Does exercise help copd

How to Manage Your COPD Like a Respiratory Therapist – Part 2

This is part 2 in our series: How to Manage Your COPD like a Respiratory Therapist. Here are the next steps to manage your COPD well:

Follow a Proper Diet Regimen

It’s vital to equip your body with a properly designed diet that will supplement your most important depleted nutrients. Then it’s up to you to follow through with it.

Indulge in the following nutrients:

  • Protein – Low fat proteins including lean-cut meats, poultry, eggs, and fish, specifically salmon, sardines, and mackerel, play an essential role in protecting your body. Protein produces antibodies that help your body fight off symptom worsening infections.
    • Whole grain foods – Not only are whole-grain bread, brown rice, bran, and oats rich in whole grains, they are loaded with fiber, which will enhance your digestive system function.
    • Fresh fruits and vegetables – Didn’t your mother ever tell you to eat your fruits and veggies? Well, nothing has changed. These natural powerhouses contain essential minerals, vitamins, and fiber that come together to keep your body healthy. Incorporate beets, corn, carrots, oranges, bananas, strawberries, raspberries, and blueberries, to name a few.
    • ​Potassium-rich foods – In order for your muscles to properly contract, especially for the heart muscle, potassium is vital. A few great sources of protein to include in your diet are yogurt, milk, tomatoes, bananas, grapefruit, oranges, avocados, squash, and dark leafy greens.
    • Magnesium – Combined with calcium the two work together to more effectively regulate lung function (producing an antihistamine like effect), muscle contractions, and even blood clotting. Magnesium is also involved in protein production, which is why it is referred to as the chemical fuel to making muscles function. The recommended daily intake of magnesium is 420 mg daily for men and 320 mg for women older than 31. The largest intake of fiber can be found in dark leafy greens. While other sources include whole grains, tofu, lentils, peas, nuts, dried fruit, yogurt, and bananas.
    • Potassium – This extremely important nutrient is a must for muscle contractions in the body, especially for your heart. Having either low or high levels of potassium can lead to very serious irregularities of heartbeat. Exceptional sources of potassium are milk, yogurt, oranges, prunes, carrots, dark leafy greens, fish, bananas, and avocados.
    • Calcium – In addition to working in congruence with magnesium to regulate lung function, muscle contractions, and blood clotting, calcium also plays a role in increasing the strength of your bones. Calcium is very important as COPD patients are also commonly diagnosed with osteoporosis. The major source of calcium is dairy products such as milk, cheese, and yogurt. You should also keep in mind that your body won’t necessarily absorb all of the calcium you take in. You can assist calcium absorption by taking regular vitamin D supplements.

Minimize your intake of the following:

  • Fried and greasy foods – Not only is fried food loaded with artery clogging fats and grease, but they can also lead to gas and indigestion.
  • Spicy foods – Spicy foods have been reported to affect breathing and cause discomfort.
  • Sodium – An excessive intake of salt/sodium can lead to something called “fluid retention,” when your body retains excess water, often impacting your ability to breathe. Instead, substitute the salt shaker with unsalted herbs and spices. Just check with your doctor to make sure these sodium substitutes don’t contain ingredients that are damaging to your health. Aim to eat food that has less than 300 mg of sodium per serving.
  • Dairy products – If you notice that consumption of dairy products such as cheese and milk cause phlegm to be thicker, you should try to limit dairy consumption. However, if dairy products do not worsen phlegm, you can continue to eat them.
  • Certain vegetables – There are some vegetables that you may notice cause excess bloating and gas, which worsen your ability to breathe. Though not all patients experience this, some do. Beans, cabbage, corn, onions, peas, and lentils are a few of the vegetables whose affects you should pay attention to. If you don’t experience gas or bloating after eating specific vegetables, you can continue to enjoy them.
  • Certain fruits – There are certain fruits that may cause bloating and gas, mainly apples, melons, and avocados. However if you do not experience gas or bloating, you can continue to eat these tasty fresh fruits.

Exercise Regularly

After completing pulmonary rehab it doesn’t mean you should stop exercising. In fact it’s quite the opposite. Exercise will improve your breathing, overall mood, weight management, and physical endurance which will reduce the occurrence of COPD related fatigue. Following your exercise plan after pulmonary rehab is vital for continuing the improvement and management of your COPD. While exercising remember everything you were taught in PR to manage your breathlessness. You should gradually work up to exercising for 20 to 30 minutes, at minimum three to four times per week.

Beneficial types of exercise:

  • Stretching – Before starting to exercise, you should take at least 5 to 10 minutes to stretch your muscles. Also stretch after your exercise has concluded.
  • Strengthening – These types of exercises are important, especially in the upper body, in people with COPD. Strengthening your upper body will strengthen your respiratory muscles.
  • Cardiovascular or aerobic – Exercises such as walking, jogging, or biking are phenomenal exercises that strengthen your heart and lungs, while improving your body’s ability to use oxygen effectively. With a consistent effort, aerobic exercises will also reduce your heart rate and blood pressure.

Tips to improve the effectiveness of exercise:

  • Gradually work up to your desired activity level
  • Choose an activity that you enjoy
  • Exercise at a steady pace
  • Use breathing techniques at the first sign of breathlessness
  • Keep records of your exercising
  • When exercising outside, dress appropriate for the weather

Harness the Power of Breathing Techniques


As you go through your day-to-day routine, if you suddenly experience an increase in breathlessness, there are a couple breathing techniques that you can perform that will help to reduce your shortness of breath to a manageable level. Breathing techniques include:

  • Pursed lip breathing
  • Diaphragmatic breathing

Receiving and Follow-through with Treatment

Though COPD cannot be cured, there are countless actionable treatment options that can be applied by your doctor to enhance your lifestyle, control symptoms, and reduce exacerbations. Treatment avenues that your doctor may prescribe are:

  • Bronchodilators
  • Inhaled (Corticosteroids) steroids
  • Oral (Corticosteroids) steroids
  • Combination inhalers
  • Theophylline
  • Antibiotics
  • Oxygen therapy (portable or home oxygen concentrator, oxygen tanks, liquid oxygen)
  • Pulmonary rehab
  • For more severe cases, lung transplant and lung volume reduction surgery

Medication Management

You should follow your medication schedule and take prescribed medications as directed. There are numerous ways that you can set yourself up for success to ensure you are taking your medications as intended. There are a few phone apps that you can install and input your medication schedule, and a reminder on your phone will go off when it is time for each medication. A less technical method is to use a pill organizer, which will help you separate your medications by day.

You should also be aware of any new medications being prescribed and speak to your doctor to make sure that they won’t conflict with any current medications or your COPD.

Conclusion

Now that you have knowledge on what it takes to manage your chronic obstructive pulmonary disease like a respiratory therapist, it’s up to you to take the initiative to follow through with treatment and take control of your disease. As you have seen, with proper disease management you can travel, visit the grandkids, shop, and so much more with greater effectiveness and ease.

