What is Pulmonary Rehabilitation (PR)?
PR is an exercise and education programme designed for people with lung disease who experience symptoms of breathlessness.
PR focuses on tailored physical exercise and information that helps people to better understand and manage their condition/s and symptoms, including feeling short of breath. It’s included as a key intervention in the NHS Long Term Plan, which has made respiratory disease a new national clinical priority. Most people who go to PR have chronic obstructive pulmonary disease (COPD), but people with other long-term lung conditions, such as bronchiectasis and pulmonary fibrosis, can also benefit. A PR course typically lasts six to eight weeks, with two sessions of around two hours each week, and includes an individually prescribed exercise and education programme including aerobic exercise and resistance training and lifestyle support.
PR courses are delivered in groups of 8-16 people and may be held in local hospitals, community halls, leisure centres and health centres. Each course is supported by a PR team made up of trained health care professionals such as physiotherapists, nurses and occupational therapists.
Evidence shows that accessing PR improves people’s ability to walk further, helps them feel less tired and breathless when carrying out day-to-day activities 90 per cent of patients who complete a PR programme have higher activity and exercise levels, and report an improved quality of life.
PR has been shown to support better self-management and reduction in exacerbations, reduction in numbers of acute and emergency admissions and reduction in primary care appointments.
Our work on PR
Respiratory disease has been identified as clinical priority within the NHS Long Term Plan which sets out the ambitions for the NHS over the next 10 years. Expansion of PR services is one of the key commitments of the Plan and as part of the cardiovascular disease and respiratory programme.
NHS England and NHS Improvement aims to increase the number of patients who would benefit by increasing referral rates to PR from 13% to 60% by 2023. To support this expansion, the updated GP Contract includes a new Quality Outcome Framework (QOF) incentive to encourage referrals to PR services . Targeted funding for PR will be available to support expansion of services, and examples of good practice and models of PR services will be made widely available.
PR services are commissioned by CCGs on a local, regional and national basis. CCGs buy services for their local community from any service provider that meets NHS standards.
The National COPD Audit Programme in 2017 identified 195 separate PR services, delivered by 158 different provider organisations in place across England. The majority of services are provided by NHS trusts and health boards, but providers also included charities, community interest companies and private providers.
NICE has published quality statements which set out what good PR should look like. They relate to people with stable COPD and exercise limitation due to breathlessness and those admitted to hospital for an acute exacerbation of COPD.
PR services are encouraged to participate in the National Asthma and COPD Audit Programme (NACAP). which involves the time-limited data collection relating to service provision and delivery of PR services for COPD in England and Wales. PR Services can also join the Pulmonary Rehabilitation Services Accreditation Scheme (PRSAS) . The aim of the scheme is to improve the quality of pulmonary rehabilitation services throughout the UK leading to accreditation. The scheme is run by the Royal College of Physicians and runs in collaboration with the NACAP.