The Case for Exercise in Managing Chronic Lung Disease

If you have chronic obstructive pulmonary disease, you might think you can't — or shouldn't — exercise. But you really must.

Chronic obstructive pulmonary disease (COPD) includes chronic bronchitis and emphysema. More than 12 million Americans have been diagnosed with the disease, most of them current or former smokers. COPD is the fourth leading cause of death in the United States: each year, roughly 120,000 people — more women than men — succumb to it. But people often live with COPD for many years, and it takes a major part of its toll by sapping the strength and stamina needed for work, social activities, and leisure-time pursuits.

There's a common belief that little can be done for COPD beyond providing medications and oxygen. Even some clinicians aren't completely up to date on the evidence supporting other therapies, including exercise. People with COPD may benefit even more than average from regular exercise. It can promote better oxygen utilization, improve energy and endurance, protect bone, lower blood pressure, help control weight, and improve mood and sleep. Such changes can add up to a better quality of life, less shortness of breath, and fewer doctor visits and hospitalizations.

Pulmonary rehabilitation

Some of the best evidence for the importance of exercise in managing COPD comes from studies of patients undergoing pulmonary rehabilitation, a program that combines exercise and breathing techniques with education about COPD and services such as nutrition counseling and occupational therapy. If you suffer from breathlessness and other symptoms even when you're using medication, chances are you'll benefit from this approach.

The American College of Chest Physicians and the American Association of Cardiovascular and Pulmonary Rehabilitation regard aerobic training of the lower extremities as essential to pulmonary rehabilitation. Their updated practice guidelines, published in the journal Chest in 2007, also endorse strength training, confirm the value of both low- and high-intensity exercises, and strongly recommend upper extremity aerobic exercise.

Pulmonary rehabilitation usually lasts about six weeks but can take more or less time depending on individual need and insurance coverage. It can take place at home or in a hospital, rehab center, or outpatient facility.

What's involved?

You'll receive aerobic exercise therapy under the supervision of a health care professional (usually a physical therapist or exercise physiologist) who will work with you to design and monitor a program tailored to your particular capabilities. The aim is to increase your endurance, strengthen your muscles, and improve your overall cardiovascular fitness.

Exercise therapy usually involves use of a treadmill or a stationary bicycle. The choice of exercises will depend on your endurance and the condition of your joints, bones, and muscles. It also depends on what kind of exercise you enjoy, what exercise equipment is available, and whether you will need regular monitoring.

If you're too breathless to walk, you may start on a stationary bicycle or make cycling motions while seated in a chair. If you can walk but have little endurance, you may start with the treadmill. Sustained exercise sessions usually last for 20 to 45 minutes, but many people initially need to alternate shorter periods of exercise with periods of rest, an approach known as interval training. Eventually, you'll be able to exercise without stopping for increasingly longer periods.