Pulmonary Rehabilitation

What is pulmonary rehabilitation?

Pulmonary rehabilitation is a health program to help improve symptoms of chronic (long-term) lung diseases. A team of healthcare providers guides you through physical activities (based on your tolerance level), education and techniques to help you manage your breathing during everyday activities.

If you have a chronic lung disease, your breathing muscles weaken. Shortness of breath and other symptoms may keep you from moving as much as you used to or would like. This can create a cycle that weakens your muscles and worsens your symptoms. Pulmonary rehabilitation can get you moving again, at a pace that’s right for you. It won’t cure lung disease, but you may notice fewer breathing problems, more strength and an improved quality of life.

What conditions is pulmonary rehabilitation used for?

Pulmonary rehabilitation can help improve lung function in chronic lung conditions, including:

• COPD (chronic obstructive pulmonary disease).
• Interstitial lung disease, like sarcoidosis and pulmonary fibrosis.
• Asthma.
• Cystic fibrosis.
• Bronchiectasis.
• Pulmonary hypertension.
• Lung cancer.
• Lung transplant or lung surgery recovery.

What happens in pulmonary rehabilitation?

Pulmonary rehabilitation focuses on exercise and education. But your team will tailor it based on your goals and an assessment of your health. Possible aspects of pulmonary rehabilitation include:

• Exercise.
• Education.
• Breathing retraining.
• Chest physiotherapy and airway clearance.
• Mental health support.
• Nutrition.

Some of these might be in one-on-one sessions and others might be in a group session.

Assessment

Before you get started and after you’ve completed your program, your healthcare provider will assess your:

• Symptoms.
• Oxygen needs.
• Exercise capacity.
• Medical history, including other health conditions (comorbidities).
• Mental health.

They might assess you with questionnaires or tests like stress tests or pulmonary function tests. They’ll also talk to you about your goals. This might include what would improve your quality of life and what kinds of activities you’d like to be able to do (visit family, get back to hobbies, take short walks and more).

Exercise

Physical activity is the main component of pulmonary rehabilitation. You’ll have exercise sessions two to three days a week. A provider will be there to guide and help you through. They’ll select physical activities that you can safely perform.

You’ll probably start out with short exercises and build strength over time. Each exercise might last a minute or two, or they might be up to 30 minutes, depending on what’s comfortable for you. During any exercise, your provider will make sure you’re managing the level of physical activity and might ask you to rate your level of effort or breathlessness.

Pulmonary rehab exercises might include:

• Warm-up and cool down.
• Flexibility training (stretching exercises).
• Respiratory muscle training. This might involve breathing in or out forcefully through a handheld device.
• Endurance or interval training. This might be cycling, walking or using a machine like a sitting elliptical.
• Resistance/weight training. You can do this with light weights, resistance bands or weight machines.
• Transcutaneous neuromuscular electrical stimulation (NMES). This contracts your muscles with small amounts of electricity.

Education

A provider will help you feel prepared to manage parts of your life affected by lung disease. This might include:

• Managing shortness of breath and other symptoms.
• Understanding medications. This includes when and how to use specific medications and their side effects.
• Understanding oxygen. This includes how to monitor your oxygen level and when to use supplemental oxygen.
• Preventing and treating flares and infections.
• Learning how to use at-home medical equipment.

Breathing retraining

A provider will help you learn to adapt to and manage breathlessness during your daily life. This can help make performing daily tasks like housework and navigating stairs feel more manageable. Techniques might include:

• Controlled breathing techniques (like diaphragmatic breathing or pursed lip breathing).
• Relaxation techniques.
• Positions that help relieve shortness of breath (like tripod/orthopneic position).

Chest physiotherapy and airway clearance

If you have a condition that causes a lot of mucus in your lungs and airways, chest physiotherapy and airway clearance might be part of your pulmonary rehab program. Providers can teach you how to use techniques or devices to clear mucus, including:

• Coughing and breathing techniques. A provider can teach you techniques that open your airways and loosen mucus. For instance, huff cough.
• Positive expiratory pressure (PEP). PEP devices provide resistance so you have to work harder to breathe out, holding your airways open and forcing out mucus. Oscillating PEP devices (Flutter®, Acapella®, AerobikA®, RC-Cornet®) are specific types of PEP that also vibrate to loosen mucus.
• Airway clearance vests. An airway clearance vest, or high-frequency chest wall oscillation device, is an inflatable vest that vibrates to loosen mucus.
• Postural drainage and percussion. This is a type of physical therapy where you move into certain positions so that your lungs can drain. Another person claps their hand on your chest and/or your back to help loosen the mucus.

