What is pulmonary rehabilitation?

Pulmonary rehabilitation (PR) is a comprehensive program designed to help people with lung conditions such as pulmonary fibrosis, chronic obstructive pulmonary disease (COPD), pulmonary hypertension or cystic fibrosis. Your doctor may also recommend pulmonary rehabilitation before and after surgery for a lung transplant or lung cancer. A PR program includes education, exercise training, breathing techniques, nutritional counseling and psychological counseling.

Why is pulmonary rehabilitation important?

Although PR cannot cure your lung disease, it can be of great benefit. It allows you to make the most of the limited lung function you have. It helps participants in the following way:

  • Experience less difficulty with breathing/decrease shortness of breath
  • Increase muscle strength and endurance/increase exercise capacity
  • Improve their ability to cope with daily activities/ increase ability to do things in life that you need and want to do
  • Understand how to use medications and oxygen appropriately
  • Increase energy and stamina
  • Improve quality of life/ improve feeling of well-being
  • Reduce hospitalizations
  • Improve depression/ decrease feelings of depression and anxiety
  • Communicate more effectively with your healthcare team
  • Serve as a forum to ask questions and discuss topics that arise when dealing with a chronic lung condition
  • Connect with other people with similar breathing problems. These classes also allow you to speak with others and get useful tips from them.
  • Increase your ability to manage your own lung problems in collaboration with your healthcare team

How does pulmonary rehab 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 pulmonary rehabilitation, 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.

What do you need to know about Pulmonary Rehabilitation?

If your doctor recommends pulmonary rehabilitation, you will receive care from a team of healthcare providers including doctors, nurses, respiratory therapists, physical and occupational therapists, dietitians or nutritionists, and psychologists or social workers. Your healthcare team will design a plan that fits your needs based on the health of your lungs, your age, and other health factors. After your program ends, your team will assess your lung function again to see if your breathing has improved.

Before starting Pulmonary Rehabilitation:

Your healthcare team will complete a thorough assessment at the beginning of PR.  This will help structure the program to your individual abilities, limitations, medical needs and goals.

To help design your pulmonary rehabilitation plan, you may have to do one or more of the following tests:

During Pulmonary Rehabilitation:

Your pulmonary rehabilitation plan may include one or more of the following:

  • In group or individual sessions, your providers can answer questions about your lung disease and offer guidance for how to manage it.

List of topics that may be covered:

  1. How to live with a chronic breathing problem
  2. How your lungs work
  3. How changes in your lungs cause your symptoms
  4. Medications, including drug action, side effects, using an inhaler, and self-care techniques
  5. Treatment options
  6. How to use your inhalers and/or nebulizer to get the most benefit out of them
  7. How to monitor your symptoms and know when to call your healthcare provider
  8. learn to recognize the signs of a flare-up early and develop a plan to avoid or manage one
  9. How to avoid being hospitalized because of your breathing problem
  10. Breathing techniques to decrease your shortness of breath and manage your daily activities
  11. Learn to manage your disease and reduce your dependence on costly medical resources
  12. How to travel more easily with your breathing condition
  13. Diet, nutrition and weight management
  14. If you are on oxygen, how to use it, and help with deciding what might be the best oxygen system for you
  15. How and why to use breathing assist machines such as CPAP
  16. If you smoke, your team may be able to help you quit
  17. You may learn how to conserve your energy and avoid feeling short of breath by finding easier ways to do daily tasks. This may include ways to avoid reaching, lifting, and bending, or ways to avoid or relieve stress.
  18. Living wills and options for life support if breathing fail
  • Breathing techniques. You may learn specific techniques such as pursed-lip breathing, belly breathing, or yoga breathing. With these techniques, you can better control your breathing and avoid feeling out of breath, especially when you are physically active or under stress. You may also learn ways to help clear mucus from your lungs using huff coughing or forced coughing.
  • Psychological counseling. People who have a chronic lung disease may also experience depression, anxiety, and other emotional problems. Individual or group support can offer training in stress management.
  • Exercise training. You will participate in exercises that are geared to your abilities. Exercise training aims to strengthen your back, arms, and legs, as well as the muscles you use to breathe. Training can also help you build stamina and flexibility, making it easier to do everyday tasks and the things you enjoy. Your healthcare team may recommend using medicine to open your airways or adjusting your regular oxygen therapy during physical activity. You will also receive recommendations on exercise you can do at home (between sessions and after the formal program is over). If you need supplemental oxygen, in many programs, it will be provided. Your oxygen level will be monitored during your exercise training.
  • Nutritional counseling. You will learn what foods to eat and how to prepare meals to manage your condition and feel your best. Nutritional counseling can help ensure that you are getting the right nutrients in the proper amounts. A dietitian may also recommend a weight-loss plan or nutritional supplements or medicines to help you build muscle

Your progress will be monitored throughout the course of the program.

After completing Pulmonary Rehabilitation:

Usually, pulmonary rehabilitation is a series of two or three weekly sessions lasting several weeks or months. At the end of your program, your healthcare team will give you tests to assess your lung function again to see if your breathing has improved. Some of these tests, such as exercise tests, will be the same ones you had at the start of your program. 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 a better breather support group. 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.

Where is pulmonary rehabilitation done?

You may have pulmonary rehabilitation in the hospital or a clinic, or you may learn physical therapy or breathing exercises to do at home. You may also use activity monitors or smartphone-based lessons or monitoring. Your team of healthcare providers will design a personal pulmonary rehabilitation plan based on your needs.

How long is a pulmonary rehabilitation program?

Pulmonary rehabilitation 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 pulmonary rehabilitation program typically meet at the program site 2-3 times a week for 6-12 weeks.

How do you enroll in a pulmonary rehabilitation program?

If you want to live better despite your breathing problems, pulmonary rehabilitation may be a good choice for you. To explore or enroll in a pulmonary rehab program, follow these steps:

  1. Find a program
    First, search to find a program near you. If there is a program in your vicinity, contact the program directly to discuss what you need to do to enroll and what your anticipated out of pocket costs will be.
  1. Seek a referral
    Second, all PR programs will require a referral from your healthcare provider. Let your healthcare provider know you would like to participate in PR and partner with them to work through the referral process.
  2. Discuss the program details with your healthcare team
    Before you enroll in a PR program, ask the staff who does your initial evaluation what your out of pocket costs will be, including any extras, such as transportation or parking. ​​​​​​​
  3. Connect with your insurance provider
    Contact your insurance provider to understand your coverage. Coverage varies between different programs and insurance policies. Therefore, out of pocket costs and co-pays can vary greatly.
  4. Self-advocate
    You do not have to wait for your healthcare provider to bring up PR as a care option. Be an advocate for yourself and ask at your next appointment.

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