About the Author: Eden Coleman is a dedicated content developer for COPDStore.com, where he pursues his passion of providing actionable and benefit-driven customer education tips for respiratory and obstructed sleep apnea (OSA) patients. Check out the latest actionable posts from the COPD Store.

COPD
(CHRONIC OBSTRUCTIVE PULMONARY DISEASE)

*This information is taken from the links at the bottom of this page and is provided to you as an educational service. It is not meant to be a substitute for consulting with your own physician.

What is COPD?

Chronic obstructive pulmonary disease (COPD) is an umbrella term used to describe airflow obstruction that is associated mainly with emphysema and chronic bronchitis.

Emphysema causes irreversible lung damage by weakening and breaking the air sacs within the lungs. As a result, elasticity of the lung tissue is lost, causing airways to collapse and obstruction of airflow to occur.

Chronic Bronchitis is an inflammatory disease that begins in the smaller airways within the lungs and gradually advances to larger airways. It increases mucus in the airways and increases bacterial infections in the bronchial tubes, which, in turn, impedes airflow.

How prevalent is COPD?

The exact prevalence of COPD is not well defined, yet it affects tens of millions of Americans and is a serious health problem in the U.S.:

In 1994, it was estimated that 16 million patients have been diagnosed with some form of COPD and as many as 16 million more are undiagnosed.

New government data based on a 1998 prevalence survey suggest that three million Americans have been diagnosed with emphysema and nine million are affected by chronic bronchitis.

COPD is the fourth leading cause of death in the U.S. in 1998.
COPD accounted for 112,584 deaths in 1998.
COPD accounted for an estimated 668,362 hospital discharges in 1998.

What are the risk factors for COPD?

Long-term smoking is the most frequent cause of COPD. It accounts for 80 to 90 percent of all cases. A smoker is 10 times more likely than a non-smoker to die of COPD.

Other risk factors include:

Heredity
Second-hand smoke
Exposure to air pollution at work and in the environment
A history of childhood respiratory infections

What are the symptoms of COPD?

The symptoms of COPD include: chronic cough, chest tightness, shortness of breath, an increased effort to breathe, increased mucus production, and frequent clearing of the throat.

How does COPD have an impact on a patient’s life?

COPD decreases the lungs’ ability to take in oxygen and remove carbon dioxide. As the disease progresses, the walls of the lungs’ small airways and alveoli lose their elasticity. The airway walls collapse, closing off some of the smaller air passages and narrowing larger ones. The passageways become clogged with mucus. Air continues to reach the alveoli when the lungs expand during inhalation; however, it is often unable to escape during exhalation because the air passages tend to collapse during exhalation, trapping the “stale” air in the lungs.
A typical course of COPD might begin after a person has been smoking for 10 years, during which symptoms are usually not very noticeable. Then the patient begins developing a productive, chronic cough. Usually, after age 40, the patient may begin developing shortness of breath during exertion, which continues and worsens over time.
Though the severity may vary, COPD patients have some degree of airway obstruction. While symptoms may vary over time, the patient will notice a gradual deterioration over the course of four to five years. Repeated and increased productive coughing begins to disable patients, who over time take longer to recover from these attacks.
Many patients with severe COPD-related lung damage have so much difficulty breathing when lying down that they sleep in a semi-sitting up position. For COPD patients, the combination of too little oxygen and too much carbon dioxide in the blood may also have an impact on the brain, and can cause a variety of other health problems, including headache, sleeplessness, impaired mental ability and irritability.5

The clinical development of COPD is typically described in three stages, as defined by the American Thoracic Society:

Stage 1: Lung function (as measured by FEV1 or forced expiratory volume in one second) is greater than or equal to 50 percent of predicted normal lung function. There is minimal impact on health-related quality of life. Symptoms may progress during this stage, and patients may begin to experience severe breathlessness, requiring evaluation by a pulmonologist.

Stage 2: FEV1 lung function is 35 to 49 percent of predicted normal lung function, and
there is a significant impact on health-related quality of life.

Stage 3: FEV1 lung function is less than 35 percent of predicted normal lung function, and there is a profound impact on health-related quality of life.

What can COPD patients do to help themselves live as normal a life as possible?

The best weapon against COPD is prevention: avoiding or ceasing smoking. Avoiding smoking almost always prevents COPD from developing, and ceasing smoking slows the disease process.

Pulmonary rehabilitation programs and medical treatment can be useful for certain patients with COPD. The key goal should be to improve physical endurance in order to overcome the conditions

that cause shortness of breath and limit capacity for physical exercise and daily activities.

What are the goals of COPD care?

It is important to identify and treat COPD at the earliest time possible in its natural history. Unfortunately, the diagnosis of COPD is frequently made when patients are in their late 50s or 60s, when FEV1 has declined to a symptomatic range, and when quality of life is rapidly deteriorating. Therefore, the goal of any physician treating patients with COPD is to help relieve their patients’ symptoms, to help patients better manage the effects of their disease and to live as full and active lives as possible.

If patients work closely with physicians to develop a complete respiratory care program, they can:

Improve lung function
Reduce hospitalizations
Prevent acute episodes
Minimize disability
Delay early death

What are the key components of COPD care?

In addition to smoking cessation, depending upon the severity of the disease, treatments may include bronchodilators that open up air passages in the lungs, antibiotics, and exercise to strengthen muscles. People with COPD may eventually require supplemental oxygen and, in the end-stages of the disease, may have to rely on mechanical respiratory assistance.

1. Medications that are prescribed for people with COPD may include:

Fast-acting beta2-agonists, such as albuterol which can help to open narrowed airways

Anticholinergic bronchodilators, such as ipratropium bromide, and
theophylline derivatives, all of which help to open narrowed airways.

Long-acting bronchodilators, which help relieve constriction of the airways and help to prevent bronchospasm associated with COPD.

Inhaled or oral corticosteroids, which help reduce inflammation. Currently, the role of these anti-inflammatory medications in COPD therapy is not well defined, and they are not yet indicated for COPD in the U.S. However, clinical trials are underway.

Antibiotics, which are often given at the first sign of a respiratory infection to prevent further damage and infection in diseased lungs.

Expectorants, which help loosen and expel mucus secretions from the airways, and may help make breathing easier.

In addition, other medications may be prescribed to manage conditions associated with COPD.

These may include:

Diuretics, which are given as therapy to avoid excess water retention associated with right-heart failure, which may occur in some COPD patients.

Digitalis (usually in the form of digoxin), which strengthens the force of the heartbeat. It is used with caution in COPD patients, especially if their blood oxygen tensions are low, since they become vulnerable to arrhythmia when taking this drug.

Painkillers, cough suppressants, and sleeping pills, which should be used only with caution, because they depress breathing to some extent.

