PRINCE Manual 2 - NUI Galway

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Transcript

01
PRINCE Structured Education Programme
Part Two | Physiotherapist Educator Manual
Supported by an unrestricted educational grant
www.princestudy.com
Introduction to Part 2
This section of the manual (Part 2) outlines the exercise sessions of the PRINCE structured
education programme and is to be delivered in tandem with the PRINCE educator (Practice
Nurse) manual. The PRINCE educator (Physiotherapist) will also be involved in the delivery of
the programme for weeks 4, 5 and 6 of the PRINCE educator (Practice Nurse) Manual.
The exercise sessions are typically delivered following the PRINCE educator (Practice Nurse)
sessions except in week 3, which are focused exclusively on exercise and in weeks 7 and 8
when the PRINCE educator (Practice Nurse) sessions follow the exercise sessions. The duration
of the exercise sessions are typically 75 minutes, except in week 1, the introduction, which is 30
minutes and week 3 which is 120 minutes
01
Session 1: Exercise Programme
Facilitator Room Layout Time
PRINCE Educators Arrange chairs in semi circle 30 mins
Check List
For this session you should have the following resources:
• A flip chart & pens;
• A3 exercise record board;
• DVD of exercise session 1 and PowerPoint session;
• Oxygen saturation monitor;
• Hand outs for each participant of:
- Home exercise diary; - Exercise class record sheet; - In preparation for exercise class…
- Borg Scale
Learning Outcomes
At the end of this session participant’s will:
• Understand the importance and benefits of regular exercise;
• Develop an understanding of the importance of exercise in the management of COPD/Outline
of future classes;
• Develop personal goals for the programme.
Session Overview
Topic & Duration Content Resources & Activities
• Getting to know participants
and setting the focus of the
session
• Explain the benefits of exercise
for people with COPD
• Flip chart/whiteboard
• Interactive teaching
• Flip chart/whiteboard
• Interactive teaching
• Show PowerPoint “Benefits
of exercise” Slide 1 of Session 1
Introduction
(5 minutes)
Benefits of
Exercise
(5 minutes)
Contents
Session 1
Exercise programme (duration 30 min) 01
Session 2
Exercise programme (duration 75 min) 08
Session 3
Exercise programme (duration 120 min) 33
Session 4
Exercise programme (duration 70 min) 43
Session 5
Exercise programme (duration 75 min) 47
Session 6
Exercise programme (duration 75 min) 50
Session 7
Exercise programme (duration 75 min) 55
Session 8
Exercise programme (duration 75 min) 60
PRINCE Physiotherapist Comments
03
Introduction
Explain to the participants that you are now going to talk to them about exercise and explain
the exercise classes on the Pulmonary Rehabilitation Programme. Explain that this is only a
brief introduction as they will learn more about exercise and its effects on COPD over the
following weeks.
Emphasise with participants that exercise is important to us all and brainstorm with participants
to carry out the following activity.
Activity 1.1 Ice Breaker
Can you give reasons why exercise is important to your health?
Summarise comments on flip chart and keep the flip chart.
Benefits of exercise
Explain that by carrying out exercise regularly participants will maintain the benefits of exercise,
however If they stop exercising regularly they will lose the benefits of exercise and will become
unfit. Emphasise with participants that when the Pulmonary Rehabilitation Programme is over
they should be confident to continue to exercise regularly at home 3-5 days a week for 30
minutes a day.
Now ask participants to carry out the following activity. Contact Sheet
02
• Outline of class exercise
sessions and home exercise
• Summary and conclusion
• Flip chart & ‘
• Give handouts of home
exercise diary
• Exercise record sheets
• Show A3 exercise record Board
• Show PowerPoint on “Types of
exercises” Slide 2 of Session 1
• Show PowerPoint on “Exercise
class” Slide 3 of Session 1
• Show power-point “During
exercise class…” Slide 4 of
Session 1
• Show PowerPoint “For next
week’s class please…”
• Give handout on “In preparation
for exercise class…” Slide 5 of
Session 1
Exercise &
COPD
15 minutes)
Closing
(5 minutes)
Activity 1.2
Ask participants to identify the possible benefits regular exercise may have for people with COPD.
Take feedback, acknowledge and reaffirm participants comments.
Reaffirm and acknowledge with participants the benefits they identified which are similar to
those listed.
Exercise and COPD
Emphasise with participants that following participation in the PR exercise programme they should
find over the coming weeks that they are less breathless carrying out daily activities than they were
at the beginning of the Pulmonary Rehabilitation Programme.
Explain to participants that exercise helps to increase the oxygen supply to the lungs. The oxygen
is then delivered around the body by the bloodstream. Exercise helps to deliver oxygen more
efficiently around the body which in time will make participants feel less breathless.
Explain that exercise will help strengthen the muscles that are working e.g. exercising your arms
will make your arms stronger; exercising your legs will make your legs stronger. When your muscles
are stronger, you will feel less tired when performing daily tasks and when walking. Exercise will
help to increase your exercise endurance meaning that you should be able to walk for a longer
distance or time.
Explain that there are different forms of exercise and that these are divided into 4 main types:
• Aerobic - works your heart and lungs;
• Endurance - increases your exercise tolerance;
• Balance - helps to prevent falls;
• Strengthening - makes your muscles stronger.
Benefits of exercise
Regular exercise can
• Improve fitness,
• Improve muscle strength,
• Improve energy levels,
• Help you feel better
• Improve your quality of life by increasing your ability to carryout daily
activities.
• Prevent hospital admissions usually caused by exacerbation of COPD.
1 of Session 1
Show Slide 1
of Session 1:
0504
Exercise classes
Explain that in the Pulmonary Rehabilitation Programme, participants will be taking part in 7
weekly exercise classes.
Explain that the exercise classes will consist of a gentle warm up, followed by 10 exercises which
will be arranged in a circuit. The circuit will be numbered 1 to 10 and there will be a poster at each
exercise station. The exercises will consist of arm and leg exercises and a walking circuit. There will
be a cool down session at the end.
Explain to participants that they will be using weights/bands in the exercise classes to strengthen
your muscles, and that when measurements were taken in the assessment we calculated the correct
weight for each participant. Explain that each participant will have an exercise plan based on their
current level of fitness and strength.
Explain that during the exercise classes participants that will be asked to say how their breathing
feels on a scale of 0 – 10.
Explain that we will use the Borg Scale and ask participants to record their score. Explain that we
will teach participants how to manage breathing during exercise. Also, during the exercise class,
we will record participants heart rate and oxygen saturation level (show participants SaO2 monitor
and how it works) so that we know participants normal values.
Show participants the home exercise record sheets and A3 exercise record board that will be used
to record the intensity of the exercise and how breathless they are. Explain that we will show them
how to fill these in, next week.
Types of exercises
• Aerobic- works your heart and lungs
• Endurance- increases your exercise tolerance
• Balance- helps to prevent falls
• Strengthening- makes your muscles stronger
2 of Session 1
Show Slide 2
of Session 1:
Time Repetitions Weights Borg Hold Steps Steps Resistance
(Min) (Number) (Kgs) (1 - 10) (Seconds) (Hi/Lo) (Number (Hi/Med/Lo)
Exercise Class Record Sheet
Participant Code: ____________ Session __________ Date____________
Pre-Test; ___________________ HR(BPM) _________ SaO2 (%) _______ BP _______
Post-Test; __________________ HR(BPM) _________ SaO2 (%) _______ BP _______
Exercises
Biceps Curls
Step ups
Arm Circles
Arm Wings
Leg Weights
Wall Press
Sit to Stand
Shoulder Lifts
Wall Squats
Circuit Walk
Pedals
Hold (Sec): Duration of hold in position Repetition
Repitition Times: No of times repeated Resistance:
Kgs: Level of weights used
Steps: Number of steps taken
Resistance: Level of resistance Lo, Med, Hi)
Minutes: Duration of peddling
06 07
Inform participants that as well as the exercise classes, we recommend that they carry out a home
exercise programme. This is very important as participants will only really benefit from exercise if
they carry it out 3 to 5 times a week. Emphasise that these home exercises will be based on the
exercises that they are carrying out in the class. Show participants the home exercise diary.
Closing
Thank participants for their input into today’s session. Finally ask participants if they have any
queries and clarify same.
Outline that it’s important that they dress appropriately so that they can carry out the exercises
more easily. Give participants the handout “In preparation for exercise class….”
Exercise Class
• Gentle Warm up
• 10 exercises in a circuit
• Exercises
- Arm and leg
- Walking
- Weight bands
• Cool down
- Personal exercise plan
3 of Session 1
Show Slide 3
of Session 1:
During Exercise Class
• Borg Breathlessness Scale
• Recording your heart rate and oxygen
• Completing exercise record sheets
• Remember home exercise and diary
4 of Session 1
Show Slide 4
of Session 1:
In preparation for exercise class
• Dress in comfortable clothes and supportive footwear
• Take your medications as prescribed
• Eat a light meal/snack at least 60mins before the class
• Bring a bottle of water. It is important not to become dehydrated.
• Do not exercise the day before or on the day of the exercise classes
5 of Session 1
Show Slide 5
of Session 1:
Explain that over the coming weeks we will monitor how participants are doing with their goals
and their progress. Explain that sometimes they may need to revise goals or set new goals and
that is fine.
Topic & Duration Content Resources & Activities
• Explain the focus of the session
• Explain what exercise
intensity is
• Explain and demonstrate
how to use the Borg
Breathless Scale
• Explain and demonstrate how
to control breathing using
pursed lip breathing techniques
and positions of ease
• Explain the Home Exercise
Programme
• Explain how to record the
Home Exercise Diary
• Explain how to exercise safely
• Establish the exercise circuit
• Demonstration
• Give handout of the “Modified
Borg Breathless Scale”
• Demonstration
• Interactive teaching
• Show PowerPoint
“Ways of controlling your
breathing”- Slide 1 of Session 2
“Pursed lip breathing technique”
- Slide 2 of Session 2
“When practising pursed lip
breathing” - Slide 3 of Session 2
• Give handout on “Pursed lip
breathing techniques”
• Show PowerPoint on “Positions
of ease” - Slide 4 of Session 2
“Description of Posiiotns of Ease”
- Slides 5 - 8 of Session 2
(x 4 slides)
“Other Positions of ease” Slides 9 - 10 of Session 2
(x 2 slides)
• Give handout on
“Positions of ease”
• Show PowerPoint of
“Home Exercise Programme”
- Slide 11 of Session 2
• Give handout “Instructions for
completing the home exercise
diary”
• Show PowerPoint “Recording
your home exercise diary” Slide 12 of Session 2
Introduction
(10 minutes)
Intensity of
exercise
(5 minutes)
Managing
breathlessness
(20 minutes)
(10 minutes)
08
Session 2: Exercise Programme
Facilitator Room Layout Time
PRINCE Educators Flat open space clear of obstacles 75 mins
for walking; chairs in a semi circle;
clear of walk area
Resources
• A3 Borg Breathless Scale for each station; • A3 exercise record board for each station;
• Blue tack; • Chairs (one per participant);
• Clock with large face; • Cones;
• Exercise posters for each station; • Exercise steps (adjustable);
• Flip chart and pens; • Non slip mat;
• O2 and tubing; • Pedals;
• Pedometer; • Pens (Biros);
• Pulse oximeter; • Stop watch X2;
• Table or stable surface at waist height; • Tape measure;
• Therabands; • DVD of Exercise Session 2 Power Point
presentations;
Learning Outcomes
At the end of this session participant’s will:
• Know how to use pursed lip breathing and positions of ease when breathless;
• Know how to use the Borg breathlessness scale;
• Know how to exercise safely at home;
• Know how to record exercise in their home exercise diary.
• Hand outs for each participant of:
- Modified Borg breathless scale;
- Pursed lip breathing technique;
- Positions of ease;
- Instructions for completing the home exercise diary;
- Exercise safety tips;
- Home exercise record sheet (one per participant).
09
Introduction
Explain to participants that today we will begin the exercise classes which will continue for the
next 7 weeks and that they will also be taking part in a Home Exercise Programme. Explain to
participants that for the Home Exercise Programme they will be provided with a diary to record
the exercises and walking that they will be doing at home. Explain to participants that we will
discuss the Home Exercise Programme in more detail later.
Emphasise that to achieve any benefits from exercise it is very important to remember exercise
should be carried out regularly. Outline that it is recommended that everyone should exercise
for at least 30 minutes a day, 3-5 days a week.
Intensity of exercise
Help participants understand that when they exercise it is important to exercise at the correct
intensity, otherwise they will not achieve the benefits of exercise. Explain that a good way of
knowing that they are exercising at the correct intensity is by measuring how breathless they
are. This is done by rating breathing on a scale of 0 to 10. This is called the modified Borg
Breathlessness Scale (Borg Scale). Emphasise that they need to measure their breathlessness
before, during and after exercise.
Now show participants the poster of the Modified Borg Scale explaining that the scale is from
0 to 10, where: 0 = No breathlessness and 10 = Maximum breathlessness. Give handout of
the Modified Borg Scale to all participants.
Nothing at all
Very, very slight
(just noticeable)
Very slight
Slight
Moderate
Somewhat severe
Severe
Very severe
Very, very severe
(almost maximal)
Maximal
Instructions for Borg Breathlessness Scale
“This is a scale that asks you to rate the difficulty
of your breathing. It starts at number 0 where
your breathing is causing you no difficulty at all
and progresses through to number 10 where
your breathing difficulty is maximal”. How much
difficulty is your breathing causing you right now?
0
0.5
1
2
3
4
5
6
7
8
9
10
Modified Borg Breathlessness Scale
10 11
Exercise timetable
Duration Topic Content
• Warm-up
• Exercise
circuit
• Walk/marching on spot swinging arms
side stepping
• Measuring 1-2 on the Borg scale
• Each participant (depending on ability) to carry
out 5 reps of each of the following activities:
- Arms pull backward with theraband;
- Shoulder flexion;
- Trunk rotation;
- Calf stretches;
- Hamstring stretches.
• Each participants (depending on ability) to walk
for 3 mins around cones (measure distance)
Use pedometer (record steps)
Measuring 4 on the Borg Scale
• Legs:
- Leg weights; - Step ups;
- Sit to stand; - Wall squats;
- Pedals.
• Arms:
- Biceps curls; - Arm circles;
- Arm wings; - Wall press;
- Shoulder lifts.
(5 minutes)
20 minutes
• Show PowerPoint “Completing
your home exercises” - Slide 13
of Session 2
Show PowerPoint “You should
stop exercising if you experience
any of the following” - Slides 14
- 15 of Session 2 (x 2 slides)
Show PowerPoint “Exercising
safety tips X 2 slides” - Slide 16
- 17 of Session 2 (x 2 slides)
• Give handout on
“Exercise safety tips”
• Show PowerPoint on “Exercise
Class (practical) Session 2” Slide 18 of Session 2
Cool-down
• Each participant to carry out 1-3 sets
8-10 reps body weight (as time allows)
• Measuring 3 on the Borg Scale
• Walk 5 minutes
1-2 Borg Scale
5 minutes
13
Ask participants to carry out the following activity.
Activity 2.1
Ask participants to identify their level of breathlessness by choosing the number closest to
how their breathing feels at this moment. Check with participants that they understand how
to use the scale.
Outline that when people exercise they are working their muscles and body harder than when
resting. Emphasise that when exercising, the heart rate increases, people often sweat and
breathing becomes harder – emphasise that they are not to worry when these things happen
as these are all normal responses to exercise.
Emphasise with participants that its important they try to keep exercising until they feel moderate
breathlessness i.e. that their breathing has increased to a level 4 on the Borg Breathlessness
Scale and therefore they should feel a noticeable increase in breathlessness before they stop
exercising.
Managing breathlessness
Explain to participants that we are now going to talk about ways of controlling their breathing
and ways of managing breathlessness when exercising or doing any activity that makes them
breathless. Explain that in Week 4, we will again discuss managing breathlessness in more
detail.
Controlling Your Breathing
There are a number of ways participants can control their breathing
and allow more air to enter their lungs. These are:
• Pursed lip breathing technique;
• Diaphragmatic breathing technique (abdominal breathing) which will be covered in week 4
• Positions of Ease.
Pursed lip breathing
Explain to participants that when you breathe out through pursed lips, you are creating a pressure
of air which can help to keep the airways of the lungs open.
Acknowledge that some participants may already know how to do this technique but as it is one
of the most important ways of reducing shortness of breath, we will practice how to use it now
Give participants the “Pursed lip breathing” handout and guide participants through the technique.
12
Ways of controlling your breathing
• Pursed Lip Breathing technique
• Diaphragmatic Breathing technique (Abdominal Breathing)
-which will be covered in week 4.
• Positions of Ease
1 of Session 2
Show Slide 1
of Session 2:
Lip Breathing Technique
• Relax your shoulders and upper chest. If able, place hand on abdomen.
• Close your mouth.
• Breath in slowly through your nose over two seconds.
• Do not take a deep breath while breathing in
• Purse your lips as if you were going to whistle
• Breath out slowly through your pursed lips over 4 seconds. feel your abdomen fall away from
your hand as you breath out
Encourage participants that they should perform pursed lip breathing until breathing feels better.
Emphasise that it’s important that they practice this technique several times a day, suggest that
they choose times to practice that are easy to remember, for example, after meals. Explain to
participants that they should use pursed lip breathing when they do anything that makes them feel
short of breath, such as climbing stairs, bathing, housework or at night if they become breathless.
(American lung association of Washington, 2005)
When Practicing Pursed Lip Breathing
Remind participant that when they are using pursed lip breathing that they need to:
• Keep the breathing quiet and relaxed;
• Try to “breathe” at a normal rhythm;
• Take normal size breaths and don’t hold the breath for too long;
• Concentrate most on breathing out for the count of 4.
Purse Lip Breathing technique
• Relax your shoulders and upper
chest. If able, place hand on
abdomen.
Close your mouth.
Breathe in slowly through
your nose over 2 seconds.
Do not take a deep breath
while breathing in.
Purse your lips as if you
were going to whistle.
Breathe out slowly through
your pursed lips over 4
seconds. Feel your abdomen
fall away from your hand
as you breathe out.
2 of Session 2
Show Slide 2
of Session 1:


Explain that some people with COPD do not breathe through the nose but through the mouth,
and that this is fine. But that people who do this need to focus on exhaling through pursed lips
and using more time to breathe out than to breathe in.
Positions of ease
Outline to participants that there are several body positions that they can use to help them breath
more easily when they are breathless. These are:
• Relaxed sitting;
• Forward lean sitting;
• Forward lean standing;
• Relaxed standing;
• High side lying.
Explain that by adopting one of these positions, they are assisting the diaphragm to change position
so that it moves upwards and forwards to help with inspiration (breathing in). Emphasise that it’s
important that they do not tense up but keep their shoulders and neck relaxed; do not grip or push
down with their hands as this will make the work of breathing harder.
Give participants the handouts on the “Positions of ease” and then guide them through relaxed
sitting and forward lean standing.
15
Relax your shoulders and upper
chest. If able, place hand on
abdomen.
Close your mouth.
Breathe in slowly through
your nose over 2 seconds.
Do not take a deep breath
while breathing in.
Purse your lips as if you
were going to whistle.
Breathe out slowly through your
pursed lips over 4 seconds. Feel
your abdomen fall away from your
hand as you breathe out.
Pursed lip breaking key steps


Place a tick in the
box if this technique
is performed correctly
14
When practising pursed lip breathing
• Keep breathing quiet and relaxed
• Try to “breathe” at a normal rhythm
• Take normal size breaths and don’t hold the breath for too long.
• Concentrate most on breathing out for the count of 4.
3 of Session 2
Show Slide 3
of Session 2:
Positions of Ease
• Relaxed sitting
• Forward lean sitting
• Forward lean standing
• Relaxed standing
• High side lying
4 of Session 2
Show Slide 4
of Session 2:
Descriptions of positions of ease
(a) Relaxed sitting
• Sit on a chair, feet on the ground, relax your
shoulders and upper chest.
• Place hand on upper abdomen, just below lower ribs.
• As you slowly breathe in for 2 seconds, feel your upper
abdomen and lower ribs rise.
• As you slowly breathe out for 4 seconds, feel your
abdomen fall away from your hand.
5 of Session 2
Show Slide 5
of Session 2
16 17
Descriptions of positions of ease
• Sit on a chair leaning forward, rest forearms on knees,
feet on the ground, relax your shoulders and upper chest.
• Slowly breathe in for 2 seconds, be aware of
your upper abdomen and lower ribs rising.
• Slowly breathe out for 4 seconds, be aware
of your abdomen and lower ribs falling back
into original position.
6 of Session 2
Forward lean sitting
• Sit on a chair, leaning forward. Have table
in front with 2 pillows placed on it.
• Rest your head and arms on the pillows.
• Slowly breathe in for 2 seconds, be aware of
your upper abdomen and • lower ribs rising.
• Slowly breathe out for 4 seconds, be aware of
your abdomen and lower ribs falling back into
original position.
7 of Session 2
Forward lean standing
• When standing, lean body forward from your hips and
rest elbows on a window ledge or similar support.
• Keep your shoulders and upper chest relaxed.
• Slowly breathe in for 2 seconds, be aware of
your upper abdomen and lower ribs rising.
• Slowly breathe out for 4 seconds, be aware of
your abdomen and lower ribs falling back into
original position.
8 of Session 2
Now ask participants to carry out the following activity.
Activity 2.2
Ask participants to practice the relaxed sitting and forward lean standing techniques.
Monitor participants performance and give positive feedback.
Now guide participants through the remaining positions.
Other Positions of Ease
• Relaxed Standing
When standing, place your back against a wall or similar support and
lean forward, with your arms relaxed by your sides.
• Keep your shoulders and upper chest relaxed.
• Slowly breathe in for 2 seconds, be aware of
your upper abdomen and lower ribs rising.
• Slowly breathe out for 4 seconds, be aware
of your abdomen and lower ribs falling back
into original position.
9 of Session 2
High Side Lying
• Lie on your side in bed, with 3-4 pillows
under your head and shoulders.
• Lean forward, keep shoulders and upper chest relaxed.
• Slowly breathe in for 2 seconds,
be aware of your upper abdomen
and lower ribs rising.
• Slowly breathe out for 4 seconds,
be aware of your abdomen and
lower ribs falling back into original
position.
10 of Session 2
Show Slide 9
of Session 2
Show
Slide 10 of
Session 2
Positions of ease (handout)
a) Relaxed sitting:
• Sit on a chair, feet on the ground, relax your shoulders and upper chest;
• Place hand on upper abdomen, just below lower ribs;
• As you slowly breathe in for 2 seconds, feel your upper abdomen and lower ribs rise;
• As you slowly breathe out for 4 seconds, feel your abdomen fall away from your hand.
(b) Relaxed sitting:
• Sit on a chair leaning forward; rest forearms on knees, feet on the ground, relax your shoulders
and upper chest;
• Slowly breathe in for 2 seconds, be aware of your upper abdomen and lower ribs rising;
• Slowly breathe out for 4 seconds, be aware of your abdomen and lower ribs falling back
into original position. (image on next page)
Show Slide 6
of Session 2
Show Slide 7
of Session 2
Show Slide 8
of Session 2
(e) Relaxed standing:
• When standing, place your back against a wall or similar support and lean forward,
with your arms relaxed by your sides;
• Keep your shoulders and upper chest relaxed;
• Slowly breathe in for 2 seconds, be aware of your upper abdomen and lower ribs rising;
• Slowly breathe out for 4 seconds, be aware of your abdomen and lower ribs falling back
into original position.
(f) High side lying:
• Lie on your side in bed, with 3-4 pillows under your head and shoulders;
• Lean forward, keep shoulders and upper chest relaxed;
• Slowly breathe in for 2 seconds, be aware of your upper abdomen and lower ribs rising;
• Slowly breathe out for 4 seconds, be aware of your abdomen and lower ribs falling back
into original position.
19
(c) Forward lean sitting:
• Sit on a chair, leaning forward. Have table in front with 2 pillows placed on it;
• Rest your head and arms on the pillows;
• Slowly breathe in for 2 seconds, be aware of your upper abdomen and lower ribs rising;
• Slowly breathe out for 4 seconds, be aware of your abdomen and lower ribs falling back
into original position.
(d) Forward lean standing:
• When standing, lean body forward from your hips and rest elbows on a window ledge or
similar support;
• Keep your shoulders and upper chest relaxed;
• Slowly breathe in for 2 seconds, be aware of your upper abdomen and lower ribs rising;
• Slowly breathe out for 4 seconds, be aware of your abdomen and lower ribs falling back
into original position.
18
2120
Home exercise programme
Explain to participants that the aim of the home exercise programme is to build up a pattern of
regular exercise to achieve health benefits. Each week they will receive a programme of exercises
to carry out at home and that these exercises will be based on the exercises practiced in the
exercise class they do each week within the PR programme.
Home exercise programme
Explain to participants:
• The exercises will include aerobic exercises to make their heart and lungs fitter and strengthening
exercises for their arms and legs, to make it easier to carry out daily tasks;
• The duration of the home exercises should build up to 30 minutes, 3-5 times a week;
• If they are unable to perform the exercises in one session, it is okay to divide the exercise session
over the day, for example, 10 minutes of exercise, three times a day will give you an accumulated
total of 30 minutes of exercise for that day;
• In addition to the strengthening exercises they will begin a walking programme, starting with a
short time interval and increasing as able to 30 minutes. Explain again that it is okay to divide
the walking time over the day, for example, walk for 10 minutes, 3 times a day, to achieve 30
minutes of walking a day;
• Over the weeks, they should aim to increase the length of time they can walk.
Once they can walk for 30 minutes without stopping for a rest, they can start
to increase the speed they walk at. This will keep a high level of exercise intensity
to help increase their fitness level.
Home exercise programme
• The exercises will include aerobic exercises to make the heart and
lungs fitter and strengthening exercises for arms and legs, to make
it easier to carry out daily tasks.
• The duration of the home exercises should build up to 30 minutes, 3-5
times a week.
• If unable to perform the exercises in one session, it is okay to divide
the exercise session over the day, for example, 10 minutes of
exercise, three times a day will give an accumulated total of 30
minutes of exercise for that day.
• In addition to the strengthening exercises begin a walking programme,
starting with a short time interval and increasing as able to 30 minutes.
It is okay to divide the walking time over the day, for example, walk for
10 minutes, 3 times a day, to achieve 30 minutes of walking a day.
• Over the weeks, aim to increase the length of time you can walk for.
Once you can walk for 30 minutes without stopping for a rest, you
can start to increase the speed you walk at. This will keep a high level
of exercise intensity to help increase fitness level.
11 of Session 2
Show
Slide 11 of
Session 2
Recording exercise in your exercise diary
In this section you will emphasise with participants that it’s really important that they record the
exercise activities that they do at home in their home exercise diary. Explain that this will allow
them to see how they are progressing and will also allow you to prescribe the correct exercises
and the weight for your strengthening exercises. For example once each person can perform 3
sets of 15 repetitions of an activity easily, the weight will be increased after reassessment.
Give participants the following handout of instructions for completing their home exercise diary.
Instructions for completing the home exercise diary
Each day:
• Record you’re walking time for exercise and distance (if known).
Record, also the resting time taken between walks;
• Record the exercise intensity of your walking by using the Borg Scale;
• Record the number of sets and repetitions of exercises. You will be prescribed
the correct amount of repetitions and sets in your exercise class;
• Record how many rests you take during exercise and how long they are.
Try to decrease the amount and length of rests as you become fitter;
• Record that you have carried out a warm up and cool down session.
Remind participants to:
• Exercise at an intensity of 4 on the Borg breathlessness scale;
• Enjoy yourself when exercising. Exercise should not be a chore
and to think of the benefits that regular exercise can bring;
• Read the “Exercise safety tips” handout before exercising;
• Bring your exercise diary to class, so that progress can be monitored
Recording your home exercise diary
Each day
• Record you’re walking time for exercise and distance (if known).
Record, also the resting time taken between walks.
• Record the exercise intensity of your walking by using the Borg Scale
• Record the number of sets and repetitions of exercises. You will be
prescribed the correct amount of repetitions and sets in your exercise
class.
• Record how many rests you take during exercise and how long
they are for. Try to decrease the amount and length of rests as you
become fitter.
• Record that you have carried out a warm up and cool down session
12 of Session 2
Show
Slide 12 of
Session 2:
2322
Now give participants the “exercise safety tips” handout and guide participants through it.
Emphasise with participants that it’s important to know when to stop exercising.
Tell participants to stop if they feel any of the following:
You should stop exercising if you experience any of the following:
• Chest pain or tightness;
• Palpitations – irregular and fast heart rate associated with shortness of breath;
• Nausea or dizziness;
• Cold or clammy;
• Increased wheezing;
• Pain in joints or muscles;
• Extreme tiredness;
• Severe headache.
Emphasise that they should stop exercising, sit down, perform pursed lip breathing, and adopt
a position of ease. Emphasise that if the symptoms persist longer than 10 minutes or become
worse, they should contact their GP or practice nurse.
Completing your home exercises
Remember:
• Exercise at an intensity of 4 on the Borg Breathlessness Scale
• Enjoy yourself when exercising. Exercise should not be a chore and to
think of the benefits that regular exercise can bring. .
• Read the Exercise Safety Tips handout before exercising
• Bring your exercise diary to class, so that progress can be monitored
13 of Session 2
Show
Slide 13 of
Session 2:
You should stop exercising if you experience any of the following:
• Chest pain or tightness
• Palpitations – irregular and fast heart rate associated
with shortness of breath
• Nausea or dizziness
• Cold or clammy
• Increasingly wheezy
• Pain in joints or muscles
• Extreme tiredness
• Severe headache
14 of Session 2
Show
Slide 14 of
Session 2:
You should stop exercising contd:
• Sit down,
• Perform pursed lip breathing,
• Adopt a position of ease
• If the symptoms persist longer than 10 minutes or become worse,
contact your GP or practice nurse.
15 of Session 2
Show
Slide 15 of
Session 2:
Exercising safety tips
Exercising safety tips
• Wear comfortable clothing and supportive footwear;
• When walking outside bring your mobile phone or inform someone,
and wear reflective clothing in dark weather;
• Take medications as prescribed;
• Bring a bottle of water to prevent dehydration;
• Ensure that you have eaten at least one hour before exercise;
• Make sure that you have a safe environment;
• Do not exercise the day before or the day of the PR exercise classes;
• Always warm up for 5 minutes before exercise and cool down for 5 minutes after exercise.
For this activity, your breathlessness should measure 1 to 2 on the Borg Scale;
• Do not carry out strengthening exercises of the same muscle groups (e.g. arms or legs/both)
two days in a row. There must be a day of rest to help the muscles recover and to prevent injury;
• Do not add or increase weights – this will be done in your exercise class on assessment;
• Take rest periods when you exercise as needed. This should be guided by measuring your
breathlessness on the Borg Scale. Record how many rests and how long they are for.
Try to decrease the amount and length of these rests as you become fitter;
• Remember when you are breathless use pursed lip breathing, positions of
ease and diaphragmatic breathing techniques (these will be covered in Week 4).
Exercising Safety Tips
• Wear comfortable clothing and supportive footwear
• When walking outside bring your mobile phone or inform someone,
and wear reflective clothing in dark weather
• Take medications as prescribed
• Bring a bottle of water to prevent dehydration
• Ensure that you have eaten at least one hour before exercise
• Make sure that you have a safe environment.
• Do not exercise the day before or the day of the PR exercise classes.
• Always warm up for 5 minutes before exercise and cool down for 5
minutes after exercise. For this activity, your breathlessness should
measure 1 to 2 on the Borg.
16 of Session 2
Show
Slide 16 of
Session 2:
25
Next commence the exercise class as outlined in the timetable at the start of this session.
The following is the list of exercises participants will complete in all the exercise classes.
Following reassessment each week the number and intensity of the exercises undertaken
by each participant will be reviewed.
Weekly class exercises
Warm Up Exercises
Arms pull backward:
• Sitting or standing, with back straight. Keep elbows straight and arms at shoulder level
in front of the body;
• Separate arms to the side, as far as possible;
• Hold for ____ seconds;
• Slowly return to the starting position;
• Repeat ___times for each arm (add weights as prescribed).
24
Guidelines for PRINCE physiotherapist re: pedals & step-ups:
• Pedals - use first with participants who cannot perform wall squats and then for the other
participants depending on time;
• In sitting, adjust resistance on pedals and inform participant to pedal for time at circuit
station e.g. 3 minutes;
• Remember that some participants will need assistance with step-ups for safety reasons;
• Progress step-ups for participants by increasing the height of the step when they can
easily exercise for 3 minutes on the low step.
Exercise class (Practical) (Session 2) (75minutes)
Establish the exercise class circuit and explain to participants that there are:
• 10 stations that each participant needs to exercise at;
• Each station takes 3 minutes;
• Each participant needs to record how breathless they
are after completing the station on the Borg Scale;
• Each participant needs to record the number of repetitions
they have done at each station.
Exercising Safety Tips contd
• Do not carry out strengthening exercises of the same muscle groups
(e.g. arms or legs/both) two days in a row. There must be a day of rest
to help the muscles recover and to prevent injury.
• Do not add or increase weights – this will be done in your exercise
class on assessment.
• Take rest periods, when you exercise, as needed. This should be
guided by measuring your breathlessness on the Borg Scale. Record
how many rests and how long they are for. Try to decrease the amount
and length of these rests as you become fitter.
• Remember when you are breathless use pursed lip breathing,
positions of ease and diaphragmatic breathing techniques (these will
be covered in Week 4)
17 of Session 2
Show
Slide 17 of
Session 2:
Exercise class (Practical) Session 2
• There are 10 stations that each participant needs to exercise at,
• Each station takes 3 minutes,
• Each participant needs to record how breathless they are after
completing the station on The Borg Scale,
• Each participant needs to record the number of repetitions they have
done at each station
18 of Session 2
Show
Slide 18
of Session 2:
Trunk rotation:
• Stand with back straight and feet shoulder width apart;
• Cross arms across your chest (see picture);
• Turn upper body and head to look over right shoulder as far as you can go;
• Keep feet in the same place;
• Hold for ____ seconds;
• Slowly return to the starting position;
• Repeat ___times to the right and left.
Class Exercises
Biceps curls:
• Sitting or standing, with back straight; • Slowly return to the starting position;
• Lift your hand up to your shoulder, bending the elbow; • Repeat ___times for each arm
(add weights as prescribed).
• Hold for ____ seconds;
2726
Calf stretches:
• Stand a little more than an arm length away from a wall;
• Keeping back and hips straight, place hands on the wall;
• Keep elbows straight;
• Bring right leg forward, bending at the knee;
• Keep left leg straight and keep left heel on the ground;
• Push gently into the wall;
• Feel a stretch on your left calf;
• Hold for ____ seconds;
• Slowly return to the starting position;
• Repeat on Right leg;
• Repeat ___times each leg.
Hamstring stretch:
• In standing position, feet shoulder width apart;
• Bring right leg forward, keep knee straight;
• Bend right foot towards the ceiling, keeping heel on the ground;
• Gently bend left knee, so that it is in line with left 2nd toe;
• Hold for____seconds;
• Repeat on left leg;
• Repeat_____times each leg.
29
Wall press:
• Stand a little more than an arm length away from a wall;
• Keeping back and hips straight, place hands on the wall, Keep elbows straight;
• Push into the wall through your shoulders;
• Be conscious of keeping your shoulder blades against your rib cage;
• Hold for ____ seconds;
• Slowly return to the starting position;
• Repeat ___times.
Arm circles:
• Sitting or standing, with back straight. Keep elbows straight and arms at shoulder level out to
the side of the body;
• Start moving your arms in small circles gradually increasing to large circles;
• Repeat ___times for each arm (add weights as prescribed).
Arm wings:
• Sitting or standing, with back straight;
• Keep elbows straight, lift arms out to the side and up, as far as possible;
• Hold for ____ seconds;
• Slowly return to the starting position;
• Repeat ___ times for each arm (add weights as prescribed).
Shoulder lifts:
• Sitting or standing, with back straight;
• Keep elbow straight, lift 1 arm up in front, followed by the other, as far as possible;
• Hold for ____ seconds;
• Slowly return to the starting position;
• Repeat ___times for each arm (add weights as prescribed).
28
Wall squat:
• Standing with your back to the wall, feet shoulder width apart and back straight;
• Slowly bend your knees so you slide down the wall. Keep your knees hip width apart
(Both knees go over the second toe, respectively);
• Hold this position for ___seconds;
• Repeat ___times.
Step-ups:
• Standing beside a step and holding onto a stable surface for balance;
• Slowly step up onto the step with foot A;
• Bring the foot B up onto the step also;
• Slowly step back down with foot B;
• Return foot A to the floor;
• Repeat ___times for each foot
(add weights as prescribed).
3130
Leg weights:
• Sitting in a hard chair, with back straight; • Hold for ____ seconds;
• Keep your toes pointing towards the ceiling; • Slowly return to the starting position;
• Straighten your knee as far as possible; • Repeat ___times for each leg
(add weights as prescribed).
Sit-to-stand:
• Sitting on a chair, with feet flat on the floor shoulder width apart;
• Lean forward, bringing your nose over your toes;
• Slowly stand up using your hands as little as possible;
• When standing, stand up straight and take a deep breath in;
• Repeat_____times.
Stand-to-sit:
• Standing in front of a chair;
• Move backwards until you can feel the chair at the back of your knees;
• Slowly lower yourself down into the chair using your hands as little as possible;
• Repeat ___times.
33
Session 3: Exercise Programme
Facilitator Room Layout Time
PRINCE Educators Flat open space clear of obstacles 120 mins
for walking; chairs in a semi circle;
clear of walk area
For this session you should have the following resources:
• A3 Borg Breathless Scale for each station; • A3 exercise record board for each station;
• Blue tack; • Chairs (one per participant);
• Clock with large face; • Cones;
• Exercise posters for each station; • Exercise steps (adjustable);
• Flip chart and pens; • Non slip mat;
• O2 and tubing; • Pedals;
• Pedometer; • Pens (Biros);
• Pulse oximeter; • Stop watch X2;
• Table or stable surface at waist height; • Tape measure;
• Therabands; • Weights:
• DVD of Exercise Session 3 - adjustable for ankles;
PowerPoint presentations. - dumbbells for arms;
Learning Outcomes
At the end of this session participant’s will:
• Understand the benefits of a warm-up and cool-down;
• Understand the importance of aerobic and progressive strengthening exercises;
• Know how to progress strengthening exercises;
• Apply safety precautions associated with progressive strengthening
exercises and balance exercises;
• Receive feedback on how home exercises are progressing.
32
Exercise timetable
Duration Topic Content
• Warm-up
• Exercise
circuit
(Includes
prescribed
individual
arm/leg
weights)
Cool-down
• Walk/marching on spot swinging arms
side stepping
• Measuring 1-2 on the Borg scale
• Each participant (depending on ability) to carry
out 5 reps of each of the following activities:
- Arms pull backward with theraband;
- Shoulder flexion;
- Trunk rotation;
- Calf stretches;
- Hamstring stretches.
• Each participants (depending on ability) to walk
for 3 mins around cones (measure distance)
Use pedometer (record steps)
Measuring 4 on the Borg Scale
• Legs:
- Leg weights;
- Step ups;
- Sit to stand;
- Wall squats;
- Pedals.
• Arms:
- Biceps curls;
- Arm circles;
- Arm wings;
- Wall press;
- Shoulder lifts.
• Each participant (depending on ability) to carry out
3 sets, 8-10 reps prescribed weights for biceps curl
and leg weights
• Measuring 4 on the Borg Scale
• Walk 5 minutes
1-2 Borg Scale
5 minutes
50 minutes
5 minutes
3534
Topic & Duration Content Resources & Activities
• Review Home Exercise
Programme & diaries
• Explain the benefits of
warm up and cool down
• Explain the specific content
of this exercise session
• Explain the benefits of walking
and different ways of making it
a “fun” event
• Review goal setting in relation
to exercise
• Explain the aim of strengthening
exercises and the need for
progressive strengthening
exercises and how these
will be prescribed
• Interactive teaching
• Group work
• Show PowerPoint
“Warm up & cool down sessions
are important as they will...”
Slide1 of Session 3
• Show PowerPoint “Exercise”
class (Practical) Session 2
• Interactive teaching
• Group activities
• Show PowerPoint “Walking
Exercises” Slides 2 - 3
(x 2 slides)
• Interactive teaching
• Show PowerPoint “Progressive
strengthening exercises” - Slide
4 - 7 of Session 3 (x 4 slides)
• Show PowerPoint “Exercise
class (Practical) Session 3” Slide 8 of Session 3
Introduction
(20 minutes)
Warm up &
cool down
(10 minutes)
Walking
exercises
(10 minutes)
Progressive
strengthening
exercises
Prescribing
weights
(20 minutes)
37
Introduction
Welcome the participants back to their second exercise class and thank them for showing
commitment and motivation to improve their lifestyle and management of COPD.
To elicit feedback on participants performance of the home exercise activities carry out the
following activity with participants.
Activity 3.1
Ask participants to work in pairs to share their achievements with each others in terms of the
amount and type of exercise that they carried out in their Home Exercise Programme. Then ask
participants to list what they found easy and why: and what they found difficult and why?
Take feedback
Activity 3.2
Still working in pairs, ask participants to look again at what they found difficult last week and
discuss what they will do to make it easier for next week.
Take feedback and acknowledge and reaffirm participants positive strategies for overcoming
difficulties
Ask the Participants if they have any questions and clarify same.
Warm up and cool down
In this session you will explain to participants about the importance of warm up and to cool
down sessions before and after engaging in any exercise activity.
Warm up
Explain to participants that a warm up session before exercise will increase the oxygen supply
throughout the body and increase the blood supply to the muscles and to the lungs, making
it easier to carry out exercise. It will also make the muscles more flexible and decrease the risk
of injury.
A warm up session comprises of a 5 minute walk, at a Borg intensity of 1-2, and gentle stretches
of the arms and legs. Explain that these will be practised in the PR exercise class.
Cool down
Emphasise that a cool down session after exercise will allow the heart rate and breathing to
return to normal. It will also allow the body’s temperature to return to normal. A cool down
session comprises of a 3-5 minute walk, breathing control, and gentle stretches. Explain to
participants that these will be practised in the PR exercise class.
Explain a warm up and cool down session will:
• Improve exercise performance;
• Decrease the risk of injury;
• Reduce muscle soreness;
36
Warm up and cool down sessions are important as they will:
• Improve exercise performance
• Decrease the risk of injury
• Reduce muscle soreness
1 of Session 3
Show Slide 1
of Session 3:
Prior to beginning the exercise class remind participants to exercise at their own pace but to try
and achieve an exercise intensity of 4 on the Borg Scale. Ask participants to inform you if they feel
unwell during the exercise session. Explain to participants that we will be recording their oxygen
saturation and heart rate on the exercise record sheet at the start of the class, after the walking
circuit or if someone feels unwell.
Notes for PRINCE Physiotherapist
Remember that the aim of the exercise programme is to increase exercise tolerance. Therefore
the focus should be on the progressive nature of the exercises i.e. increasing distance covered
and length of time walked rather than speed. The higher the intensity the participant exercises
at the bigger the improvement will be. However, high intensity exercising may be limited by
breathlessness. Try to ensure that participants avoid excessive breathlessness as they may
become adverse to exercise training.
Walking exercise
Explain to participants that walking can improve their heart and lung function, exercise endurance
and quality of life. Explain that walking doesn’t have to mean an exercise session; it can be fun like
walking with friends and family, walking to the shop, or walking up and down a corridor. Explain that
if they are walking up and down a corridor/hall, to count how many lengths walked and try and
improve as able. Remind participants that it is important to walk at the correct pace, not to start
off walking too quickly, to avoid breathlessness and aim to walk a little further each week.
Remind participants to keep a record of the time/distance walked before taking a rest break or the
number of rest breaks taken when walking for 30 minutes. Emphasise participants need to walk at
an exercise intensity of 4 on the Borg Scale. Explain to participants that there are other options to
increase exercise endurance such as dancing, exercise bike/cycling.
Explain to participants that when they are walking up stairs, it is easier to practice bringing both
feet up onto a step at a time and progressing that way. Another technique is breathing in when
climbing up one step and breathing out when climbing up the next step. This will help to reduce
breathlessness.
Activity 3.3
Remind participants that with the PRINCE educator in session 1 we looked at setting personal
goals. Now ask participants to think about their personal goals for exercising and what they
need to do to achieve those goals.
Take feedback and acknowledge and reaffirm participants positive strategies.
Explain that an exercise goal could be to walk to the shop and back without rests.
Help participants understand that short bursts of walking exercise (interval training) are as effective
as prolonged exercise sessions (continuous training). Often people with COPD find ‘short burst’
exercising easier.
Emphasise that ideally at the end of the 7 weeks exercise sessions, they should be able to see
an improvement in the distance they can walk with most participants being able to walk for up
to 30 minutes.
Explain that Participants should aim to increase the length of time
they can exercise for and decrease the rest time in between walks.
38 39
Progressive strengthening exercises
Explain to participants that progressive strengthening exercises increase muscle strength and
mass thereby improving the ability to carry things, to move about and to carry out housework/
work more easily. Explain that in this week’s session once a participant can perform 3 sets of
8-10 repetitions of an exercise easily in one go, then the exercise will be progressed
by increasing the weight or increasing the number of sets. Inform participants that
this is the weight that they will be using in the exercise class and that they will be
carrying out 3 sets of 8-10 repetitions.
Note for PRINCE Physiotherapist
Only prescribe weights in session 3, so that each participant has time to become familiar with the
exercise protocol and the correct body position for the exercise. It is essential that the participant
can perform all the exercises correctly, to decrease the risk of injury.
Once a participant can perform 3 sets of 8-10 repetitions of an exercise easily in one go, then
the exercise can be progressed by increasing the weight or increasing the number of sets. This
will be done by finding the repetition max. This is the maximum weight the participant can lift for
10 repetitions comfortably.
E.g. Leg weights: 3 sets of 8-10 repetitions – body weight
Leg weights: 3 sets of 8-10 reps with __kg (or a suitable weight)
Explain to participants that all the strengthening exercises can be done on one day, but if they find
this difficult, they can break the exercises up by performing arm exercises one day and leg exercises
another day. Emphasise however that it is important to allow at least one day of rest between
repeated strengthening exercises for the same muscle group, so as to avoid injury/ overtraining.
For example explain to participants that if they do all the strengthening exercises on Monday (arms
and legs) then take a rest from all strengthening exercises on Tuesday. But they can still carry out
the aerobic exercises on the Tuesday, but return to strengthening on Wednesday. However, if they
do only arm strengthening on Monday, then they can do the leg strengthening on Tuesday.
Explain that in order to achieve increased muscle strength, the correct number of repetitions for
each exercise must be completed and an exercise of 3 sets of 8 – 10 repetitions must be performed
in one go. Emphasise that performing one set in the morning, one in the afternoon and the last set
in the evening is not effective for muscle strengthening.
Outline to participants that the strengthening exercises can be performed seated or standing,
whichever is the most comfortable position.
Walking exercise
• Walking can improve heart and lung function, exercise endurance and
quality of life.
• It can be fun like walking with friends and family, walking to the shop,
or walking up and down a corridor.
• If walking up and down a corridor/hall, count how many lengths
walked and try and improve as able.
• It is important to walk at the correct pace, not to start off walking too
quickly and aim to walk a little further each week.
• Keep a record of the time/distance walked before taking a rest break
or the number of rest breaks taken when walking for 30 minutes.
• Walk at an exercise intensity of 4 on the Borg Scale.
• Other options - increase exercise endurance through dancing,
or cycling.
2 of Session 3
Show Slide 2
of Session 3:
Walking contd.
• Short bursts of walking exercise (interval training) are as effective as
prolonged exercise sessions (continuous training). Often people with
COPD find ‘short burst’ exercising easier.
• At the end of the 7 weeks exercise sessions, you should be able to
see an improvement in the distance you can walk and most of you
should be able to walk for up to 30 minutes.
• You should aim to increase the length of time you can exercise for
and decrease the rest time in between walks.
3 of Session 3
Show Slide 3
of Session 3:
4140
Guidelines for PRINCE physiotherapist re: pedals & step-ups
• Pedals - use first with participants who cannot perform wall squats and then for the
other participants depending on time;
• In sitting, adjust resistance on pedals and inform participant to pedal for time at circuit
station e.g. 3 minutes;
• Remember that some participants will need assistance with step-ups for safety reasons;
• Progress step-ups for participants by increasing the height of the step when they can easily
exercise for 3 minutes on the low step.
Exercise class (practical) (Session 3)
Remind participants to exercise at their own pace but to try and achieve an exercise intensity
of 4 on the Borg Scale. Ask participants to inform you if they feel unwell during the exercise
session. Explain to participants that we will be recording their oxygen saturation and heart
rate on the exercise record sheet at the start of the class, after the walking circuit or if someone
feels unwell.
Emphasise with participants that they:
• Do not increase weights unless told to do so by the PRINCE physiotherapist;
• Do not exercise on the day before or day of the exercise class;
• Always leave at least one day of rest in between doing strengthening
exercises for the same muscle groups to avoid fatigue and injury.
Establish the exercise class circuit as in exercise session 2 and remind participants that there are:
• 10 stations that each participant needs to exercise at;
• Each station takes 3 minutes;
• Each participant needs to record how breathless they are after completing the station on
The Borg Scale;
• Each participant needs to record the number of repetitions they have done at each station.
Next commence the exercise class as outlined in the timetable at the start of this session.
The types of exercises are the same as that listed in exercise session two. Following reassessment
each week the number and intensity of the exercises undertaken by each participant will be reviewed.
Progressive strengthening exercises
• Increase’s muscle strength and mass thereby improving your ability
to do normal daily activities
• In this week’s session once you can perform 3 sets of 8 -10 repetitions
of an exercise easily in one go, then the exercise will be progressed by
increasing the weight or increasing the number of sets.
• Strengthening exercises can be performed seated or standing,
whichever is the most comfortable position.
4 of Session 3
Show Slide 4
of Session 3:
Progressive strengthening exercises
• This is the weight that you will be using in the exercise class and you
will be carrying out 3 sets of 8-10 repetitions. in order to achieve in
creased muscle strength, that the correct number of repetitions for
each exercise must be completed and an exercise of 3 sets of 8 – 10
repetitions must be performed in one go. Emphasise that performing
one set in the morning, one in the afternoon and the last set in the
evening is not effective for muscle strengthening.
5 of Session 3
Show Slide 5
of Session 3:
Progressive strengthening exercises contd.
• In order to achieve increased muscle strength, the correct number of
repetitions for each exercise must be completed and an exercise of 3
sets of 8 – 10 repetitions must be performed in one go.
• Performing one set in the morning, one in the afternoon and the last
set in the evening is not effective for muscle strengthening.
• The strengthening exercises can be performed seated or standing,
whichever is the most comfortable position.
6 of Session 3
Show Slide 6
of Session 3:
Progressive strengthening exercises contd.
• All the strengthening exercises can be done on one day, but if you
find this difficult, you can break the exercises up by performing arm
exercises one day and leg exercises another day.
• However it is important to allow at least one day of rest between
repeated strengthening exercises for the same muscle group, so
as to avoid injury or overtraining.
7 of Session 3
Show Slide 7
of Session 3:
Exercise class (Practical) Session 3
• Exercise at you own pace but to try and achieve an exercise intensity
of 3 on the Borg scale.
• Please let us know if you feel unwell during the exercise session.
• Do not increase the weights unless told to do so by the PRINCE
physiotherapist
• Do not exercise on the day before or day of the exercise class.
• Always leave at least one day of rest in between doing strengthening
exercises for the same muscle groups to avoid fatigue and injury.
8 of Session 3
Show Slide 8
of Session 3:
42
Session 4: Exercise Programme
Facilitator Room Layout Time
PRINCE Educators Flat open space clear of obstacles 70 mins
for walking; chairs in a semi circle;
clear of walk area
For this session you should have the following resources:
• A3 Borg Breathless Scale for each station; • A3 exercise record board for each station;
• Blue tack; • Chairs (one per participant);
• Clock with large face; • Cones;
• Exercise posters for each station; • Exercise steps (adjustable);
• Flip chart and pens; • Non slip mat;
• O2 and tubing; • Pedals;
• Pedometer; • Pens (Biros);
• Pulse oximeter; • Stop watch X2;
• Table or stable surface at waist height; • Tape measure;
• Therabands; • Weights:
• DVD of Exercise Session 4 - adjustable for ankles;
PowerPoint presentations. - dumbbells for arms;
Learning Outcomes
At the end of this session participant’s will:
• Understand the importance of stretching exercises;
• Receive feedback on how home exercises are progressing
43
Introduction
Welcome and thank participants for attending. Ask participants how they got on with their home
exercises last week and if they recorded their activities in their home diary. Find out if anyone; had
any difficulties; felt any benefits for example if they could walk further. Ask participants if they have
any queries and clarify same.
