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)
Tuesday, March 9, 2010
Saturday, March 6, 2010
Pulmonary rehabilitation – a powerful first step to improving health among smokers
It’s interesting that so many health organizations and physicians recommend smoking cessation as the primary way to improve the health of smokers when the success rates of these programs are so abysmal. More so, it’s amazing to me that physicians walk right by a proven, highly effective treatment option known as pulmonary rehabilitation as a way to improve the health of smokers (whether they give up smoking or not) until such time smokers have already developed serious lung disease. Why not offer it sooner rather than later?
Thousands of studies have been conducted on pulmonary rehabilitation over the past three decades (don’t believe me? Do a NIH Pubmed search by clicking here using the keyword pulmonary rehabilitation and see for yourself). It is highly effective in reducing shortness of breath, improving quality of life, improving physical conditioning, slowing the progression of lung disease for people with COPD (chronic obstructive pulmonary disease), and reducing health care costs (particularly costs associated with shortness of breath attacks which repeatedly land those with compromised lung function in hospitals repeatedly).
Pulmonary rehabilitation is essentially a structured 4-8 week program of which the cornerstone element is guided exercise intended to boost endurance, stamina and strength for those with compromised lung function. It also incorporates training regarding breathing and airway clearing techniques as well as patient education regarding nutrition support, proper use of medications, and psychological support among other topics. The ironic thing is that many of the principles and practices of pulmonary rehabilitation can be practiced at home or at fitness center and physicians expect COPD patients to do just that after graduating a clinical program.
But guess what? Hardly anyone knows anything about it, and for those who do, getting into a pulmonary rehab program in our country is close to impossible. In fact, only 1-2% of COPD patients in the US can gain access to a pulmonary rehab program due to limited availability. Given that over 100 million US adults have some form of compromise lung function (40% of the US population, a number that represents a cross section of 43 million current smokers, 47 million former smokers, 24 million diagnosed cases of various lung diseases, and 12 million Americans who can’t walk up more than one flight of stairs without stopping to rest because they can’t catch their breath).
If you are a smoker who has yet to develop serious lung disease but find yourself constantly short of breath, I would especially encourage you to take a harder look at pulmonary rehabilitation when you consider we’ve poured hundreds of billions of dollars into smoking cessation awareness and prevention programs over the past 10 years in the US and yet smoking rates are essentially unchanged. Further, the prevalence and growth of chronic obstructive pulmonary disease (COPD) is staggering and getting worse by the second – it’s already the fourth leading cause of death in the US and is expected to be the third leading cause of death worldwide by 2020. Further still, lung disease is the only major disease category in the US that is rising as a cause of death (heart disease, stroke, cancer are all on the decline) and smoking is the number one cause of COPD.
In my opinion, if smokers had access to the principles and practices of pulmonary rehabilitation and the medical community broadly advocated beginning/maintaining such a program sooner rather than later (even if smokers don’t quit, or at least prior to trying a smoking cessation program), we would see notable cost drops in treating the long term effects of smoking, improved smoking cessation rates, and an improvement in the morbidity of Americans who have lung disease.
Why won’t they consider it? From my perspective it’s because there are blinders on the vast majority of health care professionals who treat smokers and those with lung disease. The unchallenged mantras are - stop smoking first and then we’ll help you, or use this inhaler when you feel short of breath.
Both are valuable pieces of advice and treatment options but the cold, hard reality is that these solutions are doing very little to solve long term patient lung health issues. The reality is that pharmacotherapy solutions only relieve immediate short-term symptoms of shortness of breath - they do nothing to improve the long-term health of smokers/COPD patients. And smoking cessation awareness campaigns and smoking cessation programs, even for part-time smokers, are not making a meaningful difference in a reduction of smoking rates or prevalence of lung disease.
