One of the “chicken versus egg” topics in the diagnosis and treatment of lung disease is whether physical inactivity contributes to the development of conditions such as COPD or whether these lung conditions instead lead to a decrease in physical activity.
Regardless of which comes first, most researchers agree that increasing physical activity in COPD patients is highly desirable and beneficial. Indeed, in one 2006 study, the researchers’ data suggested that COPD patients who were at least moderately physically active lived approximately 7 years longer than those who were highly inactive. (Garcia-Aymerich J, et al. Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study. Thorax. 2006: 61:772-778)
By the way, the same researchers reported in a different paper that active smokers who were more physically active exhibited better lung function and less incidence of COPD. To that end, the researchers noted, “It is plausible that regular physical activity could counteract the smoking effects through an anti-inflammatory and antioxidant mechanism.” (Garcia-Aymerich J, et al. Regular physical activity modifies smoking-related lung function decline and reduces risk of chronic obstructive pulmonary disease: a population based cohort study. Am J Respir Crit Care Med. 2007: 175: 458-463)
So even if you don’t have COPD yet, but you do smoke, regular physical activity can be a powerful form of medicine.
Another more recent study demonstrated that COPD patients’ level of physical activity was notably lower than healthy adults of the same relative age, weight and height. Further, the study concluded that physical activity levels of COPD patients declined in direct correlation with the severity of COPD (there are four levels of severity in COPD: Stage I – mild, Stage II – moderate, Stage III – severe, Stage IV – very severe). For example, study subjects with mild COPD engaged in 53% less moderate physical activity time as the study control subjects (healthy adults), whereas severe COPD patients devoted only 31% of the time healthy adults invested in moderate physical activity – which means the severe COPD patients were 41% less active than even mild COPD patients. (Troosters T, et al. Physical activity in patients with COPD, a controlled multi-center pilot study. Respiratory Medicine. 2010. doi:10.1016/j.med.2010.01.012)
So what’s the message here – get up, get moving. Whether you are enrolled in a pulmonary rehab program in your area, or participate in an exercise program on your own (we’d recommend you ask your doctor to recommend a suitable program for you or consider purchasing our Breathe Better for Life guide/CD for an exercise program patterned after those used in pulmonary rehab programs – http://www.breathebetterforlife.com/ ), or simply start a regular walking program, the dividends for being more active are significant and lasting. You’ll benefit more over time from increasing the intensity and duration of aerobic and strength training exercise, but even if you just start and maintain a regular walking program you will derive valuable conditioning benefits.
A rough rule of thumb for those interested in starting and maintaining a walking program is to take 10,000 steps each day (sounds like a lot of steps I know, but you’d be surprised how many steps you take already in a given day walking around your home, to/from your car, and at work). As a side note, in the above mentioned study from Respiratory Medicine, the average healthy adult in the study took 9,372 daily steps whereas moderate COPD patients took only 6,560 daily steps and severe COPD patients in the study took only 4,592 on average.
For those of you who decide to start a walking program on your own, we’d recommend you purchase a pedometer to measure the number of steps you take each day. Low cost pedometers are available online, in pharmacies, sporting goods stores and other retail locations. Simply activate the device by touch and keep the pedometer in your pocket or attached to your belt each day to record the number of steps you’ve taken and the distance you’ve traveled. Keep track of the daily steps you take for about a week to determine your baseline average daily steps. Then, as you institute your walking program, try building up to the 10,000 daily step level gradually over a period of 3-4 weeks. In other words, don’t try to vault from 4,000 average daily steps to 10,000 in one day - build your stamina over a reasonable amount of time.
What’s clear from many research studies is that the earlier in the development of lung disease you start and maintain a regular pattern of daily physical activity (whether in a structured exercise program or just getting up and walking more frequently and longer distances), the better your prognosis for a higher quality of life, better lung function, and decreased likelihood of developing severe COPD.
As one set of researchers concluded in a 2009 editorial on physical inactivity and COPD (forgive their penchant for doctor-speak, they mean well), “It is also well established that exercise capacity, whether measured on a field test, as in the BODE (body mass index, airflow obstruction, dyspnea, exercise capacity) score, or in the laboratory, is predictive of survival. Lastly, in large cohorts it is clear that self-reported physical activity predicts prognosis in COPD and may even impact on the rate of lung function decline.” (Polkey MI, Rabe KF. Chicken or egg: Physical activity in COPD revisited. Eur Respir J. 2009: 33; 227-229)
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