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Published on October 30, 2017

Strengthening your lungs – one step at a timeStrengthening your lungs – one step at a time

When Bill signed up for the Pulmonary Rehabilitation Program at Cape Cod Hospital, he didn’t realize exactly how much it would change his life. The Brewster resident has chronic obstructive pulmonary disease, also known as COPD. He participated in the twice-a-week course for eight weeks to improve his breathing.

Now 13 to 14 years later, he still travels to the pulmonary rehab clinic every Tuesday and Thursday mornings to participate in the maintenance program.

“If it weren’t for this program, I wouldn’t still be here,” he said. “Every time I see someone starting the beginner program I tell them, if you stick with it, it really works.”

The Pulmonary Rehabilitation Program at Cape Cod Hospital was started nearly 30 years ago by Dian Birch, RN, and Rose O’Sullivan, LPN. Today, it is led by rehabilitation nurses O’Sullivan and Patricia Iafrate, RN.

Over the years, both have seen many success stories.

Chronic obstructive pulmonary disorder (COPD) is an umbrella term that covers several diseases including emphysema, chronic bronchitis, bronchiectasis and cystic fibrosis, Iafrate explained. All of these conditions make it difficult to breath and there is no cure available. But pulmonary rehabilitation can help sufferers improve their well-being and quality of life.

The program has three specific goals:

  • To educate people with COPD about interventions, treatments and complications, so they can stay as healthy as possible
  • To teach participants how to cope with living with a frightening chronic disease
  • To help participants attain and maximize their highest level of functionality

“Sometimes people are able to do tasks and activities they haven’t done in a long time and that’s a great thing,” Iafrate said.

Start With A Stretch

The three-hour program begins with 30 minutes of review from the previous week and a discussion of any questions or issues patients have had since they last met. Next, O’Sullivan leads the group through a 15-minute full body stretching routine.

“There are multiple reasons that the stretching routine is so important,” Iafrate said. “Not only does it warm up and cool down muscles, but it’s working muscles that haven’t been worked in a while. It also gives them the ability to expand their chest and let the muscles that are designed for breathing do their job.”

This is especially important for those with pulmonary diseases, because they have a tendency to lean forward on their elbows to breath. It gives them the illusion of better breathing, but it actually closes up their chest cavity, Iafrate said.

For the actual exercise part of the program, patients work up to doing 15 minutes on both a treadmill and a stationary bike. While exercising, Iafrate and O’Sullivan teach participants how to do pursed lipped breathing, which they advise for all exercise for those with breathing difficulties.

“Pursed lip breathing helps with air trapping,” Iafrate said. “It helps maximize the energy of breathing so that it’s not as difficult to breathe. It also allows a breathing pattern that optimizes the respiratory tract.”

To do pursed lip breathing, you close your mouth and take a deep breath through your nose, counting one, one-thousand; two, one-thousand; or as high a number as you can achieve. You then exhale through pursed lips (like you are blowing out a candle) for twice as long.

Breathing through your nose instead of your mouth allows air to be warmed, cleansed and humidified before it reaches your lungs. Exhaling twice as long means that you clear out all the trapped stale air and have room for fresher, oxygenated air.

“They do this breathing during any exertion and it should be a way of life,” Iafrate said. “It maximizes their oxygen saturation.”

After the 30 minutes of exercise, there is another 15-minute stretching period to cool down, which means they have had a full hour of physical activity. Patients then take a half an hour break to eat a snack or lunch they bring from home to refuel and replace fluids.

Education Sessions

The last hour of the program is devoted to a one of 16 educational sessions on topics that all pertain to COPD. The topics include:

  • A dietician who talks about how diet can improve symptoms.
  • A respiratory therapist who talks about home oxygen therapy and breathing re-training.
  • An occupational therapist who talks about energy conservation.
  • A personal trainer who talks about the physiology of exercise.
  • An anatomy and physiology lecture.
  • A pharmacist from Cape Cod Hospital who talks about medications and interactions.
  • An occupational psychologist who talks about coping strategies and relaxation techniques.
  • A pulmonologist who conducts an “Ask the Doctor” session.
  • A community connections class on topics of assistance available in the community.
  • Two sessions on making healthcare decisions like signing healthcare proxies and filling out Medical Orders for Life-Sustaining Treatment (MOLST) forms.

After the eight weeks are done, the most critical part of the program begins: maintaining it.

“If you do not continue, you will lose everything you gained in two weeks,” Iafrate said. “I know that seems impossible but we have seen it again and again.”

With that in mind, on week five they ask all participants to begin thinking about what they are going to do to continue exercising at least three days a week. Suggestions include joining a gym, walking the indoor track at the Hyannis Youth & Community Center, joining the Mall Walkers or even walking the aisles of large grocery stores. Another good option is the Young-At-Heart exercise classes at local senior centers sponsored by the Visiting Nurse Association of Cape Cod.

Patients are also welcome to join the maintenance program at Cape Cod Hospital. The maintenance program is 90 minutes, three times a week. Participants do the group stretching and then their own individualized programs on the treadmill and stationary bike.

Two advantages of joining the maintenance program are socialization and accountability.

“A lot of people have formed lasting friendships here,” O’Sullivan said. “We also do social outings as a group several times a year.”

They go to a restaurant for a group meal near Christmas and have a cookout at Veteran’s Park Beach in June. They also visit the student run café at Cape Cod Regional Technical High School in Harwich for a turkey dinner for Thanksgiving and corned beef and cabbage for St. Patrick’s Day.

Anyone interested in joining the program can call 508-862-5709 to set up an evaluation.