2. People with COPD can better manage their disease by:

Avoiding:
Cigarettes, dust, air pollution, cigarette smoke, and work-related fumes
Contact with people who have respiratory infections, such as colds and flu
Excessive heat, cold or high altitudes

Maintaining:
A healthy diet and an exercise program supervised by a health care provider
Regular contact and visits with a health care provider so that he or she can carefully monitor the disease; this includes having regular spirometry tests

3. Additional treatment options for patients with COPD may include:

Regular immunizations, such as for flu and pneumococcal pneumonia
Pulmonary rehabilitation, which can improve exercise tolerance
The use of supplemental oxygen, especially in patients in the later stages of COPD
Bullectomy, or surgical removal of large air spaces in the lungs
Lung volume reduction surgery, which is currently considered experimental
Lung transplantation, which also has proven effective in some end-stage COPD patients

RECOGNIZING SIGNS AND SYMPTOMS
OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Recognizing changes in signs and symptoms of Chronic Obstructive Pulmonary Disease (COPD) is an important part of managing your illness. Knowing when symptoms are changing is helpful so that treatment and other interventions can begin promptly. Early treatment is most effective. If sever symptoms are present, it is vital to begin the appropriate treatment immediately. Accurate and timely assessment of your symptoms can help you and your health care provider decide if treatment should begin in the home, at your health care provider’s office or in the emergency room.

Early symptoms or warning signs are unique to each person. These warning signs may be the same, similar or entirely different with each episode. Usually you will be the best person to know if you are having difficulty breathing. However, some changes are more likely to be noticed by other persons, so it is important to share this information sheet with your family and those close to you.

A change or increase in the symptoms you usually experience may be the only early warning sign. You may notice one or more of the following:
-an increase or decrease in the amount of sputum produced
-an increase in the thickness or stickiness of sputum
-a change in sputum color to yellow or green or the presence of blood in the sputum
-an increase in the severity of shortness of breath, cough and/or wheezing
-a general feeling of ill health
-ankle swelling
-forgetfulness, confusion, slurring of speech and sleepiness
-difficulty sleeping
-using more pillows or sleeping in a chair instead of a bed to avoid shortness of breath
-an unexplained increase or decrease in weight
-increased feeling of fatigue and lack of energy that continues
-a lack of sexual drive
-increasing morning headaches, dizzy spells, restlessness

Symptoms do not go away when they are ignored. Therefore, knowing when to call your health care provider is very important in managing your chronic lung disease. It is very important for you to work with your health care provider to determine the appropriate treatment for signs and symptoms of COPD.

WHEN TO CALL THE DOCTOR

Call immediately if disorientation, confusion, slurring of speech or sleepiness occurs during an acute respiratory infection.

Call within 6-8 hours if shortness of breath or wheezing does not stop or decrease with inhaled bronchodilator treatments one hour apart.

Call within 24 hours if you notice one or more of the following severe respiratory symptoms:
– change in color, thickness, odor or amount of sputum persists
– ankle swelling lasts even after a night of sleeping with your feet up
– you awaken short of breath more than once a night
– fatigue lasts more than one day

Severe respiratory symptoms are a life-threatening emergency. Have an action plan for getting emergency care quickly in the event of severe symptoms. Inform family members and those who are close to you of this emergency action plan.

It is very important to work with your health care provider to determine the appropriate treatment steps for signs and symptoms of respiratory difficulty. These are guidelines and your specific treatment plan should be determined by you and your health care provider.

While there are many effective measures you can do at home to treat signs and symptoms, there are also actions that should be avoided. If you do any of the following, it can make your condition worse:
Do not take any extra doses of theophylline
Do not take codeine or any other cough suppressant
Do not use over-the-counter nasal sprays for more than 3 days
Do not increase the liter flow of prescribed oxygen
Do not smoke
Do not wait any longer than 24 hours to contact your doctor if symptoms continue

>
Eating right – Tips for the COPD patient

We learn early in life that food and air are basic to our survival. They are so basic, in fact, that to describe the importance of eating and breathing seems unnecessary–too simplistic for words.

For people with chronic obstructive pulmonary disease, eating should be treated as importantly as breathing and should not be taken for granted. A well-nourished body helps the COPD patient to fight infections, and it may help prevent illness and cut down on hospitalizations.

Food is fuel, and the body needs fuel for all of its activities, including breathing. Because the COPD patient expends much energy in the simple act of breathing, his ventilatory muscles can require up to ten times the calories required by a healthy person’s muscles. This is why it is so important for persons with COPD to eat properly. Good nutritional support helps maintain the ventilatory functions of the lungs, while improper nutrition can cause wasting of the diaphragm and other pulmonary muscles.

The American Association for Respiratory Care has gathered some nutrition tips for persons with COPD. These are general guidelines only; your physician is your best source of information on diet and other information about your lung disease.

1. Eat foods from each of the basic food groups: fruits and vegetables, dairy products, cereal and grains, proteins.

2. Limit your salt intake. Too much sodium can cause you to retain fluids that may interfere with breathing.

3. Limit your intake of caffeinated drinks. Caffeine may interfere with some of your medications and may also make you feel nervous.

4. Avoid foods that produce gas or make you feel bloated. The best process to use in eliminating foods from your diet is trial and error.

5. Try to eat your main meal early. This way, you will have lots of energy to carry you through the day.

6. Choose foods that are easy to prepare. Don’t waste all of your energy preparing a meal. Try to rest before eating so that you can enjoy your meal.

7. Avoid foods that supply little or no nutritional value.

8.Try eating six small meals a day instead of three large ones. This will keep you from filling up your stomach and causing shortness of breath.

9. If you are using oxygen, be sure to wear your cannula while eating – and after meals, too. Eating and digestion require energy, and this causes your body to use more oxygen.

10.Try to eat in a relaxed atmosphere, and make your meals attractive and enjoyable.

11. Consult your physician if you have other dietary restrictions, such as ulcers, or if you are overweight or underweight.

12. In many states, there are agencies that will provide meals for people for a small fee or at no charge. Check with local church organizations or government agencies to see what is available in your area.

A proper diet will not cure your disease, but it will make you feel better. You will have more energy, and your body will be able to fight infection better. These tips from the American Association for Respiratory Care are general guidelines. Your own physician is your best source of specific information. Good nutrition and a balanced diet are essential to everyone’s health, but patients with lung disease must be even more careful than most about following good nutrition guidelines.


View this diagram at: http://www.geocities.com/wrozenba/COPDlungs.html

COPD LINKS:

MEDLINE PLUS
http://www.nlm.nih.gov/medlineplus/copdchronicobstructivepulmonarydisease.html

COPD ALERT
http://www.geocities.com/wrozenba/COPD.html

American Lung Association® – Fact Sheet
http://www.lungusa.org/diseases/copd_factsheet.html

American Lung Association® – Around the Clock with COPD



PMC

  • McGavin CR, Gupta SP, Lloyd EL, McHardy GJ. Physical rehabilitation for the chronic bronchitic: results of a controlled trial of exercises in the home. Thorax. 1977 Jun;32(3):307–311.
  • Busch AJ, McClements JD. Effects of a supervised home exercise program on patients with severe chronic obstructive pulmonary disease. Phys Ther. 1988 Apr;68(4):469–474.
  • Ries AL, Moser KM. Comparison of isocapnic hyperventilation and walking exercise training at home in pulmonary rehabilitation. Chest. 1986 Aug;90(2):285–289.
  • Wijkstra PJ, Van Altena R, Kraan J, Otten V, Postma DS, Koëter GH. Quality of life in patients with chronic obstructive pulmonary disease improves after rehabilitation at home. Eur Respir J. 1994 Feb;7(2):269–273.
  • Reardon J, Awad E, Normandin E, Vale F, Clark B, ZuWallack RL. The effect of comprehensive outpatient pulmonary rehabilitation on dyspnea. Chest. 1994 Apr;105(4):1046–1052.
  • Casciari RJ, Fairshter RD, Harrison A, Morrison JT, Blackburn C, Wilson AF. Effects of breathing retraining in patients with chronic obstructive pulmonary disease. Chest. 1981 Apr;79(4):393–398.
  • Ries AL, Ellis B, Hawkins RW. Upper extremity exercise training in chronic obstructive pulmonary disease. Chest. 1988 Apr;93(4):688–692.
  • Casaburi R, Patessio A, Ioli F, Zanaboni S, Donner CF, Wasserman K. Reductions in exercise lactic acidosis and ventilation as a result of exercise training in patients with obstructive lung disease. Am Rev Respir Dis. 1991 Jan;143(1):9–18.
  • Casaburi R, Wasserman K. Exercise training in pulmonary rehabilitation. N Engl J Med. 1986 Jun 5;314(23):1509–1511.
  • Dekhuijzen PN, Folgering HT, van Herwaarden CL. Target-flow inspiratory muscle training during pulmonary rehabilitation in patients with COPD. Chest. 1991 Jan;99(1):128–133.
  • Wijkstra PJ, Ten Vergert EM, van Altena R, Otten V, Kraan J, Postma DS, Koëter GH. Long term benefits of rehabilitation at home on quality of life and exercise tolerance in patients with chronic obstructive pulmonary disease. Thorax. 1995 Aug;50(8):824–828.
  • Haggerty MC, Stockdale-Woolley R, Nair S. Respi-Care. An innovative home care program for the patient with chronic obstructive pulmonary disease. Chest. 1991 Sep;100(3):607–612.
  • Bergner M, Hudson LD, Conrad DA, Patmont CM, McDonald GJ, Perrin EB, Gilson BS. The cost and efficacy of home care for patients with chronic lung disease. Med Care. 1988 Jun;26(6):566–579.

Pulmonary rehabilitation or PR

Pulmonary rehabilitation is a programme of exercise and education for people with a long-term lung condition

On this page:

  • What is PR?
  • How will PR help me?
  • Who should go to PR?
  • How do I get PR?
  • What happens on a PR course?

‘Pulmonary rehabilitation is the most beneficial treatment I have received… not only for the exercise provided but more importantly for the education given’ Colin

What is PR?

Pulmonary rehabilitation (PR) is made up of:

  • a physical exercise programme, designed for people with lung conditions and tailored for you
  • information on looking after your body and your lungs, and advice on managing your condition and your symptoms, including feeling short of breath

It’s designed for people who are severely breathless. Your PR team will be made up of trained health care professionals such as physiotherapists, nurses and occupational therapists.

You’ll be in a group of about 8-16 people. A course usually lasts six to eight weeks, with two sessions of about two hours each week. PR courses are held in local hospitals, community halls, leisure centres and health centres.

Completing a course of PR is a good way to learn how to exercise safely and at the right level for you. Most people enjoy the course. It builds confidence and it’s great fun meeting others in a similar situation.

How will PR help me?

‘When I started the course, I could barely walk 500 metres before becoming too breathless to continue. By the end of six weeks, I could walk 1500 metres. It’s not about getting better – it’s about living better with my condition’ John

PR can:

  • improve your muscle strength so you can use the oxygen you breathe more efficiently
  • help you cope better with feeling out of breath
  • improve your fitness so you feel more confident to do things
  • help you feel better mentally

PR helps you manage your condition and makes you feel better, but it’s not a cure. You’re unlikely to see a change in your lung function, so you may not see a difference in breathing test results. What it can do is help you make the most of the lung function that you have. There’s evidence that it improves your ability to walk further, helps you feel less tired and breathless doing day-to-day activities and reduces your risk of ending up in hospital.

Pulmonary rehabilitation classes changed my life – Heidi’s story of living with COPD

‘Thank you for giving me my life back’ Val

Who should go to PR?

PR is aimed at people with a lung condition whose ability to be active is affected by breathing difficulties.

Most people who go to PR have chronic obstructive pulmonary disease (COPD), but people with other long-term lung conditions can also benefit, such as bronchiectasis and pulmonary fibrosis. It’s recommended for people coming out of hospital after a COPD flare-up.

If you struggle with walking, have uncontrolled heart problems or have recently had a heart attack, PR might not be suitable for you at the moment.

You can do PR if you use oxygen

People who use oxygen to help manage their condition will be assessed to see if a portable oxygen cylinder is needed during the class. If you’ve been prescribed oxygen and told that your oxygen levels drop when you exercise, portable oxygen treatment may increase how much exercise you can do.

How do I get PR?

Your GP, practice nurse or respiratory team can refer you for PR. Ask them if PR is right for you and what’s available in your area.

Some programmes will have waiting lists, so the sooner you act, the sooner you can start. If you’re told you’re not eligible for PR, you could try other ways of being active.

“Once I started, it just got easier and easier!”

Bob was diagnosed with COPD in his 60s.

“When I first started feeling chesty, I was diagnosed with asthma. Whenever I felt worse I’d use my inhaler and my symptoms would steady off. But some years later I started to get really breathless and was re-diagnosed with COPD.

Within months my breathlessness forced me into early retirement. But then I wasn’t getting any exercise and the breathlessness started to show even more. I couldn’t take care of my allotment any more. That helped me make up my mind to do something about it.

That’s when I discovered pulmonary rehabilitation. I felt so much better straight away! I realised how easy it was to get back into shape. And once I started, it just got easier and easier!

I go to the gym three times a week now, and spend ten minutes on a bike, on a rowing machine and on a stepper. In between, I lift weights.

Starting PR isn’t easy – the initial push is really hard. But I’m so glad I took the plunge.”

What happens on a PR course?

A typical PR course will always start with an assessment of your health and abilities. Your PR team will ask questions to understand you and your body, so they can help you get the best out of the course.

