Chest

ASTHMA

Asthma is a chronic disease affecting the airways of the lung. In people with asthma, the airways are sensitive to stimuli. Therefore, those who have asthma experience recurrent and reversible flare-ups (attacks) of airway narrowing and inflammation. Asthma usually begins in childhood but can affect people of any age. During a flare-up of asthma, the symptoms can include wheeze, breathlessness, cough and chest tightness.    

What causes asthma?

The actual cause and pathology behind asthma is not well-understood, but it is thought that a trigger causes airway inflammation, airway narrowing and mucous secretions. A person who has asthma will experience recurrent flare-ups (attacks) that are reversible. These flare-ups are usually triggered by exposure to some sort of stimuli or allergen, such as dust, dog or cat hair, pollen, mould, chemicals, tobacco smoke, air pollution, exercise in the cold and some types of food or drink. The symptoms of a flare-up are usually reversed by taking reliever medication, a blue or grey ‘puffer’).

How do I know if I have asthma?

During an asthma attack, common symptoms are wheeze, breathlessness, cough and chest tightness. Asthma Australia recommends that during an asthma attack, it is important to stop and rest, sit upright in a chair, and take four puffs of your asthma medication, with a spacer if you have one. If the symptoms are not relieved after four minutes, take the puffer four times again. If there is still no improvement, call 0-0-0. People with asthma who have the disease under control may not experience any symptoms normally outside of flare-ups. Refer to Asthma Australia for more information.

A GP will help diagnose asthma. They may do a variety of breathing tests to try to determine if you have asthma and how severe it is, and may then send you to a specialist medical doctor (respiratory physician) for assessment and treatment. Asthma is diagnosed based on a history of recurrent flare-ups (especially if the flare-ups occur after exposure to an allergen), reversal of symptoms and improvement in breathing immediately after taking asthma-relief medication. Because asthma cannot be cured, the treatment is focused on managing the condition and preventing flare-ups. The main component of treatment for asthma is medication (preventers and relievers) prescribed by a medical doctor. 

How can physiotherapy help with asthma?

Physiotherapy is important in the management of asthma. Your physiotherapist will help educate you about your condition. They will teach you to use and clean your asthma medication devices correctly to ensure you are getting the correct dose. There are many different types of devices, such as puffers, Turbuhalers, Autohalers and tablet devices. They each work slightly differently.

Your physiotherapist can also help prescribe and supervise exercise training for you. Sometimes exercise can induce an asthma attack, so your physiotherapist will help to assess your exercise ability, your breathing and the presence of any wheeze before you commence. They can develop an appropriate exercise program for you to do at home or in a group setting, and will teach you what to do before and during exercise sessions to prevent a flare-up induced by exercise. Your physiotherapist may also teach you breathing exercises to help with your asthma.

How effective is physiotherapy for asthma?

There is growing evidence for exercise training and breathing techniques in the management of asthma. Exercise training, such as running, cycling, swimming, walking, gymnastics and weight training, can improve fitness levels and quality of life. Breathing techniques may also help reduce symptoms and improve quality of life. Both exercise training and breathing techniques are well-tolerated and safe for people with asthma when done correctly.

What can I do at home?

Managing your asthma at home is important. Discuss with your GP or physiotherapist about having an asthma action plan. This involves having a plan for what medication to take when you are stable, how to detect if your asthma is getting worse, and what medications to take if your asthma is getting worse. An important part of your management at home is measuring your ‘peak flow’ every morning. This measures how fast you can breathe air out of your lungs and helps you keep track of your asthma severity over time. Maintaining a physically active lifestyle is also important to keep you fit and healthy.

How long until I feel better?

The symptoms of asthma during a flare-up should be relieved within four to five minutes of taking relief medication. However, other longer-term ongoing benefits are slower to occur.

The effects of exercise training will be seen after at least one month of regular training. Evidence showing the beneficial effects of exercise training for people with asthma was seen in people exercising for a minimum of four weeks and training at least twice per week.  

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CHEST PAIN

Chest pain is pain felt in the chest region. Chest pain can come from a variety of different structures within the chest, including the heart, lungs, airways, oesophagus, ribs, breathing (respiratory) muscles and nerves. Determining where chest pain comes from is very important because pain that comes from the heart associated with a heart attack requires an immediate review by a medical doctor. 