Emphasise home exercise is essential to their success with this programme
Stretching Exercises
Stretching
Explain to participants that people, who are often breathless or cough a lot, can develop a
curve in their upper spine. Explain to participants that flexibility exercises and stretching can
help to prevent this from happening. However, emphasise that exercising alone is not enough
to prevent this; they also need to be conscious of their posture and regularly check to make
sure they are not ‘stooping’.
Explain to participants that they can ‘cue’ themselves to help remember not to ‘stoop’.
For example, every time they see a tap, imagine they are ‘opening out their chest’ and
draw their shoulders back.
Remind participants to exercise at their own pace but to try and achieve an exercise intensity of
4 on the Borg Scale. Ask participants to inform you if they feel unwell during the exercise session.
Explain that we will be recording their oxygen saturation and heart rate on the exercise record
sheet at the start of the class, after the walking circuit or if someone feels unwell.
Guidelines for PRINCE Physiotherapist re: pedals & step-ups
• Pedals - use first with participants who cannot perform wall squats and then for the other
participants depending on time;
• In sitting, adjust resistance on pedals and inform participant to pedal for time at circuit station
e.g. 3 minutes;
• Remember that some participants will need assistance with step-ups for safety reasons;
• Progress step-ups for participants by increasing the height of the step when they can easily
exercise for 3 minutes on the low step;
45
Topic & Duration Content Resources & Activities
• Review Home Exercise
Programme & diaries
• Explain the benefits of
stretching exercises
• Interactive teaching
• Group work
• Interactive teaching
• Show PowerPoint “Stretching” Slide 1 of Session 4
Introduction
(5 minutes)
Stretching
exercises
(10 minutes)
Exercise timetable
Duration Topic Content
• Warm-up
• Exercise
circuit
(Includes
prescribed
individual
arm/leg
weights)
Cool-down
• Walk/marching on spot swinging arms
side stepping
• Measuring 1-2 on the Borg scale
• Each participant (depending on ability)
to carry the following activities:
- Arms pull backward with theraband;
- Shoulder flexion;
- Trunk rotation;
- Calf stretches;
- Hamstring stretches.
• Each participants (depending on ability) to walk
for 3 mins around cones (measure distance)
Use pedometer (record steps)
Measuring 4 on the Borg Scale
• Legs:
- Leg weights;
- Step ups;
- Sit to stand;
- Wall squats;
- Pedals.
• Arms:
- Biceps curls;
- Arm circles;
- Arm wings;
- Wall press;
- Shoulder lifts.
• Each participant (depending on ability)
to carry out 3 sets 8 -10 reps prescribed
weights for biceps curl and leg weights
• Measuring 4 on the Borg Scale
• Walk 5 minutes (1-2 Borg Scale)
5 minutes
45 minutes
(Each
participant to
do 3 mins at
each station)
5 minutes
44
Stretching
• People, who are often breathless or cough a lot, can develop a curve
in their upper spine.
• Flexibility exercises and stretching can help to prevent this from
happening.
• However, exercising alone is not enough to prevent this; you also need
to be conscious of your posture and regularly check to make sure that
you are not ‘stooping’.
• You can ‘cue’ yourself to help remember not to ‘stoop’. For example,
every time they see a tap, imagine they are ‘opening out their chest’
and draw their shoulders back.
1 of Session 4
Show Slide 1
of Session 4:
Session 5: Exercise Programme
Facilitator Room Layout Time
PRINCE Educators Flat open space clear of obstacles 75 mins
for walking; chairs in a semi circle;
clear of walk area
For this session you should have the following resources:
• A3 Borg Breathless Scale for each station; • A3 exercise record board for each station;
• Blue tack; • Chairs (one per participant);
• Clock with large face; • Cones;
• Exercise posters for each station; • Exercise steps (adjustable);
• Flip chart and pens; • Non slip mat;
• O2 and tubing; • Pedals;
• Pedometer; • Pens (Biros);
• Pulse oximeter; • Stop watch X2;
• Table or stable surface at waist height; • Tape measure;
• Therabands; • Weights:
- (adjustable for ankles);
- dumbbells for arms;
Learning Outcomes
At the end of this session participant’s will:
• Understand medications and exercise/medications and risk of falls;
• Receive feedback on how home exercises are progressing.
Topic & Duration Content Resources & Activities
• Review Home Exercise
Programme & diaries
• Review the use of medications
when exercising
• Interactive teaching
• Group work
• Interactive teaching
Introduction
(3 minutes)
Medications
and exercise
(10 minutes)
4746
Exercise class (practical) (Session 4)
Establish the exercise class circuit as in exercise session 2 and remind participants that there are:
• 10 stations that each participant needs to exercise at;
• Each station takes 3 minutes;
• Each participant needs to record how breathless they are after completing the station on
the Borg Scale;
• Each participant needs to record the number of repetitions they have done at each station.
Next commence the exercise class as outlined in the timetable at the start of this session.
The types of exercises are the same as that listed in exercise session two. Following
reassessment each week the number and intensity of the exercises undertaken by each
participant will be reviewed.
Medications and exercise
Explain to participants that correctly timing their exercise regimen around taking their medication
can often make exercising a little easier. Explain that exercising half an hour after they have taken
their bronchodilator can decrease breathlessness or exercising half an hour after taking pain killers
can make exercising easier. Emphasise that they should not exercise after taking medications as
that can cause them to become drowsy or tired.
Explain to participants that some side effects of some medications can result in a greater risk of
falling and bone fractures. Explain that exercise can improve balance; muscle and bone strength
and decrease the risk of falling. Remind participants that they should not exercise if they feel dizzy
or light headed, but to sit and wait a few minutes to see if this resolves. Emphasise that if the
symptoms persist longer than 10 minutes or become worse, they should contact their GP or
practice nurse.
Remind participants to exercise at their own pace but to try and achieve an exercise intensity of
4 on the Borg Scale. Ask participants to inform you if they feel unwell during the exercise session.
Explain that we will be recording their oxygen saturation and heart rate on the exercise record
sheet at the start of the class, after the walking circuit or if someone feels unwell.
Exercise class (practical) (Session 5)
Establish the exercise class circuit as in exercise session 2 and remind participants that there are:
• 10 stations that each participant needs to exercise at;
• Each station takes 3 minutes;
• Each participant needs to record how breathless they are after completing the station on
The Borg Scale;
• Each participant needs to record the number of repetitions they have done at each station.
Next commence the exercise class as outlined in the timetable at the start of this session.
The types of exercises are the same as that listed in exercise session two. Following reassessment
each week the number and intensity of the exercises undertaken by each participant will be
reviewed.
49
Exercise timetable
Duration Topic Content
• Warm-up
• Exercise
circuit
(Includes
prescribed
individual
arm/leg
weights)
Cool-down
• Walk/marching on spot swinging arms
side stepping
• Measuring 1-2 on the Borg scale
• Each participant (depending on ability)
to carry the following activities:
- Arms pull backward with theraband;
- Shoulder flexion;
- Trunk rotation;
- Calf stretches;
- Hamstring stretches.
• Each participants (depending on ability) to walk
for 6 mins around cones (measure distance)
Use pedometer (record steps)
Measuring 4 on the Borg Scale
• Legs:
- Leg weights;
- Step ups;
- Sit to stand;
- Wall squats;
- Pedals.
• Arms:
- Biceps curls;
- Arm circles;
- Arm wings;
- Wall press;
- Shoulder lifts.
• Each participant (depending on ability)
to carry out 3 sets 8 -10 reps prescribed
weights for biceps curl and leg weights
• Measuring 3 on the Borg Scale
5 minutes
55 minutes
(Each
participant to
do 3 mins at
each station)
2 minutes
Introduction
Welcome and thank participants for attending. Ask participants how they got on with their home
exercises last week and if they recorded their activities in their home diary. Find out if anyone had
any difficulties/felt any benefits; for example if they could walk further. Ask participants if they have
any queries and clarify same.
48
51
Topic & Duration Content Resources & Activities
• Review Home Exercise
Programme & diaries
• What to do if an exacerbations
of their COPD occurs during
exercise and afterward
• Interactive teaching
• Group work
• Interactive teaching
• Show PowerPoint “Exercise
Advice during exacerbations of
COPD” – Slides 1-2 of Session
6 (x 2 slides)
Introduction
(5 minutes)
Exercise &
exacerbations
of COPD
(10 minutes)
Exercise timetable
Duration Topic Content
• Warm-up
• Exercise
circuit
(Includes
prescribed
individual
arm/leg
weights)
Cool-down
• Walk/marching on spot swinging arms
side stepping
• Measuring 1-2 on the Borg scale
• Each participant (depending on ability)
to carry the following activities:
- Arms pull backward with theraband;
- Shoulder flexion;
- Trunk rotation;
- Calf stretches;
- Hamstring stretches.
• Each participants (depending on ability) to walk
for 6 mins around cones (measure distance)
Use pedometer (record steps)
Measuring 4 on the Borg Scale
• Legs:
- Leg weights; - Step ups;
- Sit to stand; - Wall squats;
- Pedals.
• Arms:
- Biceps curls; - Arm circles;
- Arm wings; - Wall press;
- Shoulder lifts.
• Each participant (depending on ability)
to carry out 3 sets 8 -10 reps prescribed
weights for biceps curl and leg weights
• Measuring 4 on the Borg Scale
• Walk 5 minutes (1-2 Borg Scale)
5 minutes
50 minutes
(Each
participant to
do 3 mins at
each station)
5 minutes
50
Session 6: Exercise Programme
Facilitator Room Layout Time
PRINCE Educators Flat open space clear of obstacles 75 mins
for walking; chairs in a semi circle;
clear of walk area
For this session you should have the following resources:
• A3 Borg Breathless Scale for each station; • A3 exercise record board for each station;
• Blue tack; • Chairs (one per participant);
• Clock with large face; • Cones;
• Exercise posters for each station; • Exercise steps (adjustable);
• Flip chart and pens; • Non slip mat;
• O2 and tubing; • Pedals;
• Pedometer; • Pens (Biros);
• Pulse oximeter; • Stop watch X2;
• Table or stable surface at waist height; • Tape measure;
• Therabands; • Weights:
• DVD of exercise Session 6 - adjustable for ankles;
PowerPoint presentations. - dumbbells for arms;
Learning Outcomes
At the end of this session participant’s will:
• Understand how to adjust exercises during an exacerbation of COPD;
• Receive feedback on how home exercises are progressing
53
Emphasise with participants that they:
• Should not exercise if they are short of breath;
• Should not exercise if they have a temperature or feel dizzy;
• Should avoid exercising in hot or cold weather.
Remind participants to exercise at their own pace but to try and achieve an exercise intensity of
4 on the Borg Scale. Ask participants to inform you if they feel unwell during the exercise session.
Explain to participants that we will be recording their oxygen saturation and heart rate on the
exercise record sheet at the start of the class, after the walking circuit or if someone feels unwell.
Exercise class (Practical) (Session 6)
Establish the exercise class circuit and remind participants that there are:
• 10 stations that each participant needs to exercise at;
• Each station takes 3 minutes;
• Each participant needs to record how breathless they are after
completing the station on The Borg Scale;
• Each participant needs to record the number of repetitions they have done at each station.
Next commence the exercise class as outlined in the timetable at the start of this session.
The types of exercises are the same as that listed in exercise session two. Following reassessment
each week the number and intensity of the exercises undertaken by each participant will
be reviewed.
52
Introduction
Welcome and thank participants for attending. Ask participants how they got on with their home
exercises last week and if they recorded their activities in their home diary. Find out if anyone;
had any difficulties; felt any benefits for example if they could walk further. Ask participants if
they have any queries and clarify same.
Exercise and exacerbations of COPD
This session focuses on helping participants to manage their breathing when exercising
and an exacerbation of their COPD occurs.
Emphasise with participants that if an exacerbation occurs they should:
• Stop exercising temporarily until symptoms have improved;
• Decrease the intensity of their exercise i.e. do not use weights;
reduce sets or repetitions, reduce walking time/distance, avoid walking up hills;
• Take extra rests/rest days;
• Use controlled coughing techniques, the Huff coughing technique, pursed lip breathing,
diaphragmatic breathing and positions of ease.
Explain to participants that following an exacerbation they must consult with their GP or
physiotherapist first, before resuming their exercise programme, as their ability to exercise
and their fitness levels may have dropped.
Emphasise that it is important to resume regular exercise as soon as they are well again.
This can help to speed up their recovery and decrease the risk of developing another
exacerbation. Emphasise that it is important that the exercise is built up gradually.
Exercise Advice during exacerbations of COPD
• Stop exercising temporarily until symptoms have improved
• Decrease the intensity of the exercise i.e. do not use weights; reduce
sets or repetitions, reduce walking time/distance, avoid walking up hills
• Take extra rests/rest days
• Use controlled coughing techniques, the Huff coughing technique,
purse lip breathing, diaphragmatic breathing and positions of ease
1 of Session 6
Show Slide 1
of Session 6:
Exercise Advice during exacerbations of COPD contd.
• Following an exacerbation you must consult with your physiotherapist
or GP first, before resuming the exercise programme, as your ability
to exercise and your fitness levels may have dropped.
• It is important to gradually resume regular exercise as soon as you are
well again. This can help to speed up recovery and decrease the risk
of developing another exacerbation.
2 of Session 6
Show Slide 2
of Session 6:
You should also avoid exercising
• If you are short of breath.
• Have a temperature or feel dizzy
• The weather is too hot or too cold
3 of Session 6
Show Slide 3
of Session 6:
54 55
Session 7: Exercise Programme
Facilitator Room Layout Time
PRINCE Educators Flat open space clear of obstacles 75 mins
for walking; chairs in a semi circle;
clear of walk area
For this session you should have the following resources:
• A3 Borg Breathless Scale for each station; • A3 exercise record board for each station;
• Blue tack; • Chairs (one per participant);
• Clock with large face; • Cones;
• Exercise posters for each station; • Exercise steps (adjustable);
• Flip chart and pens; • Non slip mat;
• O2 and tubing; • Pedals;
• Pedometer; • Pens (Biros);
• Pulse oximeter; • Stop watch X2;
• Table or stable surface at waist height; • Tape measure;
• Therabands; • Weights:
• DVD of exercise Session 7 - adjustable for ankles;
PowerPoint presentations. - dumbbells for arms;
Learning Outcomes
At the end of this session participant’s will:
• Understand the benefits of exercise in reducing stress;
• Be able to minimise exercise related stress;
• Be aware of exercises which can help to reduce stress;
• Receive feedback on how home exercises are progressing.
56 57
Topic & Duration Content Resources & Activities
• Review Home Exercise
Programme & diaries
• Understanding how exercise
can reduce stress and that
exercise should not become
a stressful activity
• Interactive teaching
• Group work
• Interactive teaching
• Show PowerPoint “Exercise &
Stress” – Slide 1-3 of Session 7
Introduction
(5 minutes)
Exercise & stress
(10 minutes)
Exercise timetable
Duration Topic Content
• Warm-up
• Exercise
circuit
(Includes
prescribed
individual
arm/leg
weights)
• Walk/marching on spot swinging arms
side stepping
• Measuring 1-2 on the Borg scale
• Each participant (depending on ability)
to carry the following activities:
- Arms pull backward with theraband;
- Shoulder flexion;
- Trunk rotation;
- Calf stretches;
- Hamstring stretches.
• Each participants (depending on ability) to walk
for 6 mins around cones (measure distance)
Use pedometer (record steps)
Measuring 4 on the Borg Scale
• Legs:
- Leg weights;
- Step ups;
- Sit to stand;
- Wall squats;
- Pedals.
• Arms:
- Biceps curls;
- Arm circles;
- Arm wings;
- Wall press;
- Shoulder lifts.
• Each participant (depending on ability)
to carry out 3 sets 8 -10 reps prescribed
weights for biceps curl and leg weights
• Measuring 4 on the Borg Scale
5 minutes
50 minutes
(Each
participant to
do 3 mins at
each station)
Cool-down • Walk 4 minutes (1-2 Borg Scale)5 minutes
Introduction
Ask participants how they got on with their home exercises last week and if they recorded their
activities in their home diary. Find out if anyone had any difficulties/felt any benefits; for example
if they could walk further. Remind participants to pace themselves during exercise.
Encourage participants to keep expanding their exercise regimen as able, e.g. take shorter rests,
exercise for longer, and achieve more sets of arm and leg exercises.
Exercise and stress
This session focuses on helping participants understand how exercise can reduce stress and
that exercise itself should not become a stressful activity.
Explain to participants that exercise reduces stress by:
• Releasing chemicals from the brain into the blood stream called endorphins which increase
feelings of well being and good mood. This decreases the feelings of depression and anxiety;
• Decreasing high blood pressure and cardiovascular risk e.g. high cholesterol;
• Reducing built up tension;
• Helping people to sleep better;
• Increasing confidence;
• Increasing energy levels, to cope better with stressful situations;
• Helping people feel more peaceful and calm.
Explain that going for a peaceful walk can sometimes help to decrease stress and give a person
time alone, or walking with someone can give the time to discuss what is making a person feel
stressed. Exercises such as yoga, Tai chi, or getting a massage, may also help to decrease stress.
Emphasise exercise should not be stressful. It should be enjoyable, so if it is making anyone
anxious or stressed they should try to change some aspects of their exercise regimen to suit
their lifestyle, for example, choose an exercise that you enjoy, exercise with a friend, choose
a time of day that suits them – some people exercise better in the mornings, whereas other
people exercise better in the evenings. Emphasise that they should not feel guilty if they miss
a day, but don’t give up! It is important that they start exercising as soon as possible again to
maintain health benefits.
Exercise & Stress
Exercise reduces stress by
• Releasing chemicals from the brain into the blood stream called
endorphins which increase feelings of well being and good mood.
This decreases the feelings of depression and anxiety.
• Decreasing high blood pressure and cardiovascular risk e.g. high
cholesterol.
• Reducing built up tension.
• Helping people to sleep better.
• Increasing confidence.
• Increasing energy levels, to cope better with stressful situations.
• Helping people feel more peaceful and calm.
1 of Session 7
Show Slide 1
of Session 7:
58 59
Remind participants that they decide - when, where, and how they want to exercise. Encourage
participants to feel proud of their achievements and commitment to exercise – remind participants
that every time they exercise they have done something positive for themselves and for their health.
Remind participants that breathlessness is a common symptom of COPD and of
exercising, therefore, try not to become stressed or anxious if they become breathless.
Emphasise that if they do become anxious or stressed, to use diaphragmatic breathing
and or pursed lip breathing and to try performing some of the relaxation techniques
which will be covered in the next session to help decrease their stress levels
Remind participants to exercise at their own pace but to try and achieve an exercise intensity
of 4 on the Borg Scale. Ask participants to inform you if they feel unwell during the exercise
session. Explain to participants that we will be recording their oxygen saturation and heart rate
on the exercise record sheet at the start of the class, after the walking circuit or if someone
feels unwell.
Exercise & Stress contd.
• Exercise should be enjoyable, not stressful
so if it is making you anxious or stressed you should try to change
some aspects of your exercise regimen to suit you lifestyle, for
example, choose an exercise that you enjoy, exercise with a friend,
choose a time of day that suits them – some people exercise better in
the mornings, whereas other people exercise better in the evenings.
• Do not feel guilty if you miss a day, but don’t give up! It is important to
resume your exercising regime the next day or as soon as possible
2 of Session 7
Show Slide 2
of Session 7:
Exercise & Stress contd.
• You decide - when, where, and how you want to exercise.
• Every time you exercise you have done something positive for yourself
and for your health.
• Remember breathlessness is a common symptom of COPD and of
exercising, therefore, try not to become stressed or anxious if you
become breathless.
• If you do become anxious or stressed, use diaphragmatic breathing
and or pursed lip breathing and to try performing some of the
relaxation techniques which will be covered in the next session to
help decrease stress levels.
3 of Session 7
Show Slide 3
of Session 7:
Guidelines for PRINCE Physiotherapist re: pedals & step-ups
• Pedals - use first with participants who cannot perform wall squats and then for the other
participants depending on time;
• In sitting, adjust resistance on pedals and inform participant to pedal for time at circuit
station e.g. 3 minutes;
• Remember that some participants will need assistance with step-ups for safety reasons;
• Progress step-ups for participants by increasing the height of the step when they can easily
exercise for 3 minutes on the low step.
Exercise class (Practical) (Session 7)
Establish the exercise class circuit as in exercise session 2 and remind participants that there are:
• 10 stations that each participant needs to exercise at;
• Each station takes 3 minutes;
• Each participant needs to record how breathless they are after completing the station on
The Borg Scale;
• Each participant needs to record the number of repetitions they have done at each station;
• Ask Participants to inform you if they feel unwell during the exercise session.
Next commence the exercise class as outlined in the timetable at the start of this session. The types
of exercises are the same as that listed in exercise session two. Following reassessment each week
the number and intensity of the exercises undertaken by each participant will be reviewed.
