Pulmonary rehabilitation is an education and exercise programme to help people with chronic breathing problems such as COPD to manage your breathing and increase your energy.
Programmes focus on education and exercise. They usually last 6–12 weeks.
The programme teaches you how to use what you learn to look after yourself after it ends.
Understanding pulmonary rehabilitation
This 2-part series aims to encourage people with chronic obstructive pulmonary disease (COPD) and other lung problems to participate in the pulmonary rehabilitation programme. Doing exercise is an effective way of reducing your symptoms and improving your overall health.
(Kings College Hospital, UK, 2007)
(Kings College Hospital, UK, 2007)
What does pulmonary rehabilitation involve?
Pulmonary rehabilitation classes are run by physiotherapists and respiratory teams. They are often held at local hospitals or community centres 2 or 3 times per week. The 2 main components of a pulmonary rehabilitation programme are exercise and education.
Exercise
An individual exercise programme is designed for you and takes your health into account. The programme is gentle at first and increases as your fitness improves. You may be given home exercises so that when the programme ends you will know how to stay fit at home.
If you prefer not to exercise, the physiotherapist can discuss other activity options such as Sing your lungs out, a community-based singing group for people with lung disease.
Education
The education session covers information and tips on topics such as:
your lung disease or condition and how to manage it
how to eat a healthy and balanced diet
energy-conserving techniques
breathing strategies
psychological counselling and/or group support.
What are the benefits of pulmonary rehabilitation?
Attending a programme won't cure your lung disease or completely ease your breathing problems, but it can help you function better in your daily life. Pulmonary rehabilitation improves the quality of life and reduces hospital admissions of people with COPD.
Taking part in pulmonary rehabilitation can improve your fitness and muscle strength. This makes you feel more confident to do things. It helps use the oxygen you breathe more efficiently and helps you cope better with feeling out of breath. It can also help you feel better mentally.
Both smokers and non-smokers can benefit from attending pulmonary rehabilitation, as the programme focuses on improving quality of life.
How do I find in a pulmonary rehabilitation programme?
Ask your GP or nurse about a pulmonary rehabilitation programme in your area. There are a range of programmes around the country, including some offered by local DHBs or branches of the Asthma & Respiratory Foundation that are tailored for Māori or Pasifika people.
You can search for a service in your area here (type the words 'pulmonary rehabilitation' in the search box).
Learn more
The following links have more information about pulmonary rehabilitation. Be aware that websites from other countries may have information that differs from New Zealand recommendations.
Dr Sharon Leitch is a general practitioner and Senior Lecturer in the Department of General Practice and Rural Health at the University of Otago. Her area of research is patient safety in primary care and safe medicine use.
Credits: Health Navigator Editorial Team . Reviewed By: Dr Sharon Leitch, GP and Senior Lecturer, University of Otago
Last reviewed: 01 May 2020
Personal stories
Jeannie's story
Jeannie Sullivan started smoking when she was 21. She started with a packet lasting a fortnight and slowly moved onto a packet a day by her late 30s. Jeannie is proud to say she finally stopped smoking about 10 years ago.
Unfortunately, the damage had been done. Jeannie thought she had asthma so went to her GP and was told she had emphysema or COPD.
Jeannie says one of the best things that ever happened to her was going to pulmonary rehabilitation. She looked forward to the twice a week classes and socialising, getting fit and learning about how to manage COPD. Read about how it changed her life: One of the best things that ever happened to me – going to rehab! Asthma Foundation, NZ, 2013
Pulmonary rehabilitation for chronic lung conditions
This video is about pulmonary rehabilitation. The first part of the video (up to 8 minutes) has simple exercises that you can do at home. Thereafter the video has information about changes you can make to improve your symptoms, such as exercising, quitting smoking, breathing techniques, etc.
(NHS Forth Valley, UK, 2017)
Pulmonary Rehabilitation Exercises at home
(NHS Greater Glasgow and Clyde, UK, 2020)
Exercise for COPD: Improve your strength and mobility
(NHS Greater Glasgow and Clyde, UK, 2021)
Information for healthcare providers on pulmonary rehabilitation
The content on this page will be of most use to clinicians, such as nurses, doctors, pharmacists, specialists and other healthcare providers.
The following information on pulmonary rehabilitation is taken from NZ COPD guidelines 2021, accessed March 2021:
Pulmonary rehabilitation should be offered to all patients with COPD. Although there may be barriers to attending pulmonary rehabilitation classes, there are a variety of ways to deliver pulmonary rehabilitation to patients in different settings depending on local respiratory services and patient preferences.
Pulmonary rehabilitation is an umbrella term for a structured programme which offers supervised exercise and education to patients with COPD, usually over a period of eight weeks
Pulmonary rehabilitation is known to relieve dyspnoea and fatigue, improve mental health and quality of life, and increase the sense of control that patients with COPD have over their health while reducing their risk of hospitalisation
All symptomatic patients with COPD will benefit from pulmonary rehabilitation, particularly:
At diagnosis
After discharge from hospital following an exacerbation
When symptoms are progressively deteriorating
Health professionals may need to use creative strategies to adapt the basic components of pulmonary rehabilitation for patients unable to attend formal programmes.
Pulmonary rehabilitation is defined as “an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities. Integrated into the individualised treatment of the patient, pulmonary rehabilitation is designed to reduce symptoms, optimise functional status, increase participation, and reduce health care costs through stabilising or reversing systemic manifestations of the disease”. Nici L, Donner C, Wouters E, et al. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation Am J Respir Crit Care Med 2006; 173:1390–1413.
Pulmonary rehabilitation is evidence-based for COPD
A Cochrane review of 65 randomised controlled trials confirms the benefit of pulmonary rehabilitation. They found that pulmonary rehabilitation relieves dyspnoea and fatigue, improves emotional function and enhances the sense of control that individuals have over their condition. These improvements are moderately large and clinically significant. McCarthy B, Casey D, Devane D, Murphy K, Murphy E Lacasse Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, 2015.
A further Cochrane review looked at whether pulmonary rehabilitation was safe after a hospital admission with a COPD exacerbation and concluded that pulmonary rehabilitation reduced hospital admissions and mortality compared with usual community care (no rehabilitation). Quality of life was also improved. Pulmonary rehabilitation appears to be a highly effective and safe intervention in COPD patients after suffering an exacerbation. Puhan MA, Gimeno-Santos E, et al. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, 2016.
Poor referral and participation rates
Making sure your patients attend a pulmonary rehabilitation programme is one of the most useful treatments you can offer your patients with COPD.
Pulmonary rehabilitation is a proven self-management programme that is effective in improving the quality of life and reducing hospital admissions of people with COPD. However, a New Zealand study found that only 1% of COPD patients who could benefit from pulmonary rehabilitation have access to it each year. Levack WMM, Weatherall M, et al. Uptake of pulmonary rehabilitation in New Zealand by people with chronic obstructive pulmonary disease in 2009. NZMJ. 2012 Dec 20; 125(1348):23-33.
More recent research has found still only 2% of uptake of eligible patients and cultural difference in attendance. McNaughton AA, Weatherall M, Williams G, Delacey D, George C, Beasley R. An audit of pulmonary rehabilitation program Clinical Audit, 2016
Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information:
