What is Pulmonary Rehabilitation?
Pulmonary rehabilitation (PR) is a program of educational classes and supervised exercise sessions for people with chronic breathing difficulty.
PR can benefit people diagnosed with COPD (chronic obstructive pulmonary disease), bronchiectasis, pulmonary hypertension, interstitial lung disease, and other chronic pulmonary disorders.
PR is designed to help you better understand your breathing, learn how to live better with your condition, and improve your strength, stamina, and endurance. PR will likely reduce your shortness of breath (breathlessness), improve your feelings of low energy, and increase your ability to exercise and stay active.
Is Pulmonary Rehabilitation Right For Me?
Have you been told that you have chronic lung disease?
Do you have symptoms from your chronic lung disease such as shortness of breath, fatigue, cough or wheezing?
Are you taking medications for your chronic lung disease, but feel they are not helping you enough?
Are you limited in your daily activities due to your chronic lung disease?
If so, then PR may help you.
PR can help you realize some or all of the following health benefits:
- Decreased shortness of breath/breathlessness
- Increased exercise capacity (your ability to do exercise)
- Increased energy and stamina
- Improved feeling of well-being
- Decreased feelings of depression and anxiety
- Increased ability to do things in life that you need and want to do
- Communicating more effectively with your healthcare team
- Connecting with other people with similar breathing problems
- Increasing your ability to manage your own lung problems in collaboration with your health care team
A recent study by Lindenauer and colleagues showed a substantial survival benefit for COPD patients who received PR after a hospitalization for an exacerbation. This information is summarized in the attached infographic and adds to the already well-demonstrated benefits of improved function, symptoms, mood, and quality of life, as well as reduction in COPD exacerbations
How Does Pulmonary Rehabilitation Work?
A major symptom associated with chronic breathing disorders is shortness of breath. Many people actually avoid daily activities and exercise because it causes shortness of breath. Yet, limiting activity and avoiding exercise then causes people to be "out of shape," or deconditioned. Deconditioning places more demand on the lungs and heart, which in turn causes more shortness of breath during the activity, making it hard to be active.
In PR, educational classes will help you better understand and manage your breathing problem, and supervised exercise classes will gradually help you be more active and "get in shape" – so that you can complete your daily activities and exercise more easily with less shortness of breath.
The educational classes are designed to help you understand your breathing and learn how to manage and live better with your condition. They also serve as a forum to ask questions and discuss topics that arise when dealing with a chronic condition. These classes also allow you to speak with others with similar lung problems and get useful tips from them.
Some people become depressed and/or anxious with a chronic disease. PR has been shown to decrease these feelings as you become more physically fit, learn more about your condition, and speak with others.
The exercise sessions are designed for your specific needs and abilities. Prior to starting the program, you will be evaluated to find out the best and safest exercises for you. Reports from PR programs worldwide have shown that PR is safe. The sessions are supervised by trained health care professionals; they will monitor you as you exercise and ensure you are safe.
PR is a complement, not an alternative to, existing medical therapy such as inhaled or pill forms of medicines. In the United States, individuals enrolled in a PR program typically meet at the program site 2-3 times a week for 6-12 weeks.
Why Does Pulmonary Rehabilitation Work?
Learning about your specific lung problem from a team of health care experts, will help empower you to be a better manager of your disease in collaboration with your own health care team. It should also help you learn to communicate your health issues more effectively with your provider.
Talking about your breathing problems with others who have similar problems may help you deal with the many emotions often experienced by those with a chronic health problem.
If you feel in control of your lung problem, you may feel less stress and have a more positive outlook about your health and life.
Individuals with breathing problems can have shortness of breath during exercise or even regular activity. Unfortunately, people try to avoid this feeling by becoming less and less active. This plan may work at first, but in time leads to a vicious circle of avoiding activities which leads to getting out of shape or becoming deconditioned. This can result in even more shortness of breath with activities. PR exercise training interrupts this cycle and helps you get in shape and be more active with less shortness of breath.
Frequently Asked Questions
Do pulmonary rehabilitation programs accept insurance?plus
Generally, PR programs accept insurance if you have been given a prescription to attend it, but insurance coverage varies between different programs and insurance policies. Therefore, the out of pocket cost to you, including any co-pays, can vary greatly.
Before you enroll in a PR program, ask the staff to help you determine what your out of pocket costs will be, including any extras, such as transportation or parking. You may also want to check with your insurance company about the co-pay costs.
Can I enter pulmonary rehabilitation if I smoke?plus
Some programs offer help with quitting. Other PR programs require that you stop smoking before beginning the program. PR, medications, and quitting smoking cannot reverse whatever permanent lung damage you may have from cigarettes, but it can prevent further damage. If you smoke, make a serious effort to quit. Get help if needed. Stopping smoking is an important part of getting stronger and healthier.
How does a pulmonary rehabilitation program work?plus
PR is the beginning of a lifestyle change. The formal program will last up to 12 weeks, but the goal is to help with changes in lifestyle that will be lifelong. Though all programs are not the same, the typical program components and structure is as follows:
- You will have a thorough assessment at the beginning of PR. This will help structure the program to your individual abilities, limitations, medical needs, and goals.
- During group sessions, you will meet others with breathing problems. You will also have the opportunity to work closely with and interact regularly with one or more health care professionals on the PR health care team. Together, these interactions give you time to ask questions, share concerns, and learn hands-on approaches to living with breathing problems and tackling common challenges.
- Your progress will be monitored throughout the course of the program.
- You will participate in exercises that are geared to your abilities. This typically includes exercises for both your arms and legs, including walking, riding a stationary bicycle, doing arm exercises, and weight training.
- You will receive recommendations on exercise you can do at home (between sessions and after the formal program is over).
- You will be evaluated weekly to find out if your exercise program should be changed. This is all part of increasing your strength and endurance (stamina) to do exercise.
- If you need supplemental oxygen, in many programs, it will be provided. Your oxygen level will be monitored during your exercise training.
- Educational topics are aimed at helping you manage your disease better (see list, below, of class topic examples).
- Nutritional guidance may be provided, including strategies to reach or maintain a proper weight.
- After the formal program is over, you will be encouraged to continue with exercise and physical activity. Some programs offer a maintenance program or an ongoing support group for individuals with breathing problems, such as an American Lung Association better breather support group.
What topics are covered in the pulmonary rehabilitation educational classes?plus
Below are examples of some of the topics that may be covered in the educational component of the PR program:
- Living with a chronic breathing problem
- How your lungs work
- How changes in your lungs cause your symptoms
- What your medicines do, and why you need them
- How to use your inhalers and/or nebulizer to get the most benefit out of them
- How to monitor your symptoms and know when to call your health care provider
- How to avoid being hospitalized because of your breathing problem
- Breathing techniques to decrease your shortness of breath and manage your daily activities
- How to travel more easily with your breathing condition
- Proper nutrition
- If you are on oxygen, how to use it, and help with deciding what might be the best oxygen system for you
- How and why to use breathing assist machines such as CPAP
- Living wills and options for life support if breathing fails
In addition to the topics listed above, the educational classes serve as an open forum to discuss other topics. These sessions provide an opportunity for you to ask questions, share concerns, and learn hands-on approaches to living with breathing problems and tackling common challenges.
How do I enroll in a pulmonary rehabilitation program?plus
What happens after I complete the pulmonary rehabilitation program?plus
The things you learn and practice during the program should carry over into your daily life after the program ends. If you stop exercising after the program, the improvements you made will soon be lost. The staff will work with you to design a long-term plan of physical activity and exercise for you. The staff will teach you how and when to exercise at home. Many programs offer a "maintenance" plan so that you can continue to exercise with others who have breathing problems. Once you know how to exercise safely, you will have the skills to continue. You might even consider going to a local exercise facility; discuss with your PR team how you can best continue exercising with the facility’s equipment. Additionally, many individuals may be able to attend an exercise facility free of charge through Medicare plans such as Medicare Advantage or Medigap through the "SilverSneakers" program. To continue getting social support and education about living well with lung disease, you can sign up for an American Lung Association Better Breathers Club program in your area at Lung.org/better-breathers. You can also find support, ask questions, and learn from others who have participated in pulmonary rehabilitation on our online community, COPD360social. For additional information on what you can do after you complete a PR program, review our page on exercise and Harmonicas for Health.