Mental health support

It can be stressful to live with a chronic health condition. Your care team can help you manage anxiety, depression, stress and other mental health concerns with:

• Relaxation and distraction techniques.
• Counseling.
• Support groups.
• Medications.

Nutrition

Depending on your underlying lung condition, your provider might make nutritional recommendations to help you gain muscle mass. This might mean eating a certain amount of protein, limiting certain foods or eating smaller but more frequent meals. If you’re at a higher risk of aspiration, your provider may also teach you swallowing techniques to reduce your risk.

How long is a pulmonary rehab session?

Pulmonary rehab sessions are usually one to two hours. This might include visits with many members of your care team working with you on different parts of pulmonary rehab.

Who leads pulmonary rehabilitation?

Your pulmonary rehabilitation team could include:

• Respiratory therapists.
• Physical therapists.
• Occupational therapists.
• Pulmonologists.
• Psychologists.
• Dietitians.
• Social workers.

How long does pulmonary rehab last?

Pulmonary rehabilitation is usually two or three times a week for four to 12 weeks or more. You have to continue safe physical activities at home to maintain the benefits of pulmonary rehab.

What are the potential benefits of pulmonary rehabilitation?

Benefits of pulmonary rehab can include:

• Symptom improvement.
• Fewer hospital visits.
• Fewer exacerbations.
• Improved quality of life.
• Improved ability to walk, exercise or perform daily tasks.
• Improved mental health.
• Less tiredness.

Can your lungs get better after pulmonary rehab?

Yes, you can improve your lung function with pulmonary rehab. It won’t cure lung disease, but it can reduce symptoms like breathlessness and coughing.

How effective is pulmonary rehabilitation?

Studies suggest that people with chronic lung disease who’ve completed a pulmonary rehabilitation program (compared to those who haven’t) have:

• A lowered risk of hospital readmission.
• An increased exercise capacity.
• Better health-related quality of life.
• Reduced shortness of breath.

Pulmonary rehabilitation gives you the best results if you continue to do the exercises and use the skills you’ve learned after you’ve completed the program. Your team will design a long-term plan for you.

What are the risks of pulmonary rehabilitation?

Pulmonary rehabilitation has very few risks. Your team will monitor you closely to make sure your shortness of breath is manageable. Your muscles may be sore when you first start the program, but this should improve with regular exercise.

The biggest risk of pulmonary rehabilitation is losing the benefits over time after you’ve completed the program. This is why it’s important to continue to follow the plan your team creates for you.

How can I get the most out of pulmonary rehabilitation?

Some tips for getting the most out of pulmonary rehab and helping it go smoothly include:

• Let your providers know your goals for completing the program. Keep these goals in mind while you work through the program.
• Be honest with your providers. Tell them if any activity is too much. Let them know how you’re feeling about your progress along the way.
• Consider what will make exercise and other therapies easier — or even fun — for you. This might include listening to music, using a fan, having outdoor exercise options, using an app to guide you through exercises or track your activity, and more.
• Ask if there are additional medical devices that could help, like a walker.
• Attend every session. You won’t see as much benefit if you don’t complete the entire program.
• Let your family or others close to you know how they can help you get the most out of the program.

When should I call my healthcare provider?

Don’t hesitate to reach out to your care team with any questions about symptoms, medications or how to apply pulmonary rehab at home. Let your providers know right away if you have any new or worsening symptoms.

A note from Cleveland Clinic

It can feel daunting to start any kind of exercise program, especially if small amounts of physical activity already leave you breathless. But pulmonary rehabilitation aims to help you regain some control over your symptoms and what you’re able to do each day. More than just exercise, it helps you manage all aspects of living with a chronic lung disease. It can reduce breathlessness, improve your quality of life and even keep you out of the hospital. And you’ll have a team of healthcare professionals with you every step of the way — to keep you safe and help you reach your goals.