Physical exercise

At each session, you’ll spend about half the time on physical exercise. This will be designed to provide the right level of activity for you. You’ll get out of breath, but this is part of the therapy. You’ll always be monitored and won’t be asked to do more than you can do safely.

Information and discussion

For the rest of the time, you’ll learn about topics such as:

  • why exercise is so important for people with lung conditions
  • how to use breathing techniques during physical activity or when you feel anxious
  • how to manage anxiety and low mood
  • how to use your inhalers and other medicines
  • how to eat healthily
  • what to do when you’re unwell

‘I am loving this group. We do as much exercise as we can for the first hour, then a cuppa and a talk. Brilliant. It has helped so much to lift my spirits.’ Jude

For PR to really work you need to be committed, attend sessions regularly and follow the advice given by your team.

After you’ve completed your course, it’s important to continue being active by using the techniques you’ve learned. Your PR team might refer you to a follow-up exercise programme – ask them if this is an option. Or try one of the other ways we’ve suggested to keep active.

Next: How to stay motivated >

Physical Activity and COPD

  • Physical therapist
  • Exercise physiologist
  • Personal trainer

There are many places to exercise. For example:

  • In your home (make sure the space is safe)
  • Around your neighborhood
  • Local fitness center
  • Local shopping mall (especially in the morning, prior to opening)
  • YMCA
  • Community center
  • Wellness center
  • Yoga or Pilates studio

Talk to the staff at your fitness facility about your COPD before you start exercising.

Ways to Stay Active

  • Try to get up and out each day, even just to walk to another room, take a shower or get the mail. Every little bit helps.
  • Light stretching is a great way to stay mobile and avoid over exertion.
  • Participate in activities you enjoyed before you were diagnosed. You may need to modify them, but they can still be enjoyed.
  • Set achievable goals for yourself such as taking a short walk every day.
  • Check out exercise programs on your television, online or cellphone apps.
  • Participate in a pulmonary rehabilitation program.

Do you have questions and concerns about managing exertion during sexual activity? Here are some suggestions “

Exercising with COPD

Why do COPD patients need to exercise?1,2

Exercising regularly is one of the best ways that patients with chronic obstructive pulmonary disease (COPD) can help manage the disease. For this reason, planning and following an exercise routine is a key part of a pulmonary rehabilitation program.

Because people with COPD often feel short of breath and tired, they can tend to avoid being active and exercising. Because they are not active, their level of physical fitness can worsen. This can lead to patients becoming even more tired and out of shape, which can make exercise and activity even more difficult. This cycle is called “de-conditioning,” and it is a common problem for COPD patients.

What are the benefits of exercising for COPD patients?1,2,3

It is very important to break the de-conditioning cycle by starting and sticking to an exercise plan. There are many benefits of regular exercise:

  • Stronger muscles
  • Higher energy levels and stamina
  • Lower blood pressure
  • Improved blood circulation and blood-oxygen levels
  • Increased heart and lung strength
  • Increased appetite
  • Healthier body weight
  • Improved balance and flexibility
  • Improved COPD symptoms, such as breathlessness
  • Better quality of life
  • Better sleep quality
  • Reduced stress, anxiety, and depression

What kinds of exercises are good for COPD patients?2,3,4

Regular stretching is a good way to improve muscle strength and flexibility. It is also helpful to stretch before and after exercising to help prevent injuries.

Aerobic exercises involve a steady level of activity over a longer period of time. Aerobic exercises that can benefit COPD patients may be:

  • Walking
  • Stationary biking
  • Stair climbing
  • Swimming
  • Water aerobics

Strengthening exercises are used to make muscles stronger. During these kinds of exercises, a person tightens groups of muscles repeatedly until they get tired. Making the muscles that are involved in the breathing process get stronger can help COPD patients to breathe easier.

What are some tips for starting an exercise routine?2,3,4

  • Start slowly and gradually increase the time you spend exercising each session
  • Exercise at least 3-4 times a week, for 20-40 minutes at a time
  • Remember to warm up and cool down before and after each exercise session
  • Find an exercise partner and do fun exercise activities
  • Keep track of your exercise sessions and measure your progress
  • Drink the amount of fluids advised by your healthcare provider
  • Don’t exercise within 90 minutes after eating
  • Listen to your body, and rest or take breaks when needed
  • Avoid hot or cold showers right after exercising
  • Wear the right type of clothing and shoes
  • Set realistic exercising goals for yourself

What precautions do COPD patients need to take while exercising?3,4

COPD patients should design an exercise routine with help from their healthcare providers or their pulmonary rehabilitation program. The routine needs to be matched to the patient’s personal level of fitness and condition.

Patients should seek advice from healthcare professionals about which kinds of exercises they should avoid, such as:

  • Heavy lifting, shoveling, mowing, or raking
  • Pushups or sit-ups
  • Exercising outdoors during very hot, cold, or humid weather
  • Walking up steep hills

Even if patients feel short of breath while exercising, it is important to remember that they are not doing damage to their lungs. Using strategies such as pursed-lip breathing can help reduce the feeling of breathlessness while exercising.

However, COPD patients should stop exercising right away and contact a healthcare provider if exercising causes serious symptoms, such as:

  • Nausea
  • Feeling dizzy or weak
  • Having a rapid or irregular heartbeat
  • Severe breathlessness
  • Feeling of pressure or pain in the chest, arm, neck, jaw or shoulder

COPD: Exercise & Activity Guidelines

Pulmonary rehabilitation

Pulmonary rehabilitation is a program that can help you learn how to breathe easier and improve your quality of life. It includes breathing retraining, exercise training, education, and counseling.

Why should I exercise?

Regular exercise has many benefits. Exercise, especially aerobic exercise, can:

  • Improve your circulation and help the body better use oxygen
  • Improve your COPD symptoms
  • Build energy levels so you can do more activities without becoming tired or short of breath
  • Strengthen your heart and cardiovascular system
  • Increase endurance
  • Lower blood pressure
  • Improve muscle tone and strength; improve balance and joint flexibility
  • Strengthen bones
  • Help reduce body fat and help you reach a healthy weight
  • Help reduce stress, tension, anxiety, and depression
  • Boost self-image and self-esteem; make you look fit and feel healthy
  • Improve sleep
  • Make you feel more relaxed and rested

Talk to your healthcare provider first

Always check with your healthcare provider before starting an exercise program. Your healthcare provider can help you find a program that matches your level of fitness and physical condition.

Here are some questions to ask:

  • How much exercise can I do each day?
  • How often can I exercise each week?
  • What type of exercise should I do?
  • What type of activities should I avoid?
  • Should I take my medicine at a certain time around my exercise schedule?

What type of exercise is best?

