? Enough Progress in Pulmonary Rehabilitation

Dear Dr. Mahler: I have stage 4 copd with a fev of 26. I have been going to pulmonary rehabilitation, and today was the 17th time. The woman that runs it said I’ve not improved enough. I’m O2 dependent need 6 liters at exercise. Day one I exercised 23 min. Day 2 32 min. Every day after is 40 min plus weights and  bands. I went from 1.0 on the si-fit to 1-3, weights 2 lbs to 3 lbs. I’m not sure how much I should be doing, I thought I was doing good from starting at no exercise at all. Hope you can help. Linda from Ascutney, VT Dear Linda: With most pulmonary rehabilitation programs, the first visit, or possibly a screening visit, is spent discussing the goals of the program for each person.  Did the “woman that runs it,” whom I assume is the pulmonary rehabilitation coordinator, ask about your individual goals? Also, I would ask her what she expects as far as improvement for you.  Generally, changes from your baseline, or starting point, are most important to assess benefit.
Woman with COPD doing arm curls with hand weights.

Woman with COPD doing arm curls with hand weights.

Certainly, your increase in exercise time (? on the treadmill) from 23 minutes to 40 minutes is impressive. This represents a 74% percent improvement.  Also, the increase is hand weights from 2 to 3 lbs (+50%) is quite good. An important benefit of pulmonary rehabilitation is improvement in doing daily activities. Do you find certain daily tasks have become easier? Or can you do something for a longer time period before you experience shortness of breath? Once again, I would talk directly to the rehabilitation coordinator about your concerns. From the information that you have provided, it appears that you are making substantial progress. Keep up the hard work. Best wishes, Donald A. Mahler, M.D.    

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.