Field: Rehabilitation program
Target group: Patients/clients in rehabilitation with COPD
Institution: Dieulefit Santé, Grenoble University Hôpital Sud, Grenoble, France

Purpose:

• Prepare patients/clients for participation in standard physical activity programmes in rehabilitation.
• Improve the patients’/clients’ physical activity and physical fitness level.
• Promote an active lifestyle after rehabilitation.
• Prepare patients/clients for reintegration into society after rehabilitation.

Programme:
COPD (chronic obstructive pulmonary disease) causes breathlessness while providing effort due to respiratory troubles and induces muscular weakness and dysfunction, and thus, poor exercise tolerance. This physical limitation is bound by amyotrophy and myopathy related to a sedentary life-style, structural changes in muscles fibre types, nutritional deficiencies, side effects of corticotherapy and oxidative stress lead by low-grade systemic inflammation associated to the disease and cigarettes smoking. Rehabilita67 tion training affords the lowering of ventilatory demand and the improvement of muscular strength and endurance by reducing some of the limiting factors mentioned above. “Dieulefit Santé” is a cardiopulmonary rehabilitation centre in France which focuses on follow-up care for patients on discharge from hospital and on patients’ rehabilitation through regular adapted physical activities and health education in order to optimise their health and quality of life and to acquire better knowledge about their illness and its treatments. Part of the rehabilitation programme is a COPD preparation programme aimed at training patients with COPD in order to enhance their exercise capacities, to reduce their symptoms and to improve their quality of life and autonomy. This allows patients to get involved in the long range in their rehab programme and more generally in physical activities. The programme is planned for four weeks duration. At day 1, a 6-minutes Walking Test is provided as well as a maximal cardiopulmonary exercise test to assess the safety of exercise and the training level. Patients are split in different groups according to the severity of their affection. General and muscle endurance and strength are trained through a variety of playful adapted physical activities. The exercise training programme
is regularly assessed to adjust it to the patient’s needs and progress. As well, community based programmes are suggested to patients at discharge from pulmonary rehabilitation to stabilise muscular and respiratory improvements and to keep on practising physical activities to maintain these benefits. The programme is coordinated by both APA teachers and physiotherapists. Physiotherapists offer standardised exercises on ergocycle or treadmill, essentially at the beginning of rehabilitation process (re-education stage) while APA teachers offer physical activities based on modified and adapted sports activities allowing patients to enjoy physical activity so that they may keep on practising after discharge from the rehabilitation centre (post rehabilitation stage).

Contact information:
Patrice Flore
Grenoble 1 University (Joseph Fourier); Research on Exercise and Health Laboratory; Hôpital Sud,
Grenoble University Hospital; BP185; 38042 Grenoble Cedex 09; France
Tel. +33476765494
Fax. +33476768921
e-mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

This interesting programme primarily helps clients with chronicle diseases. If we think about the required competences of professionals we consider specifically about therapeutic competences:

• Understand and evaluate the interrelation between determinants of human functioning.
• Understand and evaluate the impact of impairment on human functioning.
• Understand the pathophysiological basis of chronic disease, disability and disorder.
• To understand the impact and risks of physical activity.
• To know the impact of medication on exercise performance.
• Understand indications and contra-indications of sports and adapted physical activities in the rehabilitation of specific populations.

Example of good practice was described by Sandrine Tomasi & Patrice Flore from Grenoble 1 University in France.