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.
2
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.
3
Breathless
Less activity
Muscles become
unfit and
deconditioned
Breathlessness
increases
Become less
active
More unfit
Fig. 1 The spiral of deconditioning
Exercising at the correct level will improve
Muscle
your fitness and the level of activity you are
s
able to do.
becom
e unfit
What are the benefits of exercise?
&
The benefits of doing exercise are felt in decond
all
ition
areas of the body, including the heart, lungs,
muscle strength and the immune system.Breathl
There are also psychological benefits. essness
increas
Cardiovascular benefits include an increase
es
in the number of capillaries to the muscles
Becom
and more red blood cells carrying oxygen.
The heart becomes stronger and more e less
active
efficient at pumping blood and oxygen
Less
around the body. This can help lower your
unfit
blood pressure and help lower cholesterol,
4
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.
5
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.
6
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.
7
0
0.5
1
2
3
4
5
Nothing at all
Very, very slight (just noticeable)
Very slight
Slight
Moderate
Somewhat severe
Severe
6
7
8
9
10
Very severe
Very, very severe (almost maximal)
Maximal
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:
8
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.
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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:
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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).
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Positioning
Below are good positions for using your
lower chest and diaphragm for breathing.
Leaning
forwards onto a
window ledge or
back of a chair
Leaning
backwards
against a wall
Leaning
forwards onto
your knees or
onto a table
when seated
Breathing control
Breathing control or diaphragmatic
breathing can help
reduce the work of
breathing by re-learning
to breathe in the correct
pattern.
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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.
13
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.
15
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.
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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.
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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
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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 longacting 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:
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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
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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
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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
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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.
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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 - do not press canister.
8. Remove the mouthpiece from your mouth
and breathe out.
9. Wait 30 seconds then repeat steps 2 to 8.
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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.
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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
26
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.
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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.
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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.
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Breathing exercises
Normal/relaxed breathing
(10–30 seconds)
Take a deep breath and hold for
four seconds
(Repeat three or four times)
Normal/relaxed breathing (10–30
seconds)
Take a deep breath and hold for
four seconds
(Repeat three or four times)
Normal/relaxed breathing (10–30
seconds)
One or two huffs
Cough
(only if phlegm is ready
to come up)
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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.
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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
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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
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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
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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.
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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.
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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 longhandled 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.
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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.
38
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:
39
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)
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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.
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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
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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
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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!
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Notes
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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:
[email protected]
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: www.nhs.uk
Reference: THE_PRE_01
Published: July 2015
Review date: July 2017
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