*8.3.2 Occupational therapy*

*Cardiorespiratory Fitness*

*8.2.3 Flexibility training*

**8.3 Education**

*8.3.1 Disease education*

exercise regimen.

and trunk muscle strength training is achieved by using light weights (dumbbells, elastic bands), weight machines for stronger patients, rowing machines etc. Several of these instruments can also provide aerobic exercise training thereby improving

Physical therapists may provide training of upper and lower extremities on alternate days to improve patient tolerance. Progressive improvement in muscle strength is documented using standardized lifting tests, incremental resistive load tolerated by the patient and increased capacity in performing ADLs efficiently [86].

Many COPD patients suffer from modification in the structure of their chest wall due to hyperinflation, hypertrophy of the accessory respiratory muscles and physical inactivity. This further leads to changes in the posture and reduced mobility. To prevent this from happening, COPD patients undergo flexibility training as a

Flexibility exercises lead to improved mobility by increasing joint range of motion, reducing joint stiffness, better posture and increment in vital capacity [45]. Gentle stretching exercises with full body movements, coordinated with breathing

This kind of workout teaches the patient the influence of body movements on respiration. Since these exercises are done at a slower pace without any resistive loads, they can be used during warm up or cool down periods of the program. Limited research has been done on adequate duration and intensity of stretching exercises. General recommendation are to perform stretching of major muscle groups in the upper and lower extremities 2–3 days per week at the minimum [100]. Benefits of this training can be measured by documenting reduction in subjective

To provide a holistic care, every pulmonary rehabilitation program should incorporate patient education. It has been well proven that COPD patients who are well aware about the nature of their disease, its management and long-term implications are able to cope with both the disease and treatment better [101]. Education about the disease empowers the COPD patients to better recognize their symptoms, make lifestyle changes and get involved in the management of the disease. This leads to increased motivation to participate in pulmonary rehabilitation and adhere to the

At the beginning of the rehabilitation program, individual educational needs of each patient are identified. This is continuously reassessed while the patients are undergoing the rehabilitation program. Instead of a didactic teaching, a patient centered and self-management teaching approach focusing on lifelong behavioral changes are adopted these days [45]. Specifically for COPD patients, a collaborative self-management plan which helps them in an identification of symptoms of onset of an exacerbation, make treatment modification and to communicate early with a healthcare provider, is highly beneficial in the long run [102]. Patient education runs alongside the exercise training. It is meant to supplement the knowledge gaps and instill confidence in the principles of ongoing training. Various topics regarding disease and its management are covered with utilization of the expertise of various

perception of stiffness, reduced incidence of back pain and joint injuries.

both strength and endurance in the upper extremities.

part of the pulmonary rehabilitation program.

techniques are appropriate for COPD patients [65, 98, 99].

**10**

specialists.

A pulmonary rehabilitation program incorporating occupational therapy is important in COPD patients [104, 105]. Occupational therapy assists COPD patients with development of specific strategies to perform ADLs with least expenditure of energy [106]. With conservation of energy expenditure, there is an improvement in subjective perception of breathlessness, increased efficiency in performing daily basic activities, elevated sense of control and better social engagement [104–107]. Occupational therapy skills even though simple in principle, require a learning process, which is achieved through a multidisciplinary rehabilitation program. There is an ever-increasing evidence that improvement in occupation performance of COPD patients lead to a holistic improvement in their health [108]. Occupational therapist can also instruct COPD patient to use wheeled walking aids, which can result in increased functional autonomy, ventilatory capacity and waling efficiency [109–112]. Since this therapy has a major impact on social networking of COPD patients, it serves well to involve patient's family and friends [113].