What does chest pain feel like?

Chest pain can feel different depending on the casue and the structure affected. It can be rapid or sudden onset, sharp, dull, stabbing, constant, pressure, tightness, squeezing, heaviness, burning, a tearing or ripping sensation, or generalised non-specific pain. Mostly, it is felt in the chest region, however, pain coming from the heart can also be felt travelling to the jaw, arms or shoulders (most left side). Pain coming from the oesophagus can be also be felt in the lower back. Depending on the cause, other symptoms that may be experienced include breathlessness, cough, fever, high breathing rate, high heart rate, low blood pressure, nausea, vomiting, dizziness or reflux.

What causes chest pain?

Chest pain can be caused by a variety of problems. Below is a list of structures where chest pain can arise from and some of the common causes for these types of pain.

Lung

  • Infection, trauma or cancer of the lining around the lung (pleurisy)
  • Blood clot, caused by long-distance travel or immobilisation
  • Collapsed or punctured lung, caused by lung disease or trauma
  • Tumour

Heart

  • Heart attack or angina, caused by heart disease
  • Infection, inflammation, trauma or tumour of the sac around the heart (pericarditis)

Big blood vessels

  • Aortic aneurysm, caused by trauma, atherosclerosis or genetic disorder of the connective tissue (Marfan syndrome)

Oesophagus

  • Reflux, trauma, tumour or vomiting

Musculoskeletal

  • Ribs—fracture, joint or spine problem
  • Muscles—trauma or unaccustomed exercise
  • Nerve pain (neuralgia)—shingles, thoracic spine problem or tumour
  • Arthritis or other inflammatory conditions

How do I know if I have chest pain?

Chest pain is a pain or discomfort felt in the chest region that is not normal for you. It is important to distinguish the difference between chest pain arising from a heart attack compared to other problems.

How do I know if I am suffering a heart attack?

The Heart Foundation of Australia recommends that if you experience the warning signs of a heart attack for 10 minutes and, if the symptoms are severe or get worse, you must call 0-0-0 immediately for an ambulance. The warning signs are pain, pressure, heaviness or tightness in the chest, neck, jaw, arms, shoulders, abdomen, or back. If you experience these signs, you should:

  1. stop and rest
  2. tell someone about our symptoms and, if you take angina medicine, you should take a dose
  3. if your symptoms are severe, getting worse or have lasted more than 10 minutes you should call 0-0-0.

Refer to the Heart Foundation website for more information. 

Chest pain from other causes

Depending on the cause of the chest pain, the symptoms can be variable. The pain may be rapid or sudden onset, sharp, dull, stabbing, constant, pressure, tightness, squeezing, heaviness, burning, a tearing or ripping sensation or generalised non-specific pain. Mostly, it is felt in the chest region. A GP will help diagnose the cause of chest pain. They will do a variety of tests, including ECG, blood tests and X-rays, to try to identify the cause of the chest pain, and may send you to a specialist medical doctor (respiratory physician or cardiologist). If you are experiencing chest pain associated with musculoskeletal dysfunction, a physiotherapist can help diagnose the specific cause and identify the appropriate treatment for this.

How can physiotherapy help with chest pain?

Physiotherapy can help treat many musculoskeletal causes of chest pain, as well as assist in the overall management of number of chronic diseases that result in chronic chest pain, such as lung disease and cardiac disease.

Musculoskeletal chest pain

Physiotherapy may involve exercise. This could include chest, back and shoulder muscle retraining (strengthening and increasing endurance); stretching of the chest muscles; postural correction; taping of the shoulder blades or spine; manual techniques (mobilisation) of the rib joints; or education.

Chest pain secondary to chronic lung disease or heart disease

Physiotherapy plays a very important role in the management of chronic lung and heart disease. Primarily, the role of physiotherapy in these conditions is pulmonary rehabilitation and/or cardiac rehabilitation that includes exercise training, self-management education and support. There is no cure for most of these chronic diseases, however, rehabilitation can improve your quality of life, help you be more physically active and prevent flare-ups. 

How effective is physiotherapy for chest pain?

