Your home exercise and activity diary. Information for thoracic patients having lung resection surgery

Your home exercise and activity diary Information for thoracic patients having lung resection surgery

Contents Introduction 3 Physiotherapy at home before your operation General advice regarding exercises in this diary Warm up Exercises 8-11 Home exercises and activity diary 12-18 Physiotherapy in hospital following surgery 20 Arm exercises 21 Walking 22 Leg exercises 23 Positioning to relieve breathlessness 24 Daily record of distance walked in hospital 2 Physiotherapy after discharge from hospital 2 Home exercises and activity diary 28-38 2

The information in this booklet has been designed to help you in three stages. Physiotherapy, at home, before your operation to help you get fitter. Physiotherapy in the hospital to keep your chest clear and to help you get back on your feet. Physiotherapy, at home, after your operation in order to build up your stamina and help your recovery. If, before your surgery, you feel you have a high level of fitness eg you are a member of a sporting team or regularly attend the gym, please continue with your chosen activity until the time of your operation. The advice in this booklet will be useful in the early stages after your operation when strenuous activity is to be avoided. Once you have been discharged home, you will be given a follow up appointment. This is the time to discuss with your surgeon when you can restart your chosen activity/ sport. After your operation it is normal for you to feel weak and these exercises will also help you to develop your strength and fitness. The exercises explained to you by the physiotherapist at the Patient Education Programme are designed so that you can continue them at home. 3

If you have any existing problems with your shoulders or legs, discuss this with the physiotherapist before starting the exercise programme. The programme can be adapted to suit your needs. You will find some exercises more difficult than others. You should not give up on a particular exercise, instead, stick to the time slot for each exercise - even if you need to rest for most of this time period. When you are exercising it is normal to feel breathless, however, you should not be so breathless that you cannot hold a conversation. You can be guided by the Breathlessness Scale on the side of your exercise sheet to help pace yourself. Aim for a score of between 3 and 4, moderate to somewhat severe. You should not exercise if you feel unwell. If you are not sure, check with your GP, nurse or physiotherapist. 4

Physiotherapy at home before your surgery You can improve your general fitness simply by being more active in your day to day life. For example: Walk instead of using the car. Use the stairs rather than the lift. Gardening and housework ensuring you pace yourself. (Discuss with staff when to restart this after your operation) Walking is an excellent way to enhance your general fitness. Try to increase the frequency and distance you walk and the time you spend walking. Aim to walk at a pace that makes you slightly breathless. Alternate the exercise programme in this booklet with your walking programme. Aim to complete the exercise programme 3 times a week, and go for a walk 4 times a week.

General advice about the exercises in this diary Always start with the warm up. The exercises are in a set order to alternate work for your arms and legs. Please keep to this order. If you find yourself feeling more breathless than that described by number on the scale of breathlessness, severe, slow down and rest. Only return to exercise once you are comfortable again (2 or less on the scale of breathlessness, slight ). If any exercise causes you significant discomfort or pain, stop immediately, then move on to another exercise once comfortable again. It varies from person to person how long and at what intensity you can exercise for. You must work at your own pace. Duration of each exercise Do each exercise in turn for at least two minutes (even if for most of this time you are resting). When you can complete a particular exercise for two minutes, without resting, increase the time spent on that particular exercise to a maximum of five minutes. This may mean, for example, that you spend: four minutes on exercise 1, (trunk rotations), two minutes on exercise 2, (step ups), five minutes on exercise 3 etc. This is absolutely fine. Time yourself with a watch or clock, you can get someone to help you with this. Scale of breathlessness Aim for between 3 and 4 Score How breathless you feel 0 Nothing at all 0. Very, very slight 1 Very slight 2 Slight 3 Moderate 4 8 9 Somewhat severe Severe Very severe Very, very severe 10 Maximum

Difficulty - how breathless you feel Aim to keep at a pace which means that you are working at a level of 3-4 on the breathlessness scale, moderate to somewhat severe breathlessness. Before the operation, this may mean that you need to use light weights when doing the arm exercises. Time In total, including a warm-up, this programme should take a minimum of 2 minutes, increasing to a maximum of minutes as you increase the time slots for each exercise. Record your progress in your exercise log on pages 10-11. Set yourself realistic targets. The following exercises are to be done at home before coming into hospital for your surgery.

