title: Novel pulmonary rehabilitation approach in a 46-year-old female with significant decline in lung and functional status following H1N1.
abstract: BACKGROUND
  Pulmonary rehabilitation (PR) is an established therapeutic intervention for improving limb muscle dysfunction, reducing morbidity and mortality in a variety of chronic lung conditions. Providers are instrumental in improving success by optimizing disease management, minimizing barriers and tailoring a program to meet the patient's goals and functional needs.
  
  
  METHODS
  We present a case of a young woman with mild asthma who developed severe chronic obstructive pulmonary disease following H1N1. She remained limited in instrumental activities of daily living following traditional PR but participated in therapeutic horseback riding with notable improvement in functional capacity and emotional well-being.
  
  
  CONCLUSIONS
  There is a growing body of knowledge on the benefits of PR but little is known about the physiologic and psychological benefits of other forms of exercise such as horseback riding. This case highlights the importance of individualizing care and identifies a novel area of research to be explored.
authors.affiliation: a Division of Pulmonary, Allergy, Critical Care and Sleep Medicine , The Ohio State University Wexner Medical Center , Columbus , OH , USA.
authors.forename: Cathy
authors.initials: C
authors.lastname: Benninger
authors.affiliation: a Division of Pulmonary, Allergy, Critical Care and Sleep Medicine , The Ohio State University Wexner Medical Center , Columbus , OH , USA.
authors.forename: John G
authors.initials: JG
authors.lastname: Mastronarde
mesh_terms: D001249:Asthma / Q000453:epidemiology / Q000503:physiopathology*; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000150:complications* / Q000453:epidemiology; D008168:Lung / Q000503:physiopathology; D008875:Middle Aged; D009788:Occupational Therapy / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000209:etiology* / Q000534:rehabilitation*; D011788:Quality of Life; D012129:Respiratory Function Tests; D012720:Severity of Illness Index
keywords: Asthma; H1N1; pulmonary rehabilitation; therapeutic horseback riding