It’s time for a new approach to this growing and chronic issue worldwide and in my opinion a significant, proven solution is right under physicians’ noses if they would simply open their minds to the pursuit of healthier smokers using all available, proven means…and pulmonary rehabilitation is one such solution. It is the primary reason I created the Breathe Better for Life guide/CD (http://www.breathebetterforlife.com/ – to help smokers and people with COPD employ the principles and practices of pulmonary rehab at home or at a fitness center if they can’t get access to a clinical program through other means.
Thousands of studies have been conducted on pulmonary rehabilitation over the past three decades (don’t believe me? Do a NIH Pubmed search by clicking here using the keyword pulmonary rehabilitation and see for yourself). It is highly effective in reducing shortness of breath, improving quality of life, improving physical conditioning, slowing the progression of lung disease for people with COPD (chronic obstructive pulmonary disease), and reducing health care costs (particularly costs associated with shortness of breath attacks which repeatedly land those with compromised lung function in hospitals repeatedly).
Pulmonary rehabilitation is essentially a structured 4-8 week program of which the cornerstone element is guided exercise intended to boost endurance, stamina and strength for those with compromised lung function. It also incorporates training regarding breathing and airway clearing techniques as well as patient education regarding nutrition support, proper use of medications, and psychological support among other topics. The ironic thing is that many of the principles and practices of pulmonary rehabilitation can be practiced at home or at fitness center and physicians expect COPD patients to do just that after graduating a clinical program.
But guess what? Hardly anyone knows anything about it, and for those who do, getting into a pulmonary rehab program in our country is close to impossible. In fact, only 1-2% of COPD patients in the US can gain access to a pulmonary rehab program due to limited availability. Given that over 100 million US adults have some form of compromise lung function (40% of the US population, a number that represents a cross section of 43 million current smokers, 47 million former smokers, 24 million diagnosed cases of various lung diseases, and 12 million Americans who can’t walk up more than one flight of stairs without stopping to rest because they can’t catch their breath).
If you are a smoker who has yet to develop serious lung disease but find yourself constantly short of breath, I would especially encourage you to take a harder look at pulmonary rehabilitation when you consider we’ve poured hundreds of billions of dollars into smoking cessation awareness and prevention programs over the past 10 years in the US and yet smoking rates are essentially unchanged. Further, the prevalence and growth of chronic obstructive pulmonary disease (COPD) is staggering and getting worse by the second – it’s already the fourth leading cause of death in the US and is expected to be the third leading cause of death worldwide by 2020. Further still, lung disease is the only major disease category in the US that is rising as a cause of death (heart disease, stroke, cancer are all on the decline) and smoking is the number one cause of COPD.
In my opinion, if smokers had access to the principles and practices of pulmonary rehabilitation and the medical community broadly advocated beginning/maintaining such a program sooner rather than later (even if smokers don’t quit, or at least prior to trying a smoking cessation program), we would see notable cost drops in treating the long term effects of smoking, improved smoking cessation rates, and an improvement in the morbidity of Americans who have lung disease.
Why won’t they consider it? From my perspective it’s because there are blinders on the vast majority of health care professionals who treat smokers and those with lung disease. The unchallenged mantras are - stop smoking first and then we’ll help you, or use this inhaler when you feel short of breath.
Both are valuable pieces of advice and treatment options but the cold, hard reality is that these solutions are doing very little to solve long term patient lung health issues. The reality is that pharmacotherapy solutions only relieve immediate short-term symptoms of shortness of breath - they do nothing to improve the long-term health of smokers/COPD patients. And smoking cessation awareness campaigns and smoking cessation programs, even for part-time smokers, are not making a meaningful difference in a reduction of smoking rates or prevalence of lung disease.
It’s time for a new approach to this growing and chronic issue worldwide and in my opinion a significant, proven solution is right under physicians’ noses if they would simply open their minds to the pursuit of healthier smokers using all available, proven means…and pulmonary rehabilitation is one such solution. It is the primary reason I created the Breathe Better for Life guide/CD (http://www.breathebetterforlife.com/ – to help smokers and people with COPD employ the principles and practices of pulmonary rehab at home or at a fitness center if they can’t get access to a clinical program through other means.
