PT on the Net Research

Emphysema


Question

My client had a quadruple bypass and has had emphysema since childhood. What are your suggestions for training?

Answer:

As with any medical condition, the best place to start is with the recommendations of the clients' medical professionals. I want to applaud the fact that you want to learn more about each condition. First, let us look at emphysema. Emphysema is a condition of the lung where the brachioles have difficulty processing the oxygen being brought in. There are less alveoli present and the ones that are there are not as effective in the uptake of oxygen for a plethora of reasons. There are two distinct types of emphysema, panlobular and centrilobular that react differently. For the sake of this article, we will talk about them as though they are the same. It has been numerously documented that a progressive cardio program can help increase functional lung capacity in patients with chronic pulmonary (lung) diseases. We must look at our program as a systematic, progressive approach to long- term health benefits. Before we delve deeper into the lung condition we must also look at the cardiac or heart condition. You had mentioned he has under gone a quadruple bypass, but failed to mention what the underlying cause of the condition was, and how long ago it had happened. It was mentioned that he was released by the physician and told to start a conditioning program. The reason these questions are so vitally important with heart patients is they are generally put into classifications or stages of rehabilitation. It is recommended that the first 3 stages of rehabilitation should be done with ECG or echo cardio gram monitoring to ensure the safety of the patient. Because you mentioned your client has been released from doctor's care, I will assume he is at least in stage 4. We suggest that your client try to exercise 3-5 days per week, at least, and keep his heart rate between 40- 60 % of his heart rate max. It is probably best to use the Karvonen formula: ( (220 - age) - resting HR )x ( 40 % - 60 % ) + resting HR = HR range. If his resting heart rate is over 60% of his max, keep him around 30 beats per minute above his resting heart rate. It sounds as though he may be on medication to keep his heart rate at a stable level. If this is the case, you must use the R.P.E. scale or rate of perceived exertion. On a scale of 1 - 10, he should stay between 2 - 4. Start him with continuous exercise until you can get him working out at 15 or more minutes straight without a break. When he can work 15 minutes straight with his heart rate between 40 - 60% of max or RPE below 4, it is then time to increase the intensity up to 70% or up to 5. In all honesty, it seems as though this individual should be working with an exercise therapist or medical exercise specialist. I wish you the best of luck and please always try to error on the side of caution.