This week, a new Portuguese research study revealed that moderate to severe COPD patients who underwent an exercise program including both strength resistance training and aerobic exercise training reported higher levels of perceived health status compared to COPD patients who participated in either aerobic training alone or respiratory physiotherapy.
A number of previous studies have shown that the combination of aerobic exercise and strength/resistance training produces higher levels of overall physical conditioning in COPD patients than either of these two forms of exercise alone (i.e. greater endurance, greater muscle strength, greater exercise capacity). This is a key reason why most pulmonary rehabilitation programs include both strength training and aerobic/cardiovascular training in their exercise regimens.
Instead of evaluating objective, physical measures of performance between these three potential COPD treatment options (strength & aerobic exercise, aerobic exercise, physiotherapy), the new Portuguese based research study aimed to understand how COPD patients perceive their own health status through two “quality of life” surveys (the St. George’s Respiratory Questionnaire (view sample survey form by clicking here) and the Short Form [36] Health Survey (view sample survey form by clicking here).
In other words, the study team desired to know, outside of physical performance measures (e.g. did you walk farther, did you walk faster, could you lift more weight), do COPD patients actually feel differently about their own health status depending on which method of rehabilitation they receive?
To test their hypothesis, the research team divided 50 moderate to severe COPD patients into two groups (25 who participated in a 10-week combined strength/aerobic exercise program, 25 in a 10-week aerobic-only exercise group) and compared their survey results to each other and to an additional 50 moderate to severe COPD patients who received 10 weeks of respiratory physiotherapy (essentially physical therapy accompanied by breathing technique and airway clearing technique training – but no explicit exercise program). They administered the two surveys mentioned above prior to the respective treatment programs and then again at the end of the programs. They then measured the differences in the patients’ responses from their pre-program surveys and their post-program surveys and compared the mean (average) results between the three different treatment options. (Pereira AM, et al. Impact of combined exercise on chronic obstructive pulmonary patients' state of health. Rev Port Pneumol. 2010 Sep-Oct;16(5):737-57)
The results clearly showed that COPD patients who received both the strength training and aerobic exercise training reported significantly higher ratings of their perceived health status at the end of their exercise program as compared to the other two groups ON ALL SECTIONS OF BOTH SURVEYS.
For example, in the St. George’s Respiratory Questionnaire, the combined exercise group reported a 64 point increase in their “activity” rating (a section of the questionnaire designed to understand a patient’s ability to participate in activities of daily living) versus a 19 point increase for the aerobic-only exercise group and a 1 point increase for the physiotherapy group.
As another example, on the SF-36 survey, COPD patients receiving both strength and aerobic exercise training reported an 83 point jump in their perceived vitality (a section of the test designed to assess quality of daily living), versus a 14 point rise for the aerobic-only group. On this measure the physiotherapy group showed flat response between pre and post treatment.
These results reinforce the basic underlying principles and practices of COPD treatment pulmonary rehabilitation. Combined strength and aerobic exercise is highly valuable for those who suffer from chronic shortness of breath on two fronts – on physical performance measures and on quality of life perceptions.
If you are a COPD patient and you’d like to try an exercise program, consider asking your pulmonologist for a referral to an outpatient pulmonary rehabilitation program in your area. A note of upfront warning – these programs have very limited admission rates despite their proven effectiveness due to lack of available medical resources to help meet the demand for program participation. Additionally, Medicare and insurance guidelines limit reimbursement for pulmonary rehabilitation to moderate and severe COPD patients only (meaning mild and very severe COPD patients are not eligible for reimbursement – and hence are rarely admitted).
Alternatively, ask your physician to recommend an exercise program appropriate for your situation. If they don’t have such a program to offer you, consider visiting a local fitness center in your area and ask to speak with a fitness instructor certified in structuring exercise programs for people with chronic health conditions.
If none of those options appeal to you but you’d like to learn more about what a pulmonary rehabilitation-style exercise program looks like, we’d recommend you consider purchasing our Breathe Better for Life guide and companion CD-ROM, www.breathebetterforlife.com.
We’ve created an at-home or at-fitness center strength and aerobic exercise program based on pulmonary rehabilitation guidelines published by the American Thoracic Society and the European Respiratory Society. We’ve also tweaked the program to include exercise guidelines issued by the American College of Sports Medicine for elderly patients with chronic respiratory conditions. Our guide provides explicit exercise recommendations and our CD provides explicit, narrated step-by-step instructions for common strength training movements. If you do elect to purchase our guide and follow our exercise program recommendations, we recommend you discuss your plan with your physician prior to engaging in the exercise program to ensure it is appropriate for your particular situation.
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