Thursday, March 4, 2010
What is a pulse oximeter and why do I need one?
If you’ve ever been admitted to a hospital, chances are you’ve had a nurse slip a little device onto your fingertip for a short time to take a diagnostic reading. This device is called a pulse oximeter, a device that uses a small light and sensor to detect your pulse (how many times your heart beats in one minute) and the level of oxygen present in your blood (otherwise known as oxygen saturation). If you have COPD or are concerned about persistent shortness of breath, it is worth considering purchasing a pulse oximeter of your own to use at home.
While pulse oximetry does not directly indicate your lung capacity nor evalu¬ate your specific level of breathlessness, it does provide insight into the quality of the functioning of your respiratory system. A low oximetry reading indicates that a low amount of oxygen has been transferred from your lungs into your bloodstream.
Most consumer-friendly pulse oximeters are fingertip devices. To use the device, you place the device directly over your fingertip. After a few seconds, the oximeter will display the saturation percent¬age of oxygen in your blood (on a scale of 0% to 100%) and your heart’s pulse rate. Just like a heart rate or blood pressure monitor, a pulse oximeter’s readings change from moment to moment depending on your activity level, so it often makes sense to take your readings at various points of the day (both at rest and during various physical activities including during exer¬cise sessions) to get a good sense of your typical blood oxygen saturation and pulse rate. It should be noted that those with circulatory problems may find fingertip devices do not produce accurate readings. In this case, a forehead, wrist or earlobe probe is typically recommended by respiratory care professionals.
At rest, a pulse oximeter reading of 94 to 98 percent is considered normal. During exercise, oxygen levels typically fall as you stress your respiratory system to keep up with the higher level of activity. Healthy adults generally should not see their oxygen level dip below 92 percent while exercising. Below this level, there is not enough oxygen in your lungs to enter red blood cells (which are the vehicles for transporting oxygen to the rest of your body). Therefore, you are in effect starving your body’s need for oxygen to operate your organs and muscles.
In COPD patients, oxygen levels typically fluctuate between 88 and 92 percent, whether at rest or during exercise. If you fall in this range and are experiencing breathlessness, this is a definite warning sign. If you use a pulse oximeter and receive multiple read¬ings below 90 percent, you should see your doctor immediately to determine whether your device is faulty or whether you need medical assistance. In more serious cases (typically when blood oxygen saturation levels fall below 88 percent), doctors will recommend oxygen therapy.
Aerobic exercise improves physical endurance and this is often noticeable in the reduction of your resting heart rate. Likewise, the better your aerobic conditioning, the more likely your blood oxygen levels over time will increase both during exercise and at rest. Further, the pursed lip breathing technique can also increase blood oxygen levels for COPD patients. For step by step instructions of the pursed lip breathing technique taken from our Breathe Better for Life CD-ROM, click here.
A number of things can affect a pulse oximetry reading. If you are smoking while taking an oximetry reading, the chemicals in cigarettes that find their way into your blood system can generate inaccurate readings. Additionally, if you wear heavy, dark fingernail pol¬ish, the fingernail polish can inhibit the transmission of the light signals used in pulse oximetry and generate inaccurate readings. Extremely cold fingertips can also generate inaccu¬rate readings due to reduction of blood flow to the fingertip.
Most pulse oximeters are only available by prescription. If you are interested in using one at home, ask your doctor to prescribe one for you. The only pulse oximeter we are aware of that is available with or without a pre¬scription is the Nonin GO2 Achieve Pulse Oximeter (people use pulse oximeters for other purposes that don’t require prescriptions, such as mountain climbers and other adventure enthusiasts who often use pulse oximeters to gauge the effects of high elevations on their oxygen levels). The GO2 Achieve is a relatively inexpensive device to use at home to help track your oxygen levels – it costs about the same as a good blood pressure monitor or heart rate monitor. If you are interested in learning more about the GO2 Achieve, click here.
