# Exercise as it relates to Disease/The benefits of aerobic training for those suffering from Emphysema
### What is Emphysema?

Also known as Chronic Obstructive Pulmonary Disease (COPD), Emphysema is a preventable and treatable disease state characterised by airflow limitation that is not fully reversible.

### Prevalence

Between the year 2000 and 2012, the prevalence of Emphysema remained very similar with it being reported to have caused 3.1million deaths worldwide each year, and also equates to 5.6% of recorded deaths. Nationally in Australia in 2012, COPD was the underlying cause of 6,750 deaths or 4.5% of registered deaths that year.

### Signs and Symptoms

* Ongoing Cough - produces mucous
* Shortness of breath
* Wheezing
* Tightness of the chest
Seek emergency care if:
* You have trouble catching your breath or talking
* Your lips or fingernails turn blue or grey (low oxygen levels)
* Fast heartbeat
* You are not mentally alert

### Causes

Cigarette smoking is the number one cause of Emphysema. Other factors that may cause Emphysema are:
* Infections of the respiratory tract - Can destroy lung tissue and contribute to the worsening of the condition
* Hereditary (rare) - Carriers of the specific genetic abnormality called homozygous alpha-1-antitrypsin deficiency
* Aging - Aging brings changes to the lungs and air sacs in the way of lost elasticity which can become severe enough to be classified as Emphysema

## Benefits of Aerobic Exercise for Emphysema Sufferers
### Overview

Exercise training should be considered for all persons with COPD, in a formal pulