Cardio-pulmonary

Rehabilitation Programme
Home exercise information
 Welcome to the cardio-pulmonary rehabilitation programme

Over the next 8 weeks we will be giving you information, practical advice and an exercise programme
designed to help you cope with your breathlessness and to increase your activity level.

Enclosed in this booklet is:

- Information on the importance of exercising

- An exercise programme

- An exercise diary to record your progress

Please take some time to familiarise yourself with this course booklet and ask us if you have any
questions.

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 Why is exercise important for people with lung and heart
conditions?
You may have noticed that over the past few months or years you have become increasingly short of
breath and are not able to move around as much as you were previously. As a result of this, your muscles
become weaker and less efficient. This means they need more oxygen than before doing any activities.
The only way your body can take in more oxygen is by making you breathe faster and deeper. You feel
this as being more short of breath at rest or during exercise.

The aim of the pulmonary rehabilitation programme is to increase your fitness level, whilst helping you
to control your breathing. This will make your body more efficient at using oxygen, and in turn, make
you less short of breath.

This programme does not aim to reverse your lung condition, but it aims to make your body more able to
cope with it.

I am getting
more
breathless

My muscles I find it harder

need more to move
oxygen around

My muscles
are getting
weaker

Pulmonary Rehabilitation is proven to work as it breaks this cycle by making

your muscles stronger and more efficient.
 What are the benefits of doing exercise?

 Fitter muscles need less oxygen to function

 A fitter heart means a more efficient heart

 Stronger respiratory muscles which will help with your breathing

 Increased feeling of well being

 Improved circulation

 Better sleep patterns

 Build up weak muscles

 Increased appetite

 Increased resistance to infection

 Increased chest mobility

 Improved bone density

 For a given activity you will be less short of breath and less tired

 You can get more used to the feeling of being short of breath, so it doesn't feel as
uncomfortable

How do I get started?

Start gradually and build up slowly.

ALWAYS
• Warm up – Exercise - Cool down
• Exercise regularly, approximately 30 minutes 4 times per week
• Exercise to a level where you are moderately to fairly short of breath (3-4 Borg)
• Alternate between arm and leg exercises
• Keep it simple, such as walking, lifting tins of beans, sit to stand
• Try to co-ordinate your movements with breathing out on the hardest part
• Most importantly, listen to your body and ENJOY IT!

Being short of breath is not dangerous but you should not feel unwell due to exercise. If you have any
pain or feel unwell during your exercises - stop immediately. If your symptoms persist, contact your GP.
If symptoms do stop, please contact your physiotherapist before re-starting the exercises.
 Home exercise programme
When exercising at home, it is important that you warm up prior to exercising, and cool down after
exercising, to allow your heart rate and blood pressure to gradually adjust to activity or rest.

Whenever you exercise, try to use the scale shown below in order to gain the most benefit from the
activities.

Modified Borg Breathlessness Scale

The scale below (0 (less symptoms) -10 (more symptoms) should be used to help measure how your
breathing feels during an activity.

Modified BORG Breathlessness Scale

Scale Severity

0 No breathlessness at all
0.5 Very very slight (Just noticeable)
1 Very slight
2 Slight breathlessness
3 Moderate
4 Fairly breathless
5 Somewhat hard
6 Hard
7 Severe breathlessness
8 Very severe
9 Very very severe (almost max)
10 Maximum

WHEN EXERCISING YOU SHOULD AIM TO BE MODERATELY TO FAIRLY BREATHLESS:

- A SCORE OF 3 OR 4

Avoid holding your breath whilst exercising – always breathe throughout any exercise
 WARM-UP EXERCISES
All the warm-up exercises must be done at the beginning of each exercise session.

Please ensure you have a glass of water handy to take small sips to keep yourself hydrated throughout
the session.

1. Neck Rotations
Sitting with your hands relaxed in your lap
• Slowly turn your head to look over one shoulder
• Bring your head back to the centre
• Slowly turn to look over the other shoulder
• Repeat twice on each side

2. Neck Side Flexions

Sitting with your hands relaxed in your lap
• Slowly bend your head sideways so that your ear is close to your shoulder.
• Keep your head facing forwards and do not let your head turn to the side.
• Remember to move only your head down and not your shoulders up.
• Repeat the movement on the opposite side.
• Repeat twice on each side

3. Shoulder rotations (rolling)

Sitting with your hands relaxed in your lap
• Slowly circle your shoulders backwards 5 times
• Change direction and slowly circle your shoulders forwards 5 times
4. Chest stretch
Sitting slightly forwards in your chair with your feet firmly on the floor
• Put your hands behind you and place them on the small of your back
• Take a breath in
• As you gently breathe out push your shoulders backwards and downwards while pushing your
chest out
• Repeat twice more

5. Trunk rotations
Sitting slightly forwards in your chair with your feet firmly on the floor
• Cross your arms over your chest, keep your hips/knees facing forwards and your bottom still
• Take a breath in
• As you breathe out slowly twist your shoulders round as far as possible to the right
• Change direction and repeat to the left
• Repeat twice each side

6. Trunk Side Bends

Sitting slightly forwards in your chair with your feet firmly on the floor
• Hang your arms loosely by your sides and take a breath in
• As you breathe out slowly bend to the right-hand side, stretching your right hand towards the
floor with your left hand resting on your left hip
• Return to a central position and take another breath in
• As you breathe out slowly bend to the left-hand side, stretching your left hand towards the floor
with your right hand placed on your right hip
• Repeat twice each side

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7. Sitting marching on the spot
Sitting slightly forward in your chair, with your hands holding the sides of the chair for support
• Slowly lift your right knee, as high as is comfortable, keeping your knee bent and your foot
relaxed
• Lower your right leg and repeat with your left leg
• Do 10 lifts on each leg

8. Knee Extensions
Sitting with your back supported in the chair
• Slowly straighten your right knee, and point your toes towards the ceiling
• Hold for 3-5 seconds then gently lower your leg to the starting position
• Repeat with your left leg
• Do 2 extensions on each leg

9. Heel Raises
Standing with support or sitting slightly forwards in your chair
• Raise up onto the balls of your feet, so your heels clear the ground and hold for 2 seconds
• Slowly lower your heels to the floor
• Repeat 10 times

OR

10. Marching on the spot

Standing
• For 30 seconds, march fairly briskly on the spot swinging your arms

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 EXERCISE PROGRAMMES
Now that you have completed your warm up, work through either of the following exercise programmes
(strength or endurance). Allow time for your breathing to return to normal after each exercise.

Remember to pace yourself so that you only become moderately short of breath during each exercise
(refer back to the Modified Borg Scale, you are aiming for a score of 3-4).

STRENGTH PROGRAMME
For all the exercises that require a weight try to find one that is heavy enough to make you feel a slight
ache/warm sensation in the muscle you’ve just worked (e.g. 1 or 2 litre milk carton filled with water or
rice).

1. Half squat
Standing with your feet shoulder width apart, holding onto a secure object
• Take a breath in
• As you breathe out, slowly bend your knees, keeping your back upright, and stand up straight
again

Progression:

- Full squat
- Squat holding weights
- Single leg dip

Alternative:

Lunges
Sit to stand (not using arms)

2. Standing press up
Facing a wall or closed door, stand an arm’s length away from the wall with feet shoulder width apart
• Place your hands on the wall at shoulder height with your palms flat and take a breath in
• As you breathe out, keep your feet still and slowly bend your elbows bringing your nose towards
the wall
• Straighten your arms again so you are pushing your body weight back from the wall, and take
another breath in
Progression:

- Use lower surface such as

solid table/work surface

Alternative:

Chest press using elastic

theraband

4
 3. Knee lifts
Standing holding onto a secure object
• Take a breath in
• As you breathe out, slowly lift your right knee upwards in front of you as far as is comfortable and
lower gently again
• Repeat with your left leg

Progression:

- Hold leg up in the air for 5

seconds
- Add weights around ankle/
heavy shoe

4. Shoulder press
Sitting with your back supported and holding a weight e.g. small water bottle or a tin of beans
• Place the weight in your right hand and bend your elbow so that the weight is at shoulder level
• Take a breath in
• As you breathe out, slowly straighten your right arm lifting the weight towards the ceiling and
slowly lower again then repeat with your left arm

Progression:

- Lift weights in both

arms simultaneously
- Increase weight
- Stand up to perform
exercise

Alternative:

Tricep pulls / extension

5. Hip abduction
Standing holding onto a secure object work surface, wall or stable chair
• Take a breath in
• As you breathe out, slowly lift your right leg out to the side as far as is comfortable keeping your
knee straight and your body upright
• Slowly lower your leg again

Progression:

- Add weight to ankles/

heavy shoe
- Add slow kicks behind
and in front as well as
sideways

5
6. Upright Row
Sitting with your back supported, holding a weight on your lap
• Take a breath in
• As you breathe out, slowly lift both your arms up bringing the weight to your chin, keeping your
elbows pointing out to the side
Progression:

- Increase weight
- Hold weight up 5 secs
- Stand up to perform ex

Alternative:

Theraband row

7. Knee Extension
Sitting with your back supported and a weight on your leg e.g. an ankle weight or heavy boot
• Take a breath in
• As you breathe out, slowly straighten your right knee and point your toes towards the ceiling
• Hold this position for 3 seconds if possible
• Slowly lower your leg again

Progression:

- Increase weight
- Hold knee straight for
longer eg 5 seconds

8. Bicep curls
Sitting with your back supported and a weight in your hand
• Take a breath in
• As you breathe out, slowly bend your right elbow, lifting the weight towards your right shoulder
• Slowly lower the weight again

Progression:

- Increase weight
- Stand up to perform
exercise
- Lift weight in both
hands simultaneously

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ENDURANCE PROGRAMME
For this exercise programme, you will be doing less of a variety of exercises and focusing on building up
your stamina to 20mins of cardiovascular activity. On your first session, make a note of how long (in
minutes/seconds) you are able to comfortably manage, and we will then work with you regularly to set
further goals to improve your endurance. The examples below are walking and step ups but if you have
the equipment you could use a bike, pedals, cross trainer, trampette, or swimming pool.

The aim is to become moderately to fairly breathless doing these exercises (BORG 3-4). If you become
severely breathless you should stop or slow down until you’ve recovered enough to carry on.

Walking
Walk outdoors, indoors or on the spot at a comfortable pace, so that you become moderately short of
breath.

Alternatives:

- Cycling (bike or static pedals)

- Cross trainer
- Trampette
- Swimming
- Aerobic class
- Dance class

Step ups
Standing in front of a step
• Take a breath in
• As you breathe out, step up and down with either leg leading
• You should to change over your lead leg halfway through your exercise.

WELL DONE!
Now you are ready to cool down

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 COOL DOWN EXERCISES

Never stop and sit still immediately after exercising, as you need to allow your blood pressure and heart
rate to slow down gradually.

Take your time to do the following stretches

1. Thigh stretch
Standing, holding onto stable object e.g. wall, work surface, secure chair
• Stand on your left leg and bend your right knee to grasp your foot with your hand (if this is
difficult you can hold your trouser leg instead)
• Gently try to bring your heel towards your bottom but keep your knees together
• Hold for 10 seconds, repeat 2 times
• Repeat standing on your right and stretching your left leg

2. Calf stretch
Standing in front of a wall an arms width away
• Place both hands at shoulder height flat onto the wall.
• Stride stand with one foot in front of the other keeping your heels on the floor and toes facing
forwards
• Bend the knee of your front leg taking it towards the wall but making sure that your back foot
stays flat on the floor, and knee is straight throughout.
• Keep bending your front knee until you feel a gentle stretch down the calf of your back leg. Hold
for 10 seconds then relax.
• Repeat twice with each leg.

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3. Trunk tilts
Standing or sitting
• Put your right hand on your waist
• Place your left arm straight up in the air
• Reach over to the right until you feel a stretch down your left-hand side
• Repeat to the opposite side
• Repeat twice for each side

4. Hamstring stretch
Sitting, with your bottom on the edge of your chair
• Stretch your right leg out in front of you, with your knee completely straight and your heel on the
ground
• Pull your toes to the ceiling, gently lean forward and hold for 10 seconds
• Repeat with your left leg
• Repeat twice with each leg

5. Chest stretch
Sitting slightly forwards in your chair with your feet firmly on the floor
• Put your hands behind you and place them on the small of your back
• Take a breath in
• As you gently breathe out push your shoulders backwards and downwards while pushing your
chest out
• Repeat twice more

9
6. Triceps stretch
Sitting comfortable in your chair
• Put your right arm behind your head and reach down your back as far as you can go
• With your left hand gently push back on your right elbow to feel a stretch on your upper arm
• Hold for 10 seconds
• Repeat twice with each arm

WELL DONE ON COMPLETING YOUR EXERCISES!!!

Remember:
• Drink a glass of water to keep well hydrated after your exercise
• Complete your exercise diary to monitor your progress

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w/c: MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY

AIM FOR
THE WEEK:

HALF SQUAT

STANDING PRESS UP

KNEE LIFTS

SHOULDER PRESS

HIP ABDUCTION

UPRIGHT ROW

KNEE EXTENSION

BICEP CURLS

WALKING

STEP UPS

OTHER
w/c: MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY

AIM FOR
THE WEEK:

HALF SQUAT

STANDING PRESS UP

KNEE LIFTS

SHOULDER PRESS

HIP ABDUCTION

UPRIGHT ROW

KNEE EXTENSION

BICEP CURLS

WALKING

STEP UPS

OTHER
w/c: MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY

AIM FOR
THE WEEK:

HALF SQUAT

STANDING PRESS UP

KNEE LIFTS

SHOULDER PRESS

HIP ABDUCTION

UPRIGHT ROW

KNEE EXTENSION

BICEP CURLS

WALKING

STEP UPS

OTHER
w/c: MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY

AIM FOR
THE WEEK:

HALF SQUAT

STANDING PRESS UP

KNEE LIFTS

SHOULDER PRESS

HIP ABDUCTION

UPRIGHT ROW

KNEE EXTENSION

BICEP CURLS

WALKING

STEP UPS

OTHER
w/c: MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY

AIM FOR
THE WEEK:

HALF SQUAT

STANDING PRESS UP

KNEE LIFTS

SHOULDER PRESS

HIP ABDUCTION

UPRIGHT ROW

KNEE EXTENSION

BICEP CURLS

WALKING

STEP UPS

OTHER
w/c: MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY

AIM FOR
THE WEEK:

HALF SQUAT

STANDING PRESS UP

KNEE LIFTS

SHOULDER PRESS

HIP ABDUCTION

UPRIGHT ROW

KNEE EXTENSION

BICEP CURLS

WALKING

STEP UPS

OTHER
w/c: MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY

AIM FOR
THE WEEK:

HALF SQUAT

STANDING PRESS UP

KNEE LIFTS

SHOULDER PRESS

HIP ABDUCTION

UPRIGHT ROW

KNEE EXTENSION

BICEP CURLS

WALKING

STEP UPS

OTHER
w/c: MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY

AIM FOR
THE WEEK:

HALF SQUAT

STANDING PRESS UP

KNEE LIFTS

SHOULDER PRESS

HIP ABDUCTION

UPRIGHT ROW

KNEE EXTENSION

BICEP CURLS

WALKING

STEP UPS

OTHER
 INFORMATION DIARY

Please use these sheets to record any changes to your medication, hospital admissions, GP
visits, infections/illnesses or any other information you think we should be aware of.

DATE WHAT HAPPENED / CHANGED? OUTCOME?

DATE WHAT HAPPENED? OUTCOME?