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Cardiopulmonary

Physio Nexus Academy · Clinical Treatment Framework

COPD Pulmonary Rehabilitation

Exercise training, breathing strategies, education and self-management form the core of pulmonary rehabilitation, with oxygen and medical therapies coordinated with the treating team.

Assess → classifyTreat → reassessLoad → progress

Clinical decision pathway

A structured plan, not a recipe

Clinician-led · Individualised
01

Understand

Screen safety, identify the likely clinical pattern and agree meaningful goals.

02

Select

Choose only interventions that match the patient's impairments and preferences.

03

Reassess

Repeat the same comparable sign or functional task after key interventions.

04

Progress

Build capacity and participation using measurable response, not session count.

Before choosing an intervention

Clinical reasoning

  1. 1Exercise training is the core intervention; dyspnea is monitored and managed rather than avoided completely.
  2. 2Monitor oxygen saturation and cardiovascular response according to medical status.
  3. 3Airway clearance is indicated when secretion retention exists, not simply because the diagnosis is COPD.

A practical starting sequence

First-session workflow

  1. 1Record dyspnea, SpO2, heart rate, 6MWT/sit-to-stand and exacerbation history.
  2. 2Review oxygen prescription and medical restrictions.
  3. 3Teach pacing and breathing control during exertion.

Assessment & examination

  1. 1Dyspnea and exercise tolerance
  2. 2SpO2 and heart rate response
  3. 36-minute walk distance
  4. 4Lower-limb strength
  5. 5Exacerbation history and inhaler technique in multidisciplinary care

Red flags & safety screen

  1. 1Severe resting hypoxemia outside prescribed parameters
  2. 2Acute chest pain
  3. 3New arrhythmia/syncope
  4. 4Acute exacerbation requiring medical management

Indication · dosage · response

Manual therapy application

  1. 1Thoracic mobility or supported positioning may improve comfort.
  2. 2Percussion/vibration only when airway-clearance indications are present.

Adapt to irritability and capacity

Exercise prescription & dosage

  1. 1Aerobic: interval or continuous training, often 20–40 minutes total, 3–5 days/week as tolerated.
  2. 2Strength: 2–3 sets × 6–15 reps for major muscle groups, 2–3 days/week.
  3. 3Sit-to-stand: 2–4 sets × 5–15 reps.
  4. 4Inspiratory muscle training only in selected patients with appropriate assessment.

Modalities & adjuncts

  1. 1Supplemental oxygen must follow medical prescription/criteria.
  2. 2Pursed-lip breathing can be practiced during exertion if it helps dyspnea control.

Progression & regression rules

  1. 1Increase duration first in very deconditioned patients.
  2. 2Progress resistance and walking speed while monitoring SpO2, dyspnea and recovery.
  3. 3Use interval training when continuous exercise is not tolerated.

Home programme

  1. 1Regular walking/cycling program
  2. 2Pacing and energy conservation
  3. 3Exacerbation action plan coordinated medically

Outcome measures

  1. 16-Minute Walk Test
  2. 2mMRC dyspnea scale
  3. 3CAT
  4. 4Sit-to-stand tests

Common clinical mistakes

  1. 1Stopping exercise whenever the patient feels any breathlessness.
  2. 2Ignoring desaturation.
  3. 3Using chest percussion without secretion-retention indication.
  4. 4Not training legs strongly enough.

Patient education & self-management

  1. 1Teach pacing, inhaler/medical adherence through the appropriate team and exacerbation action planning.
  2. 2Explain safe breathlessness versus warning symptoms.
  3. 3Encourage daily physical activity.

Referral & escalation

  1. 1Urgent medical assessment for acute chest pain, severe desaturation, syncope or exacerbation

Clinical use & safety note

This is an educational clinical framework, not an individual prescription or a substitute for diagnosis, medical assessment, local protocols or professional judgement. Exercise dose, manual techniques and adjuncts must be adapted to examination findings, irritability, comorbidities, precautions, patient goals and response. Obtain informed consent, work within training and scope, and refer when indicated. Do not apply every intervention listed to every patient.

The PNA treatment principle

The best plan is not the one with the most techniques. It is the one that identifies the patient's main problem, selects a defensible intervention, measures the response and steadily restores meaningful function.