61
Topic & Duration Content Resources & Activities
• Review Home Exercise
Programme & diaries
• Explaining the importance of
and benefits to maintaining
their exercise regime
• Review how to exercise safely
• Interactive teaching
• Group work
• Interactive teaching
• Show PowerPoint “Long term
exercise maintenance” – Slide 1
of Session 8
• Show PowerPoint “When
exercising at home…” – Slide 2
of Session 8
• Show PowerPoint “Tips for
maintaining long term exercise”
– Slides 3-4 of Session 8
(x 2 slides)
• Give handout on “Tips for main
taining long term exercise”
• Group work Show PowerPoint
on “You should stop exercising
if you feel any of the following”
-Slides 5-6 of Session 8
(x 3 slides)
• Show PowerPoint “More
Tips for maintaining long term
exercise” – Slide 7 of Session 8
Introduction
(5 minutes)
Long-term
exercise
maintenance
(15 minutes)
Exercise timetable
Duration Topic Content
• Warm-up • Walk/marching on spot swinging arms
side stepping
• Measuring 1-2 on the Borg scale
• Each participant (depending on ability)
to carry the following activities:
- Arms pull backward with theraband;
- Shoulder flexion;
- Trunk rotation;
- Calf stretches;
- Hamstring stretches.
5 minutes
60
Session 8: Exercise Programme
Facilitator Room Layout Time
PRINCE Educators Flat open space clear of obstacles 75 mins
for walking; chairs in a semi circle;
clear of walk area
For this session you should have the following resources:
• A3 Borg Breathless Scale for each station; • A3 exercise record board for each station;
• Blue tack; • Chairs (one per participant);
• Clock with large face; • Cones;
• Exercise posters for each station; • Exercise steps (adjustable);
• Flip chart and pens; • Non slip mat;
• O2 and tubing; • Pedals;
• Pedometer; • Pens (Biros);
• Pulse oximeter; • Stop watch X2;
• Table or stable surface at waist height; • Tape measure;
• Therabands; • Weights:
• DVD of exercise Session 8 - adjustable for ankles;
PowerPoint presentations; - dumbbells for arms;
• Handouts for each participant of
“Tips for maintaining long term exercise”.
Learning Outcomes
At the end of this session participant’s will:
• Understand the necessity of regular, continued exercise;
• Understand how to keep achieving gains from exercise;
• Learn ways to maintain exercise in their lifestyles;
• Be able to use the home exercise handout as a resource for independent exercising;
• Receive feedback on how home exercises are progressing.
6362
• Each participants (depending on ability) to walk
for 10 mins around cones (measure distance)
Use pedometer (record steps)
Measuring 4 on the Borg Scale
• Legs:
- Leg weights;
- Step ups;
- Sit to stand;
- Wall squats;
- Pedals.
• Arms:
- Biceps curls;
- Arm circles;
- Arm wings;
- Wall press;
- Shoulder lifts.
• Each participant (depending on ability)
to carry out 3 sets 15 reps prescribed
weights for biceps curl and leg weights
• Measuring 4 on the Borg Scale
Cool-down • Walk 5 minutes (1-2 Borg Scale)5 minutes
Introduction
Congratulate participants on their attendance, participation and commitment to the exercise
programme over the past 8 weeks.
Ask participants how they got on with their home exercises last week and if they recorded their
activities in their home diary. Find out if anyone; had any difficulties/felt any benefits; for example
if they could walk further. Remind participants to pace themselves during exercise.
Long-term exercise maintenance
This session focuses on the fact that over the past 8 weeks participants have been gradually
building up their exercise activities and exercise should now be a part of their daily life. The need
to encourage participants to continue with their home exercise activities now that the programme
is finished must be emphasised.
Explain to participants the importance of continuing their exercise regimen of walking and arm
and leg strengthening exercises once the programme has ended. Remind participants, that in
order, to maintain the beneficial effects of exercise, e.g. increased muscle strength, increased
exercise endurance, increased fitness levels, increased energy levels and increased feeling of
well being, they must continue to exercise regularly, 30 minutes, 3 – 5 times and a week.
Emphasise that exercising should be specific to each person, and should be continued
along the same lines as the supervised exercise programme.
• Exercise
circuit
(Includes
prescribed
individual
arm/leg
weights)
45 minutes
(Each
participant to
do 3 mins at
each station)
Explain to participants that when exercising at home they should:
• Walk for 30 - 40 minutes 3 - 5 times per week. Explain that this can be
a number of short walks or one long walk as long as it adds up to the
required length of time i.e. 30-40 minutes 3-5 times per week;
• Perform strengthening exercises: 3 sets of 10-15 repetitions
of arm exercises and leg exercises 3 times per week;
• Keep monitoring their exercise ability and to progress the exercises and walking, in the same
way as during the exercise programme, that is depending on your ability. Remind participants
that we will be following up on their progress over the next 18 months. Explain that the details
of the follow up programme will be explained in the next session today.
Give participants the handout on “Tips for maintaining long term exercise” and guide them through it.
Tips for maintaining long term exercise:
• Choose an exercise you enjoy e.g. walking, aqua aerobics, aerobic class, gym, table tennis etc;
• Make time for exercise, pencil it in your diary/calendar, 30 minutes 3 to 5 days a week – this is
your time to gain health benefits;
• Exercise with a friend/group some days. Exercising with a friend or group can be very
motivational and you are more committed to exercise;
Long-term Exercise Maintenance
• In order, to maintain the beneficial effects of exercise,
- increased muscle strength,
- increased exercise endurance,
- increased fitness levels,
- increased energy levels a
- increased feeling of well being,
• You must continue to exercise regularly, 30 minutes, 3 – 5 times
and a week.
• exercising is specific to each person, and should be continued along
the same lines as the supervised exercise programme.
1 of Session 8
Show Slide 1
of Session 8:
When exercising at home
• Walk for 30-40 minutes 3-5 times per week. This can be a number
of short walks or one long walk as long as it adds up to the required
length of time i.e. 30-40 minutes 3-5 times per week.
• Perform strengthening exercises: 3 sets of 10-15 repetitions of arm
exercises and leg exercises 3 times per week.
• Keep monitoring your exercise ability and progress the exercises and
walking, in the same way as during the exercise programme.
2 of Session 8
Show Slide 2
of Session 8:
64 65
Activity 8.1
Ask Participants to list the symptoms that would alert them to stop exercising?
Take feedback and acknowledge and reaffirm participants positive strategies
Expected answers should include the following:
• Chest pain or tightness;
• Palpitations – irregular and fast heart rate associated with shortness of breath;
• Nausea or dizziness;
• Cold or clammy;
• Increased wheezing;
• Pain in joints or muscles;
• Extreme tiredness;
• Severe headache.
Reaffirm and acknowledge with participants the symptoms they identified which are similar to
those listed in this list.
Remind participants that they should stop exercising, sit down, and perform some of the helpful
breathing strategies that they have learnt over the past number of weeks for example pursed lip
breathing, diaphragmatic breathing, control coughing technique, and adopt a position of ease.
Emphasise that if the symptoms persist longer than 10 minutes or become worse, they should
contact their GP or practice nurse.
• Choose a time of day that suits you;
• Do not feel disappointed, if you are unable to exercise as you had planned due to
unforeseen reasons. Just return to your exercise plan the next day. Don’t give up;
• Set your exercise goals, what you want to achieve from exercise e.g. walk half a
mile without stopping, walk 5 times for 30 minutes in a week;
• Keep an exercise diary. This is a good way of tracking your progress and
for motivating you to keep up your levels of fitness gained through exercise;
• Remember exercise makes you feel good about yourself and improves
your confidence levels as well as all the health benefits mentioned earlier.
Exercising safely
Explain to participants that we will now take a few minutes to recap on the importance of
exercising safely as discussed in exercise session 2.
Brain storm with participants to carry out the following activity.
Tips for Maintaining Long Term Exercise
• Choose an exercise you enjoy e.g. walking, aqua aerobics, aerobic
class, gym, table tennis, etc.
• Make time for exercise, pencil it in your diary/calendar, 30 minutes 3 to
5 days a week – this is your time to gain health benefits.
• Exercise with a friend/group some days. Exercising with a friend or
group can be very motivational and you are more committed to exercise.
• Choose a time of day that suits you.
• Do not feel disappointed, if you are unable to exercise as you had
planned due to unforeseen reasons. Just return to your exercise plan
the next day. Don’t give up!
3 of Session 8
Show Slide 3
of Session 8:
Tips for Maintaining Long Term Exercise contd.
• Set your exercise goals re what you want to achieve from exercise e.g.
walk half a mile without stopping, walk 5 times for 30 minutes in a week.
• Keep an exercise diary. This is a good way of tracking your progress
and for motivating you to keep up your levels of fitness gained through
exercise.
• Remember exercise makes you feel good about yourself and improves
your confidence levels as well as all the health benefits mentioned
earlier.
4 of Session 8
Show Slide 4
of Session 8:
You should stop exercising if you experience any of the following:
• Chest pain or tightness
• Palpitations – irregular and fast heart rate associated with shortness
of breath
• Nausea or dizziness
• Cold or clammy
• Increasingly wheezy
• Pain in joints or muscles
• Extreme tiredness
• Severe headache
5 of Session 8
Show Slide 5
of Session 8:
You should stop exercising contd:
• Sit down,
• Perform pursed lip breathing,
• Adopt a position of ease
• If the symptoms persist longer than 10 minutes or become worse,
contact your GP or practice nurse.
6 of Session 8
Show Slide 6
of Session 8:
66
PRINCE Physiotherapist Comments
Session 1:
Explain to participants that they should reduce their exercise intensity/walking, if their exercise
programme has been interrupted for a few days (e.g. due to illness, bad weather) and then
gradually progress the exercises again.
Explain to participants that the advice and educational handouts that
they have received during the programme should have all they need
to know on how to keep exercising independently in the future.
However, inform participants that if they have any questions to
please contact you or the practice nurse at ________________.
Exercise class (practical) (Session 8)
Establish the exercise class circuit as in exercise session 2 and remind participants that there are:
• 10 stations that each participant needs to exercise at;
• Each station takes 3 minutes;
• Each participant needs to record how breathless they are after completing the station on
The Borg Scale;
• Each participant needs to record the number of repetitions they have done at each station.
Next commence the exercise class as outlined in the timetable at the start of this session.
The types of exercises are the same as that listed in exercise session two. Following
reassessment each week the number and intensity of the exercises undertaken by each
participant will be reviewed.
More Tips for Maintaining Long Term Exercise contd.
• You should reduce your exercise intensity/walking, if your exercise
programme has been interrupted for a few days (e.g. due to illness,
bad weather) and then gradually progress the exercises again.
• The advice and educational handouts that you have received during
the programme should have all you need to know on how to keep
exercising independently in the future.
• If you have any questions to please contact you or the practice nurse
at ________________.
7 of Session 8
Show Slide 7
of Session 8:
Session 2: Session 3:
Session 4: Session 5:
Session 6: Session 7:
Session 8:

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