Warm up It is worth while spending up to minutes on a simple warm up to prepare your body for exercise and to reduce the risk of injury. It is advisable to wear loose fitting and comfortable clothing and flat supportive footwear. Checks Make sure you are sitting in an upright position. Ensure the temperature of the room is comfortable. Ensure you have adequate space all around you to exercise. Allow adequate uninterrupted time to complete your exercises. Start in a sitting position Repeat each warm up exercise to 10 times 1. Look over your shoulder left and right. 2. Circle your shoulders one way and then the other. 3. March on the spot whilst sitting. 4. Toe tap.. Slouch and stretch your back in the chair. Suggestion: try doing it to music but at a pace which is comfortable to you. 8

Exercises 1) Trunk rotations Sit on a chair Look over your shoulder while turning your upper body Repeat to the other side Hold for seconds 2) Step-ups Step up with one leg. Bring the other leg to join it. Step down with the first leg. Bring the other leg to join it. NB: You could use the bottom step of the stairs for this. 3) Overhead arms (without weights after your operation) Sit or stand holding your hands on your chest. Lift alternate arms from your chest straight up and bring back down. 9

4) Heel raises Stand, holding onto back of chair Push up onto your toes. Hold for 3 seconds ) Wall push-ups Stand facing a wall with your arms straight out in front of you at shoulder height and your hands on the wall. Do push-ups against the wall keeping your body in a straight line and keeping your hands on the wall. ) March on spot Stand, either free, or using a wall or solid surface to aid balance. March on the spot. ) Double arm raise Stand straight with your arms in front of you, holding a ball (or similar object) Keeping your arms straight, raise the object until you are holding it above your head for 3 seconds. 10

8) Squats 9) Back stroke Stand, holding onto a chair / table with both hands for support. Slowly crouch keeping your back straight and heels on the floor. Stay crouched for approx 10 seconds, and feel the stretching in your buttocks and the front of your thighs. Standing or sitting, with both arms hanging down. Slowly rotate your arms counter-clockwise, so your arms raise in front of you and up above your head, and then down and behind. 10) Sit to stand Stand up from sitting down. Sit down again. 11

Home exercise and activity diary - Before surgery The diary is provided to encourage and monitor your progress. Please use the scale of breathlessness to the right to fill in the difficulty of each exercise. 1 Exercise Example Warm-Up Trunk Rotations Day 1 2 3 4 Time Difficulty Time Difficulty Time Difficulty Time Difficulty 2 Step Ups 3 Overhead Arms 4 Heel Raises Wall Push Ups March on Spot Double Arm Raise 8 Squats 9 Back Stroke 10 Sit to Stand Other exercises) 12

Week commencing:.../.../... Time Difficulty Time Difficulty Time Difficulty Scale of breathlessness Aim for between 3 and 4 Score How breathless you feel (difficulty) 0 Nothing at all 0. Very, very slight 1 Very slight 2 Slight 3 Moderate 4 8 Somewhat severe Severe Very severe 9 Very, very severe 10 Maximum 13

Physiotherapy in hospital Following thoracic surgery Physiotherapy plays an important part in recovery after your surgery. The four main aims of physiotherapy after surgery are: Breathing exercises Techniques to help you clear sputum (phlegm) Advice about arm exercises Building up your stamina and general exercise Breathing exercises Deep breathing exercises - These are used to help reexpand your lungs after surgery. Take a deep breath in, hold for 3 seconds and breathe out. Repeat -10 times. It is important to perform these regularly in the early days after your operation. It may be a little uncomfortable initially so do them little and often, roughly every hour. You can start these as soon as you wake up from the anaesthetic. Breathing control - This is a breathing technique used to control breathlessness and is also useful for pacing yourself as your walking improves. This involves concentrating on breathing out. Stop and do 3-4 slow breaths all the way out when you feel breathless, and then breathe normally. Repeat the above cycle until you feel your breathing is under control. 20

Clearing sputum Not everybody has sputum after their operation, but don t be surprised if you feel a bit chesty. It is a combination of the anaesthetic, the surgery, and not being able to move as much as you usually do. It is vital that you clear any sputum - if you have any - by coughing. Physiotherapy aims to make this as easy as possible. The deep breathing exercises described above move sputum up your chest so you don t have to cough as hard to clear it. You can also be shown a good way to support your wound by wrapping a towel around your back or tucking one under your arm. Some people find it hard to cough and, instead, prefer to huff. This is a sharp, fast, forced breath out after a medium breath in - rather like the breath you would take when trying to steam up a mirror. After doing your deep breathing exercises, get into the habit of doing a huff or a cough to make sure sputum isn t building up in your chest. It is also easier to clear sputum after you have moved (i.e. sat out in your chair or had a walk). So combine deep breathing exercises with walking, and have a cough afterwards when you sit down. The following exercises are to be done in hospital after your surgery. 21