While pulse oximetry does not directly indicate your lung capacity nor evalu¬ate your specific level of breathlessness, it does provide insight into the quality of the functioning of your respiratory system. A low oximetry reading indicates that a low amount of oxygen has been transferred from your lungs into your bloodstream.
Most consumer-friendly pulse oximeters are fingertip devices. To use the device, you place the device directly over your fingertip. After a few seconds, the oximeter will display the saturation percent¬age of oxygen in your blood (on a scale of 0% to 100%) and your heart’s pulse rate. Just like a heart rate or blood pressure monitor, a pulse oximeter’s readings change from moment to moment depending on your activity level, so it often makes sense to take your readings at various points of the day (both at rest and during various physical activities including during exer¬cise sessions) to get a good sense of your typical blood oxygen saturation and pulse rate. It should be noted that those with circulatory problems may find fingertip devices do not produce accurate readings. In this case, a forehead, wrist or earlobe probe is typically recommended by respiratory care professionals.
At rest, a pulse oximeter reading of 94 to 98 percent is considered normal. During exercise, oxygen levels typically fall as you stress your respiratory system to keep up with the higher level of activity. Healthy adults generally should not see their oxygen level dip below 92 percent while exercising. Below this level, there is not enough oxygen in your lungs to enter red blood cells (which are the vehicles for transporting oxygen to the rest of your body). Therefore, you are in effect starving your body’s need for oxygen to operate your organs and muscles.
In COPD patients, oxygen levels typically fluctuate between 88 and 92 percent, whether at rest or during exercise. If you fall in this range and are experiencing breathlessness, this is a definite warning sign. If you use a pulse oximeter and receive multiple read¬ings below 90 percent, you should see your doctor immediately to determine whether your device is faulty or whether you need medical assistance. In more serious cases (typically when blood oxygen saturation levels fall below 88 percent), doctors will recommend oxygen therapy.
Aerobic exercise improves physical endurance and this is often noticeable in the reduction of your resting heart rate. Likewise, the better your aerobic conditioning, the more likely your blood oxygen levels over time will increase both during exercise and at rest. Further, the pursed lip breathing technique can also increase blood oxygen levels for COPD patients. For step by step instructions of the pursed lip breathing technique taken from our Breathe Better for Life CD-ROM, click here.
A number of things can affect a pulse oximetry reading. If you are smoking while taking an oximetry reading, the chemicals in cigarettes that find their way into your blood system can generate inaccurate readings. Additionally, if you wear heavy, dark fingernail pol¬ish, the fingernail polish can inhibit the transmission of the light signals used in pulse oximetry and generate inaccurate readings. Extremely cold fingertips can also generate inaccu¬rate readings due to reduction of blood flow to the fingertip.
Most pulse oximeters are only available by prescription. If you are interested in using one at home, ask your doctor to prescribe one for you. The only pulse oximeter we are aware of that is available with or without a pre¬scription is the Nonin GO2 Achieve Pulse Oximeter (people use pulse oximeters for other purposes that don’t require prescriptions, such as mountain climbers and other adventure enthusiasts who often use pulse oximeters to gauge the effects of high elevations on their oxygen levels). The GO2 Achieve is a relatively inexpensive device to use at home to help track your oxygen levels – it costs about the same as a good blood pressure monitor or heart rate monitor. If you are interested in learning more about the GO2 Achieve, click here.
Tuesday, March 2, 2010
Tai chi – an alternative form of exercise for COPD patients
In previous posts we’ve discussed the significant benefits of aerobic exercise and strength training for people who suffer from chronic shortness of breath. The scientific research is clear and unambiguous – an ongoing exercise program reduces shortness of breath, improves physical conditioning and mobility, and improves perceived quality of life.
But maybe you don’t have access to the appropriate exercise equipment to begin and maintain your own exercise program. Or maybe you have such limited mobility and balance it feels too challenging to step up on a treadmill to walk. Or possibly you become quickly bored by a traditional exercise program and find that you quit due to what feels like a tedious routine.