Exercise can be divided into 3 basic types:

  1. Stretching: Slow lengthening of the muscles. Stretching the arms and legs before and after exercising helps prepare the muscles for activity and helps prevent injury and muscle strain. Regular stretching also increases your range of motion and flexibility.
  2. Cardiovascular or aerobic: Steady physical activity using large muscle groups. This type of exercise strengthens the heart and lungs, and improves the body’s ability to use oxygen. Over time, aerobic exercise can help decrease your heart rate and blood pressure, and improve your breathing (since your heart won’t have to work as hard during exercise). Aerobic exercises include: walking, jogging, jumping rope, bicycling (stationary or outdoor), cross-country skiing, skating, rowing, and low-impact aerobics or water aerobics.
  3. Strengthening: Repeated muscle contractions (tightening) until the muscle becomes tired. Strengthening exercises for the upper body are especially helpful for people with COPD, as they help increase the strength of your respiratory muscles.

How often should I exercise?

The frequency of an exercise program is how often you exercise. In general, to achieve maximum benefits, you should gradually work up to an exercise session lasting 20 to 30 minutes, at least 3 to 4 times a week. Exercising every other day will help you keep a regular exercise schedule.

What should I include in my program?

Every exercise session should include a warm-up, conditioning phase, and a cool down. The warm-up helps your body adjust slowly from rest to exercise. A warm-up reduces the stress on your heart and muscles, slowly increases your breathing, circulation (heart rate), and body temperature. It also helps improve flexibility and reduce muscle soreness.

The best warm-up includes stretching, range of motion activities, and beginning of the activity at a low intensity level.

The conditioning phase follows the warm-up. During this phase, the benefits of exercise are gained and calories are burned. During the conditioning phase, you should monitor the intensity of the activity. The intensity is how hard you are exercising, which can be measured by checking your heart rate. Your healthcare provider can give you more information on monitoring your heart rate.

Over time, you can work on increasing the duration of the activity. The duration is how long you exercise during one session.

The cool-down phase is the last phase of your exercise session. It allows your body to gradually recover from the conditioning phase. Your heart rate and blood pressure will return to near resting values. Cool-down does not mean to sit down. In fact, do not sit, stand still, or lie down right after exercise. This might cause you to feel dizzy, lightheaded, or have heart palpitations (fluttering in your chest).

The best cool-down is to slowly decrease the intensity of your activity. You might also do some of the same stretching activities you did in the warm-up phase.

Rated Perceived Exertion (RPE) Scale

The RPE scale is used to measure the intensity of your exercise. The RPE scale runs from 0-10. The numbers below relate to phrases used to rate how easy or difficult you find an activity. For example, 0 (nothing at all) would be how you feel when sitting in a chair; 10 (very, very heavy) is how you feel at the end of an exercise stress test or after a very difficult activity.

0 – Nothing at all

0.5 – Just noticeable

1 – Very light

2 – Light

3 – Moderate

4 – Somewhat heavy

5 – Heavy

7 – Very heavy

10 -Very, very heavy

In most cases, you should exercise at a level that feels 3 (moderate) to 4 (somewhat heavy). When using this rating scale, remember to include feelings of shortness of breath, as well as how tired you feel in your legs and overall.

General exercise guidelines

  • Gradually increase your activity level, especially if you have not been exercising regularly.
  • Remember to have fun. Choose an activity you enjoy. Exercising should be fun and not a chore. You’ll be more likely to stick with an exercise program if you enjoy the activity. Here are some questions you can think about before choosing a routine:
    • What physical activities do I enjoy?
    • Do I prefer group or individual activities?
    • What programs best fit my schedule?
    • Do I have physical conditions that limit my choice of exercise?
    • What goals do I have in mind? (losing weight, strengthening muscles, or improving flexibility, for example)
  • Wait at least 1½ hours after eating a meal before exercising.
  • When drinking liquids during exercise, remember to follow your fluid restriction guidelines.
  • Dress for the weather conditions and wear protective footwear.
  • Take time to include a five-minute warm-up, including stretching exercises, before any aerobic activity and include a five- to 10-minute cool down after the activity. Stretching can be done while standing or sitting.
  • Schedule exercise into your daily routine. Plan to exercise at the same time every day (such as in the mornings when you have more energy). Add a variety of exercises so you do not get bored.
  • Exercise at a steady pace. Keep a pace that allows you to still talk during the activity.
  • Exercise does not have to put a strain on your wallet. Avoid buying expensive equipment or health club memberships unless you are certain you will use them regularly.
  • Stick with it. If you exercise regularly, it will soon become part of your lifestyle. Make exercise a lifetime commitment. Finding an exercise “buddy” will also help you stay motivated.
  • Keep an exercise record.

Breathing during activity

Always breathe slowly to save your breath. Inhale through your nose, keeping your mouth closed. This warms and moisturizes the air you breathe and at the same time filters it. Exhale through pursed lips.

  • Breathe out slowly and gently through pursed lips. This permits more complete lung action when the oxygen you inhale is exchanged for the carbon dioxide you exhale.
  • Try to inhale for two seconds and exhale for four seconds. You might find slightly shorter or longer periods are more natural for you. If so, just try to breathe out twice as long as you breathe in.
  • Exercise will not harm your lungs. When you experience shortness of breath during an activity, this is an indication that your body needs more oxygen. If you slow your rate of breathing and concentrate on exhaling through pursed lips, you will restore oxygen to your system more rapidly.

Walking guidelines

  • Start with a short walk. See how far you can go before you become breathless. Stop and rest whenever you are short of breath.
  • Count the number of steps you take while you inhale. Then exhale for twice as many steps. For example, if you inhale while taking two steps, exhale through pursed lips while taking the next four steps. Learn to walk so breathing in and exhaling out will become a habit once you find a comfortable breathing rate.
  • Try to increase your walking distance. If you can set specific goals, you’ll find you can go farther every day. Many people have found that an increase of 10 feet a day is a good goal.
  • Set reasonable goals. Don’t walk so far that you can’t get back to your starting point without difficulty breathing. Remember, if you are short of breath after limited walking, stop and rest.
  • Never overdo it. Always stop and rest for two or three minutes when you start to become short of breath.

Stair climbing

  • Hold the handrail lightly to keep your balance and to help yourself climb.
  • Take your time.
  • Step up while exhaling or breathing out with pursed lips. Place your whole foot flat on each step. Go up two steps with each exhalation.
  • Inhale or breathe in while taking a rest before the next step.
  • Going downstairs is much easier. Hold the handrail and place each foot flat on the step. Count the number of steps you take while inhaling, and take twice as many steps while exhaling.

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5 Things You Should Know About Exercise if You Have COPD

2. Pulmonary Rehabilitation Is a Great Starting Point

“It’s hard for anyone to embark on an exercise program unless they have some success and some confidence building,” says Ouellette. “What I recommend for most of my patients who have significant COPD is to enroll in a pulmonary rehabilitation program.”

