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Respiratory medicine · London

Pulmonary rehabilitation programme - London

A consultant-led six to eight-week supervised programme for adults with chronic lung disease. Individually prescribed exercise, breathing techniques and self-management education, delivered by specialist respiratory physiotherapists. Typical private cost £2,400 to £4,500.

What it is

Medically supervised exercise, breathing training and education

Pulmonary rehabilitation is a structured, multidisciplinary programme combining individually prescribed exercise, breathing technique training, inspiratory muscle work and self-management education for adults living with chronic lung disease. It is delivered in a hospital or clinic gym under the supervision of a specialist respiratory physiotherapist, with consultant respiratory oversight throughout.

NICE guidance and the British Thoracic Society (BTS) recommend pulmonary rehab for anyone with symptomatic COPD and an MRC dyspnoea score of 3 or higher (breathless walking on the flat), interstitial lung disease, bronchiectasis, symptomatic asthma with fixed airflow obstruction, patients recovering from lung cancer resection or lung transplant, and adults with persistent post-COVID breathlessness.

Evidence

The strongest non-drug intervention in chronic lung disease

Cochrane systematic reviews of pulmonary rehab in COPD and ILD consistently show clinically meaningful improvements: six-minute walk distance rises by roughly 48 metres, Borg dyspnoea scores drop by around one point on exertion, Chronic Respiratory Questionnaire (CRQ) quality of life scores improve by about six points, and hospital admissions and length of stay for exacerbations fall. Benefits are seen across all severity grades, and gains persist for six to 12 months when patients continue a home maintenance plan.

Who benefits

Suitable candidates

  • COPD with MRC dyspnoea 3 or higher, or after any hospitalised exacerbation.
  • Idiopathic pulmonary fibrosis (IPF) and other interstitial lung disease.
  • Bronchiectasis, including adults with cystic fibrosis.
  • Asthma with fixed airflow obstruction and persistent exertional breathlessness.
  • Recovery after lung cancer resection (lobectomy, segmentectomy, pneumonectomy).
  • Post-lung transplant rehabilitation.
  • Persistent post-COVID lung disease with breathlessness or reduced exercise tolerance.

The programme

From baseline testing to a titrated exercise prescription

  1. Consultant respiratory assessment, spirometry, and either a six-minute walk test or a cardiopulmonary exercise test (CPEX).
  2. Baseline Borg dyspnoea score, HADS anxiety and depression score, CRQ or CAT quality of life score.
  3. Six to eight weeks of supervised sessions, twice weekly, 90 minutes each.
  4. Individually prescribed aerobic training (treadmill, cycle ergometer, walking circuits), progressive resistance training and inspiratory muscle training.
  5. Structured weekly education (see below), delivered by a multidisciplinary team.
  6. Written home exercise plan for the days between sessions.
  7. End-of-programme repeat walk test, spirometry and outcome scores, plus a maintenance plan.

Education topics

Self-management, session by session

  • Medication use and inhaler technique review.
  • Breathing techniques: pursed lip breathing, paced breathing, active cycle of breathing.
  • Energy conservation and activity pacing for daily tasks.
  • Recognising and managing exacerbations, with a written action plan.
  • Nutrition, weight optimisation and sarcopenia prevention.
  • Smoking cessation support.
  • Long-term and ambulatory oxygen therapy, if indicated.

Cost in London

Typical private fees

Full six to eight-week supervised programme, including baseline testing, 12 to 16 supervised sessions, education blocks and end-of-programme retesting: £2,400 to £4,500.

Follow-up review or one-off maintenance session with a respiratory physiotherapist: £120 to £220.

Baseline cardiopulmonary exercise test (CPEX) if not already available: typically £450 to £750, sometimes bundled into the programme quote.

Where it is offered

Recognised London pulmonary rehabilitation services

  • Royal Brompton Hospital Pulmonary Rehabilitation (private).
  • HCA The Wellington Hospital, respiratory rehabilitation service.
  • Cromwell Hospital (Bupa Cromwell), respiratory medicine.
  • London Chest Hospital private respiratory service (Barts Health).
  • One Welbeck Respiratory, Harley Street.

Related

Related pathways

Frequently asked

Pulmonary rehabilitation - your questions

Programme length, who benefits, the evidence base, referral requirements, insurance cover and post-COVID rehab.

  • How long is a pulmonary rehabilitation programme?

    A standard NICE and BTS compliant programme runs for six to eight weeks, with two supervised 90-minute sessions per week alongside a written home exercise plan for the other days. Longer 12-week programmes are used for interstitial lung disease, complex bronchiectasis and post-lung transplant patients.

  • Who benefits most from pulmonary rehab?

    Adults with symptomatic chronic lung disease and an MRC dyspnoea score of 3 or higher. That includes COPD, idiopathic pulmonary fibrosis and other interstitial lung disease, bronchiectasis (including cystic fibrosis), asthma with fixed airflow obstruction, patients recovering from lung cancer resection or lung transplant, and adults with persistent breathlessness after COVID-19.

  • What is the evidence that it works?

    Cochrane systematic reviews show pulmonary rehab improves six-minute walk distance by around 48 metres, reduces Borg dyspnoea scores by approximately one point, improves Chronic Respiratory Questionnaire quality of life scores by six points, and reduces hospital admissions and length of stay in COPD. Benefits are consistent across mild, moderate and severe disease.

  • Do I need a referral or a lung function test before starting?

    Yes. A baseline consultant respiratory review, spirometry and either a six-minute walk test or a cardiopulmonary exercise test (CPEX) are required to set safe intensity, exclude unstable cardiac disease, and prescribe oxygen if needed. Borg breathlessness and HADS mood scores are taken at baseline and at discharge.

  • Will private insurers cover pulmonary rehabilitation?

    Cover is variable. Bupa, AXA Health, Vitality and WPA will often reimburse a supervised programme where a consultant respiratory physician has documented symptomatic chronic lung disease and standard therapy has been optimised. Pre-authorisation is required and cover is usually capped at six to eight weeks.

  • Can I do pulmonary rehab after COVID-19?

    Yes. Adults with persistent breathlessness, exertional desaturation or reduced exercise tolerance more than 12 weeks after COVID-19 benefit from a modified programme. Post-COVID rehab includes a paced exercise progression, breathing pattern retraining and fatigue management to avoid post-exertional symptom exacerbation.

Start pulmonary rehab in London

Speak to a respiratory consultant within one working day

Send your recent lung function results or discharge summary and we match you with a consultant-led private pulmonary rehabilitation service in London. Baseline CPEX or six-minute walk test, six to eight weeks of supervised sessions and a written home maintenance plan included.

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