If any of the above reasons apply to you, then I have a fun and therapeutic form of low intensity exercise for you to consider – tai chi.
A recent article from the Mayo Clinic describes tai chi as “meditation in motion because it promotes serenity through gentle movements — connecting the mind and body. Originally developed in ancient China for self-defense, tai chi evolved into a graceful form of exercise that's now used for stress reduction and to help with a variety of other health conditions…Tai chi, also called tai chi chuan, is a noncompetitive, self-paced system of gentle physical exercise and stretching. To do tai chi, you perform a series of postures or movements in a slow, graceful manner. Each posture flows into the next without pause, ensuring that your body is in constant motion.” Click here for the full text of the article.
Interestingly, there has been a significant amount of research conducted on tai chi over the past few decades evaluating its health benefits for those with cardiovascular disease, hypertension (high blood pressure), diabetes, and arthritis among other conditions. However, one has to look back to 1995 to find any studies specifically examining tai chi for COPD as an alternative to aerobic exercise in pulmonary rehabilitation programs (Lai JS, et al. Two-year trends in cardiorespiratory function among older Tai Chi Chuan practitioners and sedentary subjects. J Am Geriatr Soc. 1995 Nov; 43(11):1222-7). Despite the dearth of recent pulmonary rehab/COPD studies related to tai chi, many of the studies related to heart disease have shown impressive results from an ongoing commitment to a tai chi program.
For example, one recent review article examining studies conducted on tai chi for those with cardiovascular disease concluded, “Given the existing evidence, tai chi exercise may be a reasonable adjunct to conventional care. It may be appropriate for those unable or unwilling to engage in other forms of physical activity or as a bridge to more rigorous exercise programs in frail or deconditioned patients. Patients with early detection of cardiovascular disease risk factors (e.g. borderline hypertension) may be reluctant to begin drug therapy and nonpharmacological approaches are often welcomed. These lifestyle interventions have been recognized as important and effective strategies for primary prevention. In addition, patients with either pre-hypertension or established hypertension, who otherwise feel well, may be less motivated and find it difficult to engage in and maintain a regular exercise regimen. Finding an appropriate, nonthreatening, easy-to-perform activity that patients will maintain is critical to therapeutic success. Clinical trials have reported excellent compliance with tai chi interventions and suggest that tai chi may promote exercise self-efficacy.
Likewise, exercise is a well-recognized and effective strategy for secondary prevention in patients with established cardiovascular disease.” (Yeh GY, et al. Tai Chi Exercise for Patients with Cardiovascular Conditions and Risk Factors. Journal of Cardiopulmonary Rehabilitation and Prevention. 2009; 29:152–160)
In Dr. Yeh’s review of 29 good-quality tai chi/cardiovascular studies, many of the reviewed studies showed statistically significant improvement in subject exercise capacity, reduction in resting heart rate (pulse), reduction in blood pressure levels, improvement in peak expiratory air flow, and improved pulmonary function.
Tai chi has been shown in other studies to promote balance among elderly patients and those who are primarily sedentary (by the way, tai chi movements can be done from a seated position for those who are concerned about their balance or mobility). It also has a strong track record for exercise program compliance (meaning people tend to stick with tai chi classes longer than traditional aerobic exercise regimens).
In our opinion, tai chi is worthy of your consideration as a complementary or alternative form of exercise even though there are not recent studies conducted on COPD patients in the context of pulmonary rehabilitation. There are many tai chi DVDs available for purchase online and many fitness centers, YMCA’s, and community centers offer low-cost (and in some cases, no cost) tai chi classes. Look for DVDs and/or classes that are tailored for either the elderly or those with limited mobility for these resources have adapted the traditional tai chi movements to help people who have some level of compromised physical condition.