Pulmonary rehabilitation combines exercise training, education, and support. While it cannot cure lung disease, it can decrease symptoms and improve your quality of life.

“These are structured programs that have testing at the beginning to make sure that exercise is safe,” Ouellette says. “Pulmonary rehabilitation offers supervised exercise in a controlled setting. People can gradually increase the number of things that they do and improve their exercise tolerance.”

Your doctor can refer you to a qualified pulmonary rehab program. When choosing a program, remember that the cost can vary greatly. Find out what your insurance will cover, and if you have to meet certain requirements.

3. Take a Walk

“The best exercise for most of our patients is simply walking,” says Ouellette. “After people compete the basic pulmonary rehab program, I encourage them to try to translate the exercise skills they’ve learned to their everyday activities. Taking a daily walk is a way you can do that.”

According to research published in October 2016 in the Journal of the COPD Foundation, patients who walked at least 60 minutes per day reduced their COPD rehospitalization rate by 50 percent.

“In some geographic areas, it’s very hot in the summer or very cold in the winter; and it can be difficult to exercise outside,” Ouellette says. Think of places where you can walk regardless of the weather, such as a shopping mall or fitness center with an indoor track.

Besides walking, Ouellette also recommends bicycle riding and dancing.

4. What’s Good for the Body Is Good for the Mind

Roberto Benzo, MD, a pulmonologist at the Mayo Clinic in Minnesota, points out that exercise has emotional as well as physical benefits. “People learn not only to move more, but they also deal with their emotions as they move,” he says.

Living with COPD can pose emotional challenges, and “exercise is a very good antidepressant,” Dr. Benzo adds. “Consistency is important. Treat this time as a moment for you.”

5. Resistance Training Is Important, Too

While aerobic exercise is especially good for the heart and lungs, resistance or strength training helps make muscles stronger.

Resistance training improves muscular fitness by exercising a specific muscle or muscle groups against external resistance, such as weights or resistance bands.

“COPD patients often have a loss of muscle mass or muscle strength,” Ouellette says. “If you add conditioning programs that include strength training, particularly upper body strength, you will have additional benefits.”

Exercise Prescription Table

Summary of Exercise Prescription

This table provides details for the initial prescription for a patient with COPD.

See relevant sections in the toolkit for examples of the exercises (i.e. mode) and details for exercise progression

Mode

Intensity

Protocol

Duration

Frequency

Lower limb

1) endurance training

Ground walking

Treadmill walking

Stationary Cycle

or a combination of the above with a total duration of 30 minutes

2) strength training

Walking training

Ground-based

80% average speed on 6MWT

75% peak speed on ISWT

Dyspnoea rating of 3 (moderate)

Continuous or interval

30 minutes

4 or 5 times a week that includes 2 or 3 supervised sessions and home exercise training

Walking training

Treadmill

As for ground-based walking training but reduce speed by 0.5 to 1 kph until familiar with treadmill

Continuous or interval

30 minutes

4 or 5 days a week that includes 2 or 3 supervised sessions and home exercise training

Stationary cycle training (if possible)

Dyspnoea rating of 3 (moderate)

Continuous or interval

30 minutes

4 or 5 days a week that includes 2 or 3 supervised sessions and home exercise training

See relevant section for examples of strength exercises

10 RM (repetition maximum)

10 repetitions (1 set)

2 or 3 times a week with at least 1 day rest between sessions

Upper limb

1) endurance training

See relevant section for examples of exercises

Determine the weight that the patient can only lift 15 times

Dyspnoea rating of 2 or 3 (slight or moderate)

15 repetitions (1 set)

4 or 5 times a week that includes 2 or 3 supervised sessions and home exercise training

2) strength training

See relevant section for examples of exercises

10 RM (repetition maximum)

10 repetitions (1 set)

2 or 3 times a week with at least 1 day rest between sessions

See text below for exercise considerations specific to other chronic lung disease.

Bronchiectasis

Bronchiectasis is the term used for the permanent abnormal dilatation of one or more bronchi. The main causes of permanent abnormal dilatation are damage to the airways due to severe lower respiratory tract infections such as pneumonia, whooping cough, measles (usually in childhood), gastric aspiration, primary ciliary dyskinesia. Bronchiectasis may also a secondary manifestation of COPD, sarciodosis and bronchiolitis obliterans. However, often the underlying cause of bronchiectasis is not identified.

Bronchiectasis is characterised by repeated episodes of acute bronchial infection with increased cough and mucus production.

Pulmonary rehabilitation has been shown to be effective in improving exercise capacity and health-related quality of life of people with bronchiectasis.1 However, all trials of PR for bronchiectasis have included airway clearance techniques, which may not be a standard component of all PR programs. Therefore, those PR programs that include people with bronchiectasis should ensure that there are staff (physiotherapists) skilled in airway clearance techniques.

Interstitial lung diseases

Interstitial lung diseases (ILDs) are a group of over 200 conditions which are characterised by varying degrees of interstitial inflammation and fibrosis. People with ILD experience distressing breathlessness on exertion and fatigue, reduced health-related quality of life, and anxiety and depression.

Pulmonary rehabilitation has been shown to be effective in improving exercise capacity and health-related quality of life and reducing breathlessness of people with ILD.1 However, since many patients with ILD experience significant exercise-induced desaturation, programs that provide PR for people with ILD should ensure that supplemental oxygen is available during training if necessary.

Pulmonary Hypertension

Pulmonary hypertension (PH) is defined as an increase in the resting mean pulmonary arterial pressure to at least 25 mm Hg on right heart catheterization. People with PH usually experience breathlessness on exertion and may have other symptoms such as fatigue, dizziness, chest discomfort, chest pain, palpitations, cough, pre-syncope, syncope, lower limb oedema and abdominal distension.

Pulmonary rehabilitation has been shown to be effective in improving exercise capacity and health-related quality of life of people with PH.1 However, people with PH should be stable on pharmacotherapy prior to undertaking an exercise training programme and PR programs should be delivered in centres experienced in managing people with PH.

Exercise training and pulmonary rehabilitation: new insights and remaining challenges

THE INTERVENTION OFFERED

Pulmonary rehabilitation programmes are multidisciplinary programmes that are built around an exercise training intervention. The aim of the exercise training is to reverse the systemic consequences of COPD, in particular the skeletal muscle dysfunction. Furthermore, exercise training enhances the mechanical efficiency of physical activities (particularly walking) and may also reduce the sensitivity to dyspnoea. In order to reverse the skeletal muscle abnormalities, exercise training needs to be of high intensity in order to result in an anabolic stimulus. When exercise training is offered at a high intensity it improves the oxidative capacity of the skeletal muscle. This leads to enhanced exercise capacity and, through its reduction of ventilation at submaximal work loads, also reduces the symptom burden in patients. Effective exercise training enhances anabolic processes in the muscle . The interventions and the principles through which they lead to enhanced exercise capacity are demonstrated in figure 1⇓.