If the chest pain is due to a problem with the musculoskeletal system, your physiotherapist will be able to assess and treat the structures causing the pain. Treatment may include exercise, rest, manual therapy (massage, joint mobilisation or manipulation) and education regarding posture and care. 

 
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Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a chronic lung disease that is usually progressive and not curable. It is sometimes referred to as emphysema or chronic bronchitis. COPD is most commonly caused by smoking and is seen in people over the age of 40. The disease is linked with ongoing airway limitation and inflammation. COPD causes problems with breathing, especially breathing air out of the lungs, and problems with the exchange of oxygen and carbon dioxide within the lungs. Other problems caused by the disease are changes to the breathing mechanics (pattern), breathlessness, reduced heart function, problems with skeletal muscles and lower overall fitness. The most common symptoms experienced by people are breathlessness, chronic cough and sometimes, phlegm production.     

What causes COPD?

The most common cause of COPD is cigarette smoking, however, there is a small group of people with COPD (3-11 per cent) who have never smoked. Other risk factors for developing COPD include exposure to second-hand smoke, outdoor air pollution, occupational dusts and chemicals, fumes from burning fuels, and a genetic preposition. Exposure to these agents causes inflammation and damage to the lungs. The incidence of COPD is rising due to increasing smoking rates worldwide, early diagnosis and the ageing population.

How do I know if I have COPD?

A GP will help diagnose COPD. They will ask you to blow into a spirometer to determine if you have COPD and how severe it is. They may send you to a specialist medical doctor (respiratory physician) for assessment and treatment. COPD is diagnosed based on a history of symptoms (breathlessness, chronic cough or phlegm production), exposure to smoke or other risk factors and the results of breathing tests and chest X-ray. As COPD cannot be cured, the treatment focuses on managing the condition and preventing flare-ups. There are many things that people with COPD can do to keep healthy and minimise their symptoms including: stop smoking, optimise your medication, keep up to date with vaccinations (Fluvax) and attend pulmonary rehabilitation. For more severe cases, management may also include surgery, home oxygen or the use of breathing machines (non-invasive ventilation). 

How can physiotherapy help with COPD?

Physiotherapy is important in the management of COPD. Physiotherapy involves a variety of different treatments depending on your main symptoms. Overall, exercise is the most important part of pulmonary rehabilitation. Avoiding sedentary time and keeping up an active lifestyle is extremely important to keep fit, healthy, strong and out of hospital.

What is pulmonary rehabilitation?

Pulmonary rehabilitation is a program for people with chronic lung disease, including COPD, that involves supervised group exercise training, self-management education and support. Joining a pulmonary rehabilitation program is the easiest way to learn about exercise and managing your disease. The programs are widely available throughout Australia. At a pulmonary rehabilitation program, your physiotherapist will measure your functional exercise capacity, your symptoms and safety for exercise. They will teach you how to do the exercises and then supervise your group exercise training, once or twice a week for six to eight weeks. The education part of the program will help you to learn how to: understand your disease, best manage your symptoms, take medications, stop smoking and eat a healthy diet. The programs are located at local hospitals or community centres around Australia. Speak to your doctor or physiotherapist for more information and to get a referral to your local program. Pulmonary rehabilitation is a great option for anyone diagnosed with COPD.

How much should I exercise?

The recommendations for exercise for people with COPD are 30 minutes of aerobic exercise on at least five days of the week. Examples of aerobic exercise are brisk walking, jogging, riding on a stationary bike or swimming. It is also recommended to do strengthening exercises on two to three days of the week to keep your muscles strong. If you have had falls or poor balance, it is also recommended that you do balance exercises. Your physiotherapist will incorporate these exercises into your pulmonary rehabilitation program.

How hard should I exercise?

The most effective exercise is normally done at a moderate intensity. This means that during exercise, your heart rate is increased slightly and you get a bit puffed, but not so puffed that you cannot talk to the person next to you. On a scale of 0 (nothing) to 10 (very, very strong), your breathing should be between 3 (moderate) to 4 (somewhat strong) while completing aerobic exercise, such as walking or cycling.

Will exercise make my disease worse?