But maybe you don’t have access to the appropriate exercise equipment to begin and maintain your own exercise program. Or maybe you have such limited mobility and balance it feels too challenging to step up on a treadmill to walk. Or possibly you become quickly bored by a traditional exercise program and find that you quit due to what feels like a tedious routine.
If any of the above reasons apply to you, then I have a fun and therapeutic form of low intensity exercise for you to consider – tai chi.
A recent article from the Mayo Clinic describes tai chi as “meditation in motion because it promotes serenity through gentle movements — connecting the mind and body. Originally developed in ancient China for self-defense, tai chi evolved into a graceful form of exercise that's now used for stress reduction and to help with a variety of other health conditions…Tai chi, also called tai chi chuan, is a noncompetitive, self-paced system of gentle physical exercise and stretching. To do tai chi, you perform a series of postures or movements in a slow, graceful manner. Each posture flows into the next without pause, ensuring that your body is in constant motion.” Click here for the full text of the article.
Interestingly, there has been a significant amount of research conducted on tai chi over the past few decades evaluating its health benefits for those with cardiovascular disease, hypertension (high blood pressure), diabetes, and arthritis among other conditions. However, one has to look back to 1995 to find any studies specifically examining tai chi for COPD as an alternative to aerobic exercise in pulmonary rehabilitation programs (Lai JS, et al. Two-year trends in cardiorespiratory function among older Tai Chi Chuan practitioners and sedentary subjects. J Am Geriatr Soc. 1995 Nov; 43(11):1222-7). Despite the dearth of recent pulmonary rehab/COPD studies related to tai chi, many of the studies related to heart disease have shown impressive results from an ongoing commitment to a tai chi program.
For example, one recent review article examining studies conducted on tai chi for those with cardiovascular disease concluded, “Given the existing evidence, tai chi exercise may be a reasonable adjunct to conventional care. It may be appropriate for those unable or unwilling to engage in other forms of physical activity or as a bridge to more rigorous exercise programs in frail or deconditioned patients. Patients with early detection of cardiovascular disease risk factors (e.g. borderline hypertension) may be reluctant to begin drug therapy and nonpharmacological approaches are often welcomed. These lifestyle interventions have been recognized as important and effective strategies for primary prevention. In addition, patients with either pre-hypertension or established hypertension, who otherwise feel well, may be less motivated and find it difficult to engage in and maintain a regular exercise regimen. Finding an appropriate, nonthreatening, easy-to-perform activity that patients will maintain is critical to therapeutic success. Clinical trials have reported excellent compliance with tai chi interventions and suggest that tai chi may promote exercise self-efficacy.
Likewise, exercise is a well-recognized and effective strategy for secondary prevention in patients with established cardiovascular disease.” (Yeh GY, et al. Tai Chi Exercise for Patients with Cardiovascular Conditions and Risk Factors. Journal of Cardiopulmonary Rehabilitation and Prevention. 2009; 29:152–160)
In Dr. Yeh’s review of 29 good-quality tai chi/cardiovascular studies, many of the reviewed studies showed statistically significant improvement in subject exercise capacity, reduction in resting heart rate (pulse), reduction in blood pressure levels, improvement in peak expiratory air flow, and improved pulmonary function.
Tai chi has been shown in other studies to promote balance among elderly patients and those who are primarily sedentary (by the way, tai chi movements can be done from a seated position for those who are concerned about their balance or mobility). It also has a strong track record for exercise program compliance (meaning people tend to stick with tai chi classes longer than traditional aerobic exercise regimens).
In our opinion, tai chi is worthy of your consideration as a complementary or alternative form of exercise even though there are not recent studies conducted on COPD patients in the context of pulmonary rehabilitation. There are many tai chi DVDs available for purchase online and many fitness centers, YMCA’s, and community centers offer low-cost (and in some cases, no cost) tai chi classes. Look for DVDs and/or classes that are tailored for either the elderly or those with limited mobility for these resources have adapted the traditional tai chi movements to help people who have some level of compromised physical condition.
Monday, March 1, 2010
Is your shortness of breath really from COPD?
