dynamic

hyperinflation during exercise Irreversible

Fibrosis and narrowing of the airways Loss of elastic recoil due to alveolar

destruction Destruction of alveolar support that maintains

patency of small airways

PULMONARY DISEASE

• Obstructive• Flow

• Restrictive• Volume

PULMONARY FUNCTIONS

PULMONARY FUNCTIONS

Diagnosis Restrictive Disease ( Vol)

Normal > 80% of predicted VC

Mild 60 to 75% of predicted VC

Moderate 50 to 60% of predicted VC

Severe < 50% of predicted VC

Diagnosis Obstructive Disease ( Flow)

Normal > 80% of predicted FEV1

Mild 60 to 70% of predicted FEV1

Moderate 40 to 59% of predicted FEV1

Severe < 40% of predicted FEV1

Diagnosis SaO2

Average 95-100%

Normal 96 – 98 %

Low <92%

Dysfunction < 88 %--need supplemental O2

% of oxygen bound to hemoglobin Measures for Hypoxia (decreased O2)

Hypoxic – not enough supply of 02 Anemic Hypoxia – not enough HGB

Men VC = 0.1626*Height(inches) - 0.031*Age(years) -

5.335

Women VC = 0.1321*Height(inches) - 0.018*Age(years) -

4.360

http://www.hopkinsmedicine.org/pftlab/predeqns.html

White males 15-79 years (Cherniack, 1972) = (0.09107 * (height in inches)) - (0.0232 * (age in years)) -

1.50723White females 15-79 years (Cherniack, 1972) = (0.06029 * (height in inches)) - (0.01936 * (age in years)) -

0.18693Black males 20-92 years years (Stinson, 1981) = (0.096 * (height in inches)) - (0.021 * (age in years)) - 2.51 Black females 20-92 years (Stinson, 1981) = (0.062 * (height in inches)) - (0.017 * (age in years)) - 0.951

http://www.medal.org/visitor/www%5CActive%5Cch8%5Cch8.01%5Cch8.01.01.aspx

Venti

lati

on (

L/m

in)

VO2 (ml/min kg) Max

Max

Ventilatory Adaptations to Graded Exercise

Normal

Pulmonary Impairment

THE VENTILATORY RESPONSE TO EXERCISE

COPD complications include: Weight loss

fat free mass (FFM) Osteoporosis

Further reduces exercise capacity, quality of life and survival Loss excess energy Increased energy cost of breathing Reduced tissue oxygen levels Metabolic responses that enhance

breakdown of body proteins

Identify and eliminate sources of bronchopulmonary inflammation cigarette smoking, inhaled irritants

Inhale or oral bronchodilators and corticosteroids

Establish individualized rehabilitation programs for stable patients

Rehabilitation programs generally similar to moderate physical and breathing exercises Respiratory muscle training may improve exercise

performance Cardiovascular or selective respiratory muscle

training May improve oxygen delivery and

endurance performance at submaximal exercise

Chronic home oxygen therapy for patients whose PaO2 remains below 55 mmHg (the

goal is to alleviate hypoxemia)

Smoking Exposure to pollution or other noxious

agents Genetics Age History of childhood respiratory

infections

Pay special attention to environmental conditions

Follow GENERAL FIT recommended by ACSM Walking most similar to daily living activities Minimal goals for frequency is 3-5 d/wk—

reduced function more frequent exercise training

NO CONCENSUS AS TO THE OPTIMAL INTENSITY tolerated OR 50% of Max

Start at few minutes…progress as able Pulmonary effect the lungs as well as muscles

Follow older adults guidelines Shoulder girdle exercises

Monitor for signs and symptoms Use dyspnea scale for 2-3 on 4 point scale

May exhibit arterial desaturation w/ exercise May measure blood oxygenation Oximetry

May need O2 for patients with reduced PaO2

Complete extensive pulmonary function tests prior

Only stable patients should exercise in a nonmedical setting

RXEX Suggested that patients exercise at 50% VO2 peak

Emphasize progression over intensity To exercise Must be fully be symptom free from

bronchitis Have a bronchodilating inhaler with them at all

times Perform breathing exercises to help strengthen

respiratory muscles

Avoid upper-body exercises initially because of the increased strain on the pulmonary system.

Some COPD individuals may require supplemental oxygen during exercise. Generally, supplemental oxygen is recommended for patients with a PaO2 < 55 mmHg or SaO2 < 88%, while breathing room air

COPD clients should not smoke The type and dose of medications should be reviewed with

the clients physician, based on the clients response to exercise

If a COPD clients exercise performance in a nonmedical supervised program worsens, they should be encouraged to participate in a pulmonary rehabilitation program, until signs and symptoms have improved