What if a Pulmonary Rehabilitation program is not available?plus
Here you can find additional information and resources.
American Thoracic Societyplus
The American Thoracic Society (ATS) improves global health by advancing research, patient care, and public health in pulmonary disease, critical illness, and sleep disorders. Founded in 1905 to combat tuberculosis, the ATS has grown to tackle asthma, COPD, lung cancer, sepsis, acute respiratory distress, and sleep apnea, among other diseases.
To learn more about ATS visit https://www.thoracic.org.
American College of Chest Physiciansplus
The American College of Chest Physicians (CHEST) is a global leader in advancing patient outcomes through innovative chest medicine education, clinical research, and team-based care. With more than 19,000 members in 100+ countries around the world, CHEST champions the prevention, diagnosis, and treatment of chest diseases through education, communication, and research. Established in 1935, the CHEST Journal is the leading peer-reviewed medical journal covering chest diseases and related issues, including pulmonology, cardiology, thoracic surgery, transplantation, breathing, airway diseases, and emergency medicine.
To learn more about CHEST visit www.chestnet.org.
Canadian Lung Associationplus
The Canadian Lung Association (CLA) is a national, vounteer-based organization and charity that focuses on all issues that affect the ability of Canadians to breathe. The CLA works at the national, provincial and community levels to improve and promote lung heath. The organization focuses primarily on chronic lung diseases such as asthma and COPD, infectious diaseses such as tuberculosis, flu and pneumonia, breathing disorders such as sleep apnea and cystic fibrosis, and lung cancer.
To learn more about CLA visit https://www.lung.ca.
Pulmonary Education and Research Foundationplus
The Pulmonary Education and Research Foundation (PERF) is a non-profit foundation dedicated to assisting patients with chronic respiratory disease through education and research. PERF contributes to the scientific basis for the practice of pulmonary rehabilitation (PR), promotes clinical application of pulmonary research, supports the development of pulmonary research, assists in developing and supporting PR programs, and works to increase public awareness of pulmonary disease and the benefits of PR.
To learn more about PERF visit https://perf2ndwind.org.
National Heart, Lung, and Blood Instituteplus
The National Heart, Lung, and Blood Institute (NHLBI) - one of the largest institutes and centers that makes up the National Institutes of Health - is the U.S. leader in the prevention and treatment of heart, lung, blood, and sleep disorders. NHLBI provides global leadership for a research, training, and education program to promote the prevention and treatment of heart, lung, and blood disorders and enhance the health of all individuals so that they can live longer and more fulfilling lives.
To learn more about NHLBI visit https://www.nhlbi.nih.gov.
American Lung Associationplus
As the nation’s leading voluntary health organization working to save lives by improving lung health and preventing lung disease, the American Lung Association has resources and support for the more than 35 million Americans that live with chronic lung disease. Our Better Breathers Club program has been connecting people living with lung disease to education, support and each other in communities around the country for over 40 years. In the over 500 in-person support groups throughout the United States you can learn better ways to cope with lung conditions such as COPD, pulmonary fibrosis, and asthma while getting the support of others in similar situations. Better Breathers Club offers a fun and stimulating combination of guest speakers, problem-solving discussions, and social activities. Led by trained facilitators, these in-person adult support groups give you the tools you need to stay active and healthy, living the best quality of life you can.
Find a Club near you at Lung.org/better-breathers
"Live Better with Pulmonary Rehabilitation" is a project originated by the American Thoracic Society and the Gawlicki Family Foundation to increase public awareness of pulmonary rehabilitation. Together, our mission is to inform and educate individuals with chronic lung disease about the potential benefits of pulmonary rehabilitation.