Most people have no idea that lung disease, including emphysema, can also be caused by a rare genetic condition called alpha-1antitrypsin deficiency (AAT deficiency for short). In simple terms, AAT is a critical protein normally found in your lungs and bloodstream. It helps protect your lungs from diseases such as emphysema. But if you don’t have enough of it, you’re far more likely to develop lung disease.
If you haven't previously heard of alpha-1 antitrypsin deficiency (sometimes also referred to as AATD), you can read a good topic review published in January’s Canadian Family Physician (click here for the full free text of the review). It's a little technical in spots but overall provides a fairly understandable overview of the condition, causes, symptoms and treatment options.
People with alpha-1 antitrypsin deficiency develop the first signs and symptoms of lung disease at a younger age, usually between ages 20 and 50. The earliest symptoms are things like shortness of breath after doing mild activity, reduced ability to exercise, and wheezing. Other signs can include unintentional weight loss, recurring respiratory infections, fatigue, and rapid heartbeat upon standing.
It’s believed that up to 3% of patients with diagnosed COPD actually suffer with AAT deficiency instead – that’s 360,000 people. But only about 6% of people with this deficiency know they have it!
This also means you could be getting the WRONG treatment! Why? COPD medications that provide temporary relief from shortness of breath episodes simply mask the symptoms of AATD - so you get worse and don’t know why. In our opinion, if you suffer from chronic shortness of breath, you should ask your doctor to be tested for AATD. The simple blood test is reimbursable by most insurance companies and Medicare. And the good news is that an effective AATD treatment option exists - a blood plasma replacement therapy that essentially introduces elevated levels of the missing AAT protein into the bloodstream and can help halt the progression of further lung function deterioration.
To learn more about how to talk to your doctor about getting tested, you can visit http://www.testtodaychangetomorrow.com/. This site was created by one of the leading pharmaceutical companies that produce a plasma replacement therapy for AATD patients. It provides a checklist you can complete and print to take to your doctor to help you get tested. This checklist can be especially helpful if you are currently managing your breathlessness through your primary care physician instead of a pulmonologist given that many primary care doctors have little to no knowledge of AAT!
If you haven't previously heard of alpha-1 antitrypsin deficiency (sometimes also referred to as AATD), you can read a good topic review published in January’s Canadian Family Physician (click here for the full free text of the review). It's a little technical in spots but overall provides a fairly understandable overview of the condition, causes, symptoms and treatment options.
People with alpha-1 antitrypsin deficiency develop the first signs and symptoms of lung disease at a younger age, usually between ages 20 and 50. The earliest symptoms are things like shortness of breath after doing mild activity, reduced ability to exercise, and wheezing. Other signs can include unintentional weight loss, recurring respiratory infections, fatigue, and rapid heartbeat upon standing.
It’s believed that up to 3% of patients with diagnosed COPD actually suffer with AAT deficiency instead – that’s 360,000 people. But only about 6% of people with this deficiency know they have it!
This also means you could be getting the WRONG treatment! Why? COPD medications that provide temporary relief from shortness of breath episodes simply mask the symptoms of AATD - so you get worse and don’t know why. In our opinion, if you suffer from chronic shortness of breath, you should ask your doctor to be tested for AATD. The simple blood test is reimbursable by most insurance companies and Medicare. And the good news is that an effective AATD treatment option exists - a blood plasma replacement therapy that essentially introduces elevated levels of the missing AAT protein into the bloodstream and can help halt the progression of further lung function deterioration.
To learn more about how to talk to your doctor about getting tested, you can visit http://www.testtodaychangetomorrow.com/. This site was created by one of the leading pharmaceutical companies that produce a plasma replacement therapy for AATD patients. It provides a checklist you can complete and print to take to your doctor to help you get tested. This checklist can be especially helpful if you are currently managing your breathlessness through your primary care physician instead of a pulmonologist given that many primary care doctors have little to no knowledge of AAT!
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