No, exercise is safe—it is the best thing you can do for yourself and will not make your disease worse. When you exercise, your lungs need to work harder to deliver more oxygen to your working muscles. Therefore, when you exercise, it is normal to feel a little more breathless—this is a good sign and, when you stop exercising, the breathlessness should go back to normal. However, for safety, it is recommended that you consult a physiotherapist or GP before you start exercising for the first time.

What else can physiotherapy do?

Depending on your condition and main problems, physiotherapy may offer a number of other treatments. These may occur on the hospital ward while you are in hospital or, as an outpatient, if you are at home. A thorough assessment by your physiotherapist when you are diagnosed with COPD, and then at regular intervals, will help determine your main problems and the best treatment to assist with these.

Physiotherapy may involve breathing exercises, airway clearance techniques and inhalation therapy to help clear phlegm from the airways. This is particularly important for people who commonly experience high volumes of phlegm on a daily basis, or for people who are having trouble clearing their phlegm.

If you have trouble sleeping or breathing at night, your physiotherapist, in conjunction with your respiratory doctor, may prescribe a breathing machine to help you. This could include continuous positive airway pressure (CPAP), non-invasive positive pressure (NIV) or bilevel positive airway pressure (BiPAP).

Physiotherapy may also involve assessment and management of other conditions that can result from, or occur alongside, COPD. These include musculoskeletal problems such as spinal pain, restricted chest wall, ribs or arm movement, or poor posture; osteoporosis; and urinary incontinence (common due to chronic coughing).

Your physiotherapist will help with education about your condition, including how to use your COPD medication devices correctly to ensure you are getting the correct dose and cleaning the device correctly. There are many different types of devices, such as puffers, Turbuhalers, Autohalers and tablet devices, and they each work slightly differently. 

 
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CORONARY HEART DISEASE

Coronary heart disease—sometimes referred to as ischaemic heart disease (IHD) or coronary artery disease (CAD)—is chronic heart disease that is usually progressive and not curable. It occurs when the coronary arteries become narrowed, causing less blood going to the heart muscle than is needed. This is most commonly caused by atherosclerosis of the coronary arteries, which is a progressive build-up of fatty material (plaque) in the arteries. Lack of blood supply to the heart can cause chest pain and discomfort (angina), and this sometimes occurs during exercise or when the heart rate is evaluated. However, if the coronary artery is completely blocked this can cause a heart attack and is a medical emergency. 

What causes coronary heart disease?

Coronary heart disease is a chronic disease that is mostly seen as people age and is more common in males than females. The most common modifiable risk factors are smoking, high blood pressure, high cholesterol, diabetes, poor diet, lack of exercise and obesity. The most common symptom is chest pain. However, the symptoms of coronary heart disease can be silent until angina or a heart attack occurs, and therefore many people do not realise they have coronary heart disease.

Coronary heart disease is caused by a combination of both modifiable risk factors and non-modifiable risk factors.

  • Modifiable risk factors include smoking, high blood pressure, high cholesterol, diabetes, poor diet, lack of exercise, obesity, depression and social isolation.
  • Non-modifiable risk factors include older age, being male, family history of cardiac disease and coming from an Aboriginal and Torres Strait Islander background.

Taking steps to reduce the occurrence and severity of the modifiable risk factors is an important part of prevention and management of coronary heart disease

How do I know if I have coronary heart disease?

A GP will help diagnose coronary heart disease. Often the symptoms are silent and, therefore, if you have any of the risk factors for coronary heart disease, you should discuss these with your GP. Your GP may do a variety of tests to try to determine if you have coronary heart disease and how severe it is, and may send you to a specialist medical doctor (such as a cardiac doctor) for assessment and treatment. Coronary heart disease is diagnosed based on a history of symptoms (chest pain, such as angina) and results of a number of tests, including blood tests, an electrocardiogram (ECG), an echocardiogram and an angiogram. Because coronary heart disease cannot be cured, the treatment is focused on managing the condition and preventing the risk of future heart events, attacks or death.

In stable coronary heart disease, there are many things that people can do to keep healthy. Important components of management include stopping smoking, exercising (cardiac rehabilitation), managing weight and diet, and, sometimes, taking medications to reduce blood pressure and cholesterol. For people with unstable or more severe disease, the medical management may also include heart surgery.

How can physiotherapy help with coronary heart disease?

Physiotherapy is important in the management of coronary heart disease. The cornerstone of physiotherapy management is cardiac rehabilitation. In patients undergoing heart surgery, physiotherapy can also help with recovery after surgery. Your physiotherapist may see you before and after your surgery to help prevent a chest infection and regain your mobility and walking as soon as possible.

What is cardiac rehabilitation?

Cardiac rehabilitation is a program for people with a variety of cardiovascular diseases. The cornerstone of cardiac rehabilitation is exercise training. The program also involves education and support about managing the disease, including reducing risk factors, getting back to your usual life, managing your medications, psychological issues, maintaining a good diet and stopping smoking. Joining a cardiac rehabilitation program (widely available throughout Australia) is the easiest way to learn about how to exercise with your disease. At the cardiac rehabilitation program, a physiotherapist will measure your exercise capacity, your symptoms and your safety for exercise. They will teach you how to do the exercises and then supervise you exercising in the group environment once or twice a week for 6-8 weeks. The programs are located at local hospitals or community centres around Australia. Speak to your doctor or physiotherapist for more information and to get a referral to your local program—it is the best thing you can do.

When should I start cardiac rehabilitation?

There are three types of cardiac rehabilitation.

  • Phase I occurs in the hospital straight after surgery. A physiotherapist will teach you some gentle exercises and provide education on the things to do and not to do to help your recovery. They may also provide you with a home-exercise program to start once you get home. Phase I usually runs multiple times per week on the hospital ward from the first day after your surgery.
  • Phase II cardiac rehabilitation occurs in the outpatient setting after discharge from hospital following surgery and stenting. As well, people with coronary heart disease not requiring surgery are suitable for cardiac rehabilitation once cleared by a medical doctor. This phase usually runs once or twice a week for 6-8 weeks.
  • Phase III is a long-term maintenance program running in the community for people who have already completed the other phases.

What is the role of physiotherapy before and after heart surgery?

Physiotherapy before heart surgery may involve breathing exercises and education. Physiotherapy after surgery usually commences on the first day after, and involves helping you get out of bed and start walking, as well as the prescription and supervision of exercise in the Phase I cardiac rehabilitation class. A physiotherapist will also give you advice on what to do and not do after surgery during the recovery.

How effective is physiotherapy for coronary heart disease?

There is a large body of research to confirm the effectiveness of physiotherapy improving many aspects of life for people with coronary heart disease. Research has supported the development of a number of clinical practice guidelines for clinicians about how to best manage their patients. In particular, the Australian Cardiovascular Health and Rehabilitation Association (ACRA) has developed guidelines for secondary prevention and cardiac rehabilitation. These are evidence-based guidelines for the management of coronary heart disease and recommend both physiotherapy and cardiac rehabilitation.

There is strong evidence that cardiac rehabilitation reduces hospital readmissions and death within the first year of a cardiac event. It also speeds up recovery, reduces risk factors (such as high blood pressure and cholesterol), improves fitness levels, reduces smoking, reduces further hospitalisations or cardiac events, and improves quality of life. There is also growing evidence that shows breathing exercises (muscle training) before and after cardiac surgery results in faster recovery after surgery, including fitness, anxiety and quality of life:

What can I do at home?

Managing your coronary heart disease at home is important. Discuss with your GP or physiotherapist about having a self-management plan to help prevent or manage crises. Take all your medication as recommended and be able to recognise the signs of worsening disease or angina, so you can respond quickly before it gets worse. It is best to speak to your GP or physiotherapist about a self-management plan if you do not already have one.

The best thing to do at home is to exercise daily and lead an active lifestyle. A good aim is to undertake at least 30 minutes of exercise on most days of the week. Brisk walking is a safe and easy way to achieve this if you are not used to exercising. You can pace yourself using the ‘talk test’ (ie, if you can walk and talk without being short of breath, that is the correct pace for you).

In addition, avoiding too much sedentary time during the day is important (eg, avoid sitting down for too long, watching television). Some people wear activity trackers such as Fitbits, pedometers or smartphones to track the number of steps they take each day. This is a great way to monitor your activity levels and ensure you are keeping up an active lifestyle. Aim to do 10 000 steps every day.

Remember to listen to your body, as it sets the safe limits for you. Ensure your coronary heart disease is well controlled before you start exercising and talk to your doctor or physiotherapist before you start, to check that it is safe to do so.

 
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LUNG CANCER

Cancer is a generic term for a large group of diseases. Cancer occurs when abnormal cells are not destroyed by normal bodily processes. Instead, these cells multiply and spread to other parts of the body. Cancer can affect any part of the body. Lung cancer is a tumour that grows in one or both lungs. Primary lung cancer starts growing in the lungs and can sometimes spread to other parts of the body. Secondary lung cancer, or metastatic lung cancer, starts growing in another part of the body and then spreads (metastasises) to the lungs. Common symptoms experienced by people with lung cancer are breathlessness, cough, pain and fatigue. 

How common is lung cancer?

Lung cancer is the leading type of cancer diagnosed in males around the world. In females, lung cancer is the fourth-most common cancer diagnosed after breast cancer, colorectal cancer and cancer of the cervix uteri. Cancer is the leading cause of death worldwide and lung cancer is the leading cause of cancer death. However, survival rates for cancer have significantly improved over recent decades, meaning there are many people who have survived cancer with particular needs for their quality of life.

What causes lung cancer?

The most common cause of lung cancer is tobacco smoking, however, there is a small group of people with lung cancer who have never smoked. Lung cancer is usually caused by a combination of risk factors, including:

  • exposure to second hand smoke
  • exposure to asbestos
  • exposure to other environmental or occupational dusts and chemicals
  • being of an older age
  • having other lung diseases
  • a genetic preposition.

Lung cancer is usually seen in people over the age of 60.

 

How do I know if I have lung cancer?

The early signs of lung cancer can be a new cough or change in an old cough, breathlessness, chest pain, coughing up blood, fatigue, weight-loss, wheeze and/or a hoarse voice. However, many of these symptoms are signs of other lung problems as well, and they do not necessarily mean you have lung cancer. If you have any of these symptoms and you are concerned, you should speak with your GP. Some early-stage lung cancers are diagnosed when a person has a routine test, such as a chest radiograph, for another problem and may not actually have any symptoms from the lung cancer.

A GP will help diagnose lung cancer. They may do a variety of tests to try to determine if you have lung cancer and send you to a specialist medical doctor (such as respiratory physician, thoracic surgeon or oncologist) for assessment and treatment. Your treatment will depend on the type of lung cancer, the location of the tumour and the stage of the lung cancer (progression and spread of the disease). It may include a combination of lung surgery (to remove the tumour), chemotherapy or radiotherapy. Physiotherapy is important before and after cancer treatment to help you stay fit and active.

How can physiotherapy help with lung cancer?

Physiotherapy works alongside your cancer treatment (such as surgery, chemotherapy or radiotherapy) with the aim of keeping you fit, reducing your symptoms and maximising your quality of life. A thorough physiotherapy assessment aims to identify any problems you are having and treat them accordingly. The main treatment a physiotherapist will provide is exercise prescription, which is a program of exercises and physical activities individually tailored to you. Exercise aims to help keep you physically active and strong, and counteracts the side-effects of cancer and the treatments.

When should I exercise?

People with cancer, including those with lung cancer, can be offered exercise before, during or after cancer treatment. However, it is strongly recommended that you undergo a thorough pre-exercise screening assessment to rule out any specific dangers to exercise. The assessment will also establish your baseline level of physical ability. Your physiotherapist can do this for you.

The aim of exercise is slightly different depending on the stage of your treatment:

  • Before surgery, chemotherapy or radiotherapy, the aim is to maximise your physical fitness to help you tolerate treatment better and speed up your recovery. Exercise before surgery is often referred to as prehabilitation or prehab.
  • During chemotherapy or radiotherapy, exercise aims to keep you fit, reduce symptoms, and maximise your quality of life and psychological status.
  • After finishing surgery, chemotherapy or radiotherapy, exercise aims to restore any loss in fitness and muscle strength that occurred while having treatment, and maximise your functional abilities, psychological status and quality of life for the long-term.

How much should I exercise?

The exercise recommendations for people with cancer include 30 minutes of aerobic exercise at least five days per week. Examples of aerobic exercise are brisk walking, jogging, riding on a stationary bike or swimming. It is also recommended to do strengthening exercises 2-3 days per week to keep your muscles strong. If you have had falls or poor balance, it is also recommended that you do balance exercises. Early after lung surgery there are some restrictions on the type of exercise you can do and the amount of heavy lifting and strengthening exercises. Your physiotherapist will incorporate the best exercises for your particular situation into your exercise program

Will exercise make my disease worse?

No, exercise will not make your disease worse. When you exercise, your lungs need to work harder to deliver more oxygen to your working muscles. Therefore, you may experience increased breathlessness when exercising; however, that is a good sign and quite normal when you are exercising. The breathlessness should go back to normal as soon as you stop the exercise. However, for safety, it is recommended that you consult your physiotherapist or GP before you start exercising for the first time after being diagnosed with lung cancer.

What is pulmonary rehabilitation?

Pulmonary rehabilitation is a program for people with chronic lung disease, including lung cancer, that usually involves supervised group exercise, education and support. Joining a pulmonary rehabilitation program is a great way to learn how to exercise with lung cancer and how to best manage your disease. At the pulmonary rehabilitation program, a physiotherapist will measure your current abilities, your symptoms and your safety for exercise. They will teach you how to do the exercises and then usually supervise you exercising in the group environment once or twice a week for 6-8 weeks. The program will also include education, including how to understand your disease, how to best manage your symptoms, how to stop smoking or cut down (if you are a smoker), and how to eat a healthy diet. The programs are located at local hospitals or community centres around Australia. Speak to your doctor or physiotherapist for more information and to get a referral to your local program. There are also similar exercise programs available called cancer rehabilitation or oncology rehabilitation. Pulmonary, cancer or oncology rehabilitation is a great option for anyone diagnosed with lung cancer.

What else can physiotherapy do?

You may also see a physiotherapist on the hospital ward while you are in hospital receiving treatment. Physiotherapy after surgery usually commences on the first day after surgery and involves helping you get out of bed and start walking early, as well as the prescription and supervision of exercise. Your physiotherapist will also give you advice on what to do and what not do after surgery, including some exercises to complete at home once you leave hospital.

Physiotherapists can also help with treatment of other complications that may arise from the cancer and cancer treatment. These can be pain and fatigue, as well as musculoskeletal injuries, osteoporosis, falls and balance problems, neurological problems or respiratory problems. It’s recommended that you see a physiotherapist early after diagnosis in order to maximise your healt

How effective is physiotherapy for lung cancer?

There is a large body of research to confirm the effectiveness of physiotherapy improving many aspects of life for people with lung cancer. The majority of evidence comes from breast, colorectal, prostate and haematological cancer, with rapidly growing evidence in lung cancer. The guidelines on exercise and cancer recommend patients with cancer do 150 minutes or more of moderate intensity aerobic exercise per week (eg, walking) and 2-3 sessions of resistance training per week, as well as avoiding sedentary time.

The evidence demonstrates that exercise is associated with strong and consistent benefits on many fronts, including:

  • improving exercise capacity (fitness)
  • improving muscle strength
  • reducing cancer symptoms (including breathlessness and cancer-related fatigue)
  • reducing depression
  • reducing anxiety
  • reducing cancer distress
  • improving quality of life.

There is also growing evidence linking higher physical activity levels after diagnosis of certain types of cancer, with reduced rates of mortality. Exercise and cancer is a rapidly growing area of physiotherapy practice. There are now a number of private physiotherapy practices offering specific services to patients with cancer, as well as a number of cancer rehabilitation programs available in community centres and local hospitals.

What can I do at home?

The best thing to do at home is to exercise daily and lead an active lifestyle. A good aim is to undertake at least 30 minutes of exercise on most days of the week. Brisk walking is a safe and easy way to achieve this if you are not used to exercising. In addition, avoiding too much sedentary time during the day is important (such as avoiding sitting down for too long, watching television). Some people wear activity trackers such as Fitbits, pedometers or smartphones to track the number of steps they take each day. This is a great way to monitor your activity levels and ensure you are keeping up an active lifestyle. Aim to do 10 000 steps every day. If you are starting exercise for the first time after being diagnosed with lung cancer, talk to your physiotherapist about what will work best for you.

 
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