Barriers to Exercise - Respiratory Disorders

Jamie Street

 There are many physical conditions that could be a barrier to exercise — that is, unless you know a skilled exercise expert who can guide you along the way. This topic of barriers to exercise is very important to me, and I am passionate about empowering people to be as physically active and fit as possible, even with chronic illnesses. This will be a continued series for the next few months as we dive into various perceived, or in some cases actual barriers to fitness and active lifestyle. Does exercise take your breath away? Actually, in this case I mean in the literal sense. For this first installment I want to address respiratory problems. In general, respiratory diseases fall into two categories: obstructive and restrictive.
 
​Obstructive respiratory diseases that are more common in the population are asthma, COPD, emphysema, and chronic bronchitis. For the purposes of exercise prescription, I will focus on asthma and COPD and the implications for exercise. It is certainly possible to exercise safely and effectively with either condition.
 
Asthma
 
Asthma is an autoimmune condition that results in spasm in the large airways (bronchi) as well as increased mucous secretion. This results in blockage of the airway, thus the fact that it is an obstructive respiratory disorder. Asthma can make it difficult to breathe in or out and attacks can be triggered by high intensity exercise. For many this may seem impossible to deal with when trying to exercise, but by applying the FITT principle (Frequency, Intensity, Time, and Type) it is possible to progress to more intense exercise with the guidance of a physical therapist. As a general example:
 
Frequency: 3-5 days per week
Intensity: 30-40% of maximum heart rate (light) working up to 60-80% of maximum heart rate (high intensity/vigorous).
Time: 20-60 minutes per day (either continuous or intermittent)
Type: Walking or stationary cycling
 
Calculating your heart rate maximum and percentages is a topic for another time, but suffice it to say that with such a guideline you will likely improve control of your asthma and decrease risk of hospitalization. Another alternative to cycling and walking is swimming, which is also cardiovascular exercise.
 
Some considerations for exercise with asthma:
 
1. Do not attempt an unsupervised exercise regimen without the expertise of a physical therapist. Developing an individualized exercise prescription that is safe depends upon your individual vital signs and monitored response to exercise.
 
2. Always have your rescue inhaler with you, even if exercise has not provoked an attack.
 
3. Minimize the chance of bronchospasm (asthma attack) by choosing a safe environment for exercise. If you are prone to allergies, don’t walk or jog outdoors, at least not at first. Indoor tracks or even inside of your home could be safer. Also, some pools have a high chlorine content, which can induce attack. Pools that are salinated (salt water) are good and pools designed for aquatic physical therapy are even better due to the fact that they are kept above body temperature (typically around 100 degrees F) and the space is kept humid and warm, which can aid in keeping airways open and relaxed.
 
COPD
 
 Chronic Obstructive Pulmonary Disease, or COPD, is typically associated with tobacco abuse and results in air becoming trapped inside the lungs when exhaling due to blockage of the airways with secretions and constricted bronchi. Due to the air being trapped in the lungs, gas exchange becomes imbalanced resulting in increased CO2 in the bloodstream. If left unchecked, hypoxia, or too little O2 saturation in the blood, can result and present a medical emergency. That may sound a bit scary, but safe exercise is possible with COPD. In fact, there are huge benefits. One example of clinical research in this area comes from Ferreira, et al in 2009 where they cite the benefits found in a simple walking program. The program was conducted three (3) days per week for twenty (20) minutes for a total of two (2) months. The results they found were:
 

• Significant increase in 6-minute walk test distance (an endurance measure)
• Significant decrease in shortness of breath (dyspnea)
• Significant reduction in perception of dyspnea
• And tendency for less instance of oxygen desaturation

 
A similar exercise prescription to asthma would be effective. Even if wearing supplemental oxygen, a monitored exercise program can still be developed and have positive results. Interval training has also been found to be very effective for COPD. Interval training involves combinations of different exercises such as warm up stretches/light walking, followed by upper body and lower body resistance exercises, then cool down. Typically rest periods last as long as the exercise, so for example, a typical interval session might look like warming up by walking for 1 minute, stretch for 1 minute, then doing 20 mini squats, then fast walking for 1 minute, then resting for 1 minute, etc. With COPD the exercises are usually of shorter duration and also have a 1:1 ratio of rest to exercise. For a client with COPD (as an example), I would likely recommend 30 seconds of walking at regular pace, followed by 30 seconds rest, then 30 seconds of marching in place, 30 seconds rest, 30 seconds worth of mini squats, 30 seconds rest, etc and the following may be applied:
 
Frequency: 3-4 days per week aerobic, 2-3 days per week strengthening
Intensity: Light to moderate (30-60% max heart rate) and progress to 80% max heart rate for aerobics.  50-80% of 1 rep maximum for resistance/strengthening exercise
Time: 15-20 minute sessions
Type: Interval training (similar to above), resistance training for lower and upper body major muscle groups, aerobic exercise.
 
Some considerations for exercise with COPD:
 
1. Again. Do not attempt an unsupervised exercise regimen without the expertise of a physical therapist. Developing an individualized exercise prescription that is safe depends upon your individual vital signs and monitored response to exercise.
 
2. Always time exercise for the peak times with your bronchodilator medication. That way you get the most bang for your buck in terms of ability to bring air in and out due to the airways being more open.
 
3. Stop smoking! Please. I’ll just leave it at that.
 
For restrictive pulmonary diseases, the picture isn’t so rosy. These diseases include pulmonary fibrosis, sarcoidosis, etc. This results in inability to inspire enough air into the lungs due to lack of expansion. Hypoxia, chronic shortness of breath, and eventual decline in the function of the alveoli in the lungs (the small sacs that fill with air and exchange gases) make exercise extremely difficult, if not impossible, for some individuals. Many individuals will eventually need lung transplant or be placed on hospice for the long term. The main thing to consider is maintaining the best quality of life possible by maintaining an airway, promote adequate oxygenation, manage dyspnea, and to prescribe exercise with adequate rest periods for best tolerance of exercise. As an example, I have treated a gentleman that has ankylosing spondylitis, a skeletal condition resulting in spinal fusion and rib stiffness, as well as a new diagnosis of Amyotropic Lateral Sclerosis (ALS or Lou Gehrig's disease). He required the use of a machine to assist in his breathing while sleeping, and attached to supplemental oxygen, as well as elevation of the head of the bed while sleeping. Despite the impairments and restrictive respiratory issues, he was able to tolerate shorter sessions that involved walking with his walker for as far as tolerated, or bed exercises, or repeated sit to stand. Additions of any other exercises proved to be too much for him, but he was still able to tolerate activity each time and actually made some progress. For him, the goal was to stay as functional as possible for as long as possible, though ultimately his medical issues will eventually be terminal. This is to illustrate that it is still possible to exercise with such conditions.
 
Overall, respiratory issues can be worked around to allow you to have an active lifestyle and improved quality of life. As a physical therapist certified in exercise prescription for aging adults, this is exactly what I can help people to do every day. So, take a deep breath, and let's get you moving!