FIGURE 1.

Mechanism through which pulmonary rehabilitation and pharmacotherapy may enhance physical activity. V′E: minute ventilation; V′O2: maximal oxygen uptake.

To be effective, a training stimulus needs to be applied three times per week for a minimum of 8 weeks. The training intensity in healthy subjects is set at 55–85% of the heart rate reserve . In patients with COPD, however, the exercise limitation is often the ventilatory system, which makes it complex with whole body endurance training to impose sufficient training load to the skeletal muscle. In the last few years, strategies have been developed to enhance the local load on the skeletal muscle in severely ventilatory limited patients. One strategy is that peak ventilatory capacity can be maximised using optimal bronchodilator therapy. Thus, optimal bronchodilator therapy allows enhanced training intensity and yields superior results than training performed without optimal bronchodilator therapy . Another way to enhance the maximum breathing capacity of patients is the administration of gas mixtures with a density below ambient air; helium is such a gas. Breathing a gas mixture where N2 is replaced by helium acutely enhances exercise tolerance. It unloads the respiratory system allowing a higher peripheral oxygen delivery. Heliox reduces the metabolic cost of exercise and renders the peripheral muscle less fatiguable . Recently, a study showed superior effects of helium breathing during exercise training. In this study , a mixture of helium and an increased oxygen fraction was used, which makes it difficult to dissect the effects of helium and the effect of the oxygen supplements. Besides being impractical, the cost of these mixtures is currently substantial and may render their application expensive. Unloading the respiratory muscles, thus yielding a larger oxygen delivery to peripheral muscles, can also be achieved using noninvasive mechanical ventilation (NIMV). Although this has been performed successfully in severe COPD patients to aid the exercise regiment during pulmonary rehabilitation , the application of NIMV during rehabilitation remains difficult and time consuming. Nevertheless, in very severe patients (e.g. those on a waiting list for lung transplantation) NIMV application may render a difficult-to-train patient trainable. In patients with respiratory failure, the combination of night-time noninvasive ventilation and daytime pulmonary rehabilitation may be more efficient .

The former interventions aim at supporting the impeded ventilatory system in patients with COPD. Another strategy may be to limit the ventilatory requirements during exercise. This may also give more comfort during exercise training to the ventilatory limited patient or, alternatively, allow for a higher training intensity. The first approach is to offer oxygen supplements to patients. This reduces the ventilatory drive and, thus, pulmonary ventilation for a given work load at the expense of hypercapnia. Due to the enhanced oxygen delivery it also delays lactic acidosis, which further contributes to reduced ventilator needs. Emtner et al. showed that it was possible to train patients at a higher training intensity when oxygen supplements were given. As a result they showed larger improvements in whole body endurance in the patients who trained with oxygen supplements . A second approach may be to reduce the muscle bulk used during the training; this obviously reduces the metabolic demand of exercise. If training load is focused on a smaller group of muscles these can be loaded more without utilising the full ventilator capacity. Dolmage et al. used this paradigm in a study comparing single leg cycling exercise training to conventional cycling training and showed superior effects when each leg was trained separately. A final approach to reduce the ventilator needs during exercise is to use interval training rather than endurance training. During interval training small bursts of training are offered to patients. Due to the short exercise duration and the slow kinetics of pulmonary ventilation, the ventilation does not rise to high levels, even when the imposed work load is high. Interval training has comparable effects to endurance training and leads to skeletal muscle hypertrophy . Importantly patients reported fewer symptoms during this training regimen and less unexpected stops were observed.

The final strategy of interventions is specifically aimed at enhancing skeletal muscle force. Specific resistance training can be applied to enhance peripheral muscle function and, although some cross-over effect towards enhanced whole body exercise tolerance may be expected, the effect is particularly seen in the enhanced peripheral muscle strength and endurance. These are clearly important features to daily life activities. Specific resistance training has been applied in several studies and summarised in several excellent review papers . Resistance training (or weight lifting) significantly enhances skeletal muscle strength when applied alone or in combination with whole body exercise training . Therefore, it is a powerful rehabilitation tool to enhance the skeletal muscle “machinery”. More recently, several authors have used “nonphysiological” neuromuscular electrical stimulation to enhance peripheral muscle function . Electrical stimulation has also been shown to be effective in enhancing skeletal muscle function. However, as the stimulations are not physiologically evoked and are not embedded in neuromuscular coupling pathways, we would advise restricting the use of neuromuscular electrical stimulation to situations where prevention of the loss of skeletal muscle function is required, or in programmes where neuromuscular electrical stimulation is combined with conventional pulmonary rehabilitation. The effects of neuromuscular electrical stimulation and resistance training may be amplified by the addition of pharmacotherapy directed to improve skeletal muscle function. Testosterone supplements in addition to resistance training have been proven in hypogonadal males to restore skeletal muscle strength more rapidly compared with resistance training alone . Other targets for skeletal muscle directed pharmacotherapy are being identified but, to date, its clinical application has not been validated . Such therapy can target scavenging processes of oxidative stress in susceptible patients , anabolic signalling and substrates or key proteins of the muscle machinery. Patient selection for supplemental interventions will be crucial to show their effectiveness.

All the above interventions focus on fine-tuning the exercise training intervention. Pulmonary rehabilitation, however, consists of more than just exercise training. Surprisingly, little research has been presented in recent years on the specific effects of introducing other disciplines involved in pulmonary rehabilitation. In particular, there is little knowledge on how to transfer the gains in exercise capacity into enhanced participation in daily life activities. Several studies have assessed the effects of rehabilitation programmes on physical activity. The improvement of physical activity levels is not guaranteed after pulmonary rehabilitation, as is indicated in table 1⇓ and figure 2⇓. Importantly, it is unknown how much improvement in physical activity is a clinically relevant improvement. Any increase in the proportion of patients meeting the required amount of physical activity for healthy ageing would be a significant benefit for both patients and society. Whether pulmonary rehabilitation enhances the proportion of patients meeting these goals (30 min of physical activity at moderate intensity on at least 5 days·week−1) has not yet been investigated. Indeed, surprisingly little research has focused on ways to facilitate the transfer of benefits to physical activity. A study from the Netherlands suggested that the use of simple pedometer devices may provide patients with real-time feedback on their physical activity levels . When appropriate guidance is given this may enhance physical activity levels, much like in healthy subjects . Whether other behavioural interventions may help to achieve a long-term change towards a more physically active lifestyle remains to be investigated in COPD.

FIGURE 2.

Improvement of physical activity. ▪: studies that were statistically significant; ▓: studies that were statistically nonsignificant. S: standard; I: individualised; C: classic; CP: classic+pedometer feedback; 3M: 3 months; 6M: 6 months.

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Table. 1—

Changes in physical activity after pulmonary rehabilitation

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