One of the most valuable steps anyone who suffers from chronic shortness of breath can undertake is to engage in a regular program of physical activity (including those diagnosed with chronic obstructive pulmonary disease or COPD).
Often the biggest challenge to become more physically active among those with pronounced breathing difficulties is a poor level of conditioning. Shortness of breath often leads people to rest more (meaning sitting or lying for larger segments of the day). The trend towards a more sedentary existence weakens muscles, bones, and the body’s cardiovascular function.
To help COPD patients “kick start” a physical activity program, pulmonology professionals can prescribe a treatment option known as pulmonary rehabilitation. In these programs, respiratory therapists and physicians first assess the baseline physical condition of each patient and then they design a somewhat customized 8-12 week exercise program that includes aerobic exercise (typically walking on a treadmill, riding a stationary cycle, or utilizing a device known as a cycle ergonometer) and strength training (weight lifting). Patients typically visit an outpatient rehab center 2-3 days per week for the 1 hour exercise sessions, and at various points along the way the therapists increase the duration and/or intensity of the exercise to help patients build back strength and endurance. Most rehab programs also include counseling and education sessions regarding breathing techniques, nutrition, smoking cessation, proper use of medications and social support.
Sounds great, right? Well, it is. Literally thousands of studies have been conducted on the effectiveness of pulmonary rehabilitation in reducing COPD patient shortness of breath, improving physical conditioning (strength and endurance), reducing exacerbations (shortness of breath attacks), shortening hospital stays and reducing overall health care costs. You’d think pulmonary rehab would be offered to every COPD patient…but it isn’t. In fact, only 1-2% of COPD patients are admitted to pulmonary rehab programs each year for a variety of reasons (none of them compelling).
At particular disadvantage are COPD patients considered “severe” cases. You see, there is a bit of a goldilocks mentality when it comes to doling out access to pulmonary rehab. If you have mild COPD (Stage I), you are unlikely to be admitted. If you have very severe COPD (Stage IV), you are also unlikely to be admitted. Why? Because Medicare and insurance companies will only reimburse rehab clinics for moderate to severe COPD patients (Stage II and III). And hospitals are not in the business of offering services for which they do not get paid.
Further, there is somewhat of an unspoken bias against admitting severe and very severe patients to begin with among pulmonology professionals. There seems to be an undercurrent that offering pulmonary rehab to severe patients is a waste of resources since their condition is unlikely to improve.
But research studies counter such notions. For example, a recent Nigerian study designed a 6-week pulmonary rehab program for 42 severe/very severe COPD patients. In particular, the study team desired to see whether the program would boost both the physical condition of patients as well as improve quality of life. [1]
Their results were remarkable in that the 6 week program (2 visits weekly for 2 ½ hours each session) delivered clinically significant improvements in distance walked on a timed test (21% improvement). Further, quality of life ratings for dyspnea (perceived shortness of breath), fatigue, emotional support and mastery all improved above the clinically significant threshold established in past research studies. Further still, the percentage of study participants acknowledging depression (40%) and anxiety (32%) both fell to 27% by the end of the study. More remarkable is the fact that the vast majority of these improvements were maintained 4 months after the 6 week program ended.
The study authors concluded, “This study has shown that a successful outpatient based rehabilitation programme is feasible and possible in patients with very severe COPD. Significant improvements can be achieved in shuttle walking distance, quality of life and psychological measurements, and the improvement is maintained for at least three more months without further intervention.”
If you are a COPD patient, we highly recommend you speak to your pulmonologist about gaining entry to a pulmonary rehab program in your area. If they won’t refer you, if you get rejected for admission, or there is no program in your area, we suggest you consider purchasing our Breathe Better for Life guidebook and companion CD-ROM.
We devised a pulmonary-rehab style exercise program based on guidelines established by the American Thoracic Society and the European Respiratory Society. We then augmented these guidelines with the exercise protocol recommended by the American College of Sports Medicine for those with chronic respiratory conditions. The guide and the CD were reviewed and edited by prominent respiratory care professionals, and both resources cover elements of a pulmonary rehab program that go beyond exercise (breathing techniques, airway clearing techniques, nutrition, proper use of inhaler medications, and other topics). To learn more about Breathe Better for Life, visit www.breathebetterforlife.com.
If you decide to follow our exercise program please consult your physician first to ensure the program is appropriate for your particular situation. While we did create two different programs based on condition severity (with different starting points, intensities, durations), it is important to include your doctor in your plans to begin an exercise program.
[1] Ige OM, et al. Outpatient Pulmonary Rehabilitation in Severe Chronic Obstructive Pulmonary Disease. Indian J Chest Dis Allied Sci. 2010 Oct-Dec; 52(4)
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