Arm exercises to prevent shoulder stiffness It is also important after your operation to exercise your arms to help prevent stiffness in your shoulders and back, and to promote good posture. The following exercises should be started on the first day after your operation, and should be done 2-3 times daily. When your shoulder on the operated side can move as well as the shoulder on the other side just do these exercises once a day. It is normal to feel a stretch or pull over the incision site when exercising your arms, but it should not be painful. To start with, try shrugging your shoulders. Aim to lift the arm of your operated side above your head. Lift your arm as far as is comfortable and hold it for 3-4 seconds. You may need your other hand to support the raised arm initially. At first this may be difficult due to lines and drains, just work within their limits. Once the lines are removed you will find this easier to do. Continue to do these exercises in the hospital and for the first six weeks at home after discharge. Walking It is important that you are up and about again as soon as possible after your operation. It is likely that you will be sitting out in a chair the first day after your surgery. This will help your lungs to re-expand and help to keep your chest clear of sputum. Your first walk is likely to be the first day after your operation. Staff will assist with your drips and drains. On the second day, aim to walk twice in the morning, twice in the afternoon and twice in the evening. If you need assistance with drips and drains in order to move, this will be given by staff. 22

By the third day aim to walk each hour. At first concentrate on how often you walk rather than how far. Then build up your distance. If you are not feeling confident ask your visitors to walk with you on longer distances. Use the diary to record how far you have walked. At first this should be recorded in 10m intervals. Once you are able to walk laps of the ward it will be easier to record these. The walk-talk test is a good guide to help you progress your walking. It simply means that you should be able to maintain a conversation whilst walking. If you are unable to, you should stop, and spend a few minutes of relaxed breathing to help get your breath back. Leg exercises When you feel confident to walk by yourself on the ward, you can restart these exercises. There are 3 numbered stations on the ward where you can stop and practice: Heel raises Marching on the spot Squats Aim to try sets of up to 10 of each exercise, in a controlled manner, three times a day. These are designed to help improve your balance as you may feel a little unsteady at first. Continue them until you feel steady when walking by yourself. 23

Positioning to relieve breathlessness The following positions may help you to relax and make your breathing easier. They may be particularly useful to use after a period of physical activity, or after a long session of coughing. Try to find one that is comfortable for you, and relax your breathing with the exercises described above, continuing until you feel calm and settled. Forward lean sitting High side lying In a sitting position, lean forward to rest your elbows on your knees and let your stomach relax. Alternatively, you may prefer to lean forward over a table with a pillow on top. Lying on one side propped up with pillows can also be very relaxing. The side you lie on will depend on the operation you have had. If you have had a pneumonectomy (whole lung removed), you should lie with your scar facing downwards. If you have had only a part of one lung removed you should lie with your scar facing upwards. Forward lean standing This may help if you feel breathless when you re walking. Find a wall or fixed object to lean forward onto for support, and let your stomach relax. 24

Daily record of distance walked in hospital Day 1 Day 2 8am 9am 10am 11am 12am 1pm 2pm 3pm 4pm pm pm pm 8pm 9pm 10pm Day 3 8am 9am 10am 11am 12am 1pm 2pm 3pm 4pm pm pm pm 8pm 9pm 10pm 8am 9am 10am 11am 12am 1pm 2pm 3pm 4pm pm pm pm 8pm 9pm 10pm Day 4 8am 9am 10am 11am 12am 1pm 2pm 3pm 4pm pm pm pm 8pm 9pm 10pm 2

Physiotherapy at home after discharge from hospital In the first two weeks after discharge Continue to increase the distance you walk each day. Set a target to walk further from one week to the next. You will already have started your walking programme whilst in the hospital. When you first go home your first walk should be roughly equal to what you have been doing on the ward. Examples may be to the bottom of the garden several times, or up the road and back. Walk with someone at first if you are not feeling confident. Continue with the arm exercises that reduce shoulder stiffness. If after six weeks your shoulder is significantly stiff, go to your own GP to see if further physiotherapy is advised. At the start of the third week Restart the exercise programme that you did before surgery as shown in this booklet on pages -9. Aim to do the programme three times a week, and go for a walk four times a week. It is advised that you continue with this programme for the next six weeks. Don t be disappointed if you cannot exercise for as long as you could before your surgery, work up to this. If you have any active sports or hobbies which you would like to return to, discuss with your surgeon during the follow-up appointment as to the best strategies to recommencing them. 2

Home exercise and activity diary - After surgery The diary is provided to encourage and monitor your progress. Please use the scale of breathlessness to the right to fill in the difficulty of each exercise. 1 Exercise Example Warm-Up Trunk Rotations Day 1 2 3 4 Time Difficulty Time Difficulty Time Difficulty Time Difficulty 2 Step Ups 3 Overhead Arms 4 Heel Raises Wall Push Ups March on Spot Double Arm Raise 8 Squats 9 Back Stroke 10 Sit to Stand Other exercises)

Leaflet printing funded by the Yorkshire Cancer Centre Appeal supporting Leeds Cancer Centre www.yorkshirecancercentre.org.uk Leeds Teaching Hospitals NHS Trust 201 2nd edition (Ver 1) Developed by Sandra Dixon Thoracic CNS and Mary Andrews, Senior Physiotherapist Design by Medical Illustration Services 201090_001/JG Printed by: The Leeds Teaching Hospitals NHS Trust Print Unit W***** LN00388 Publication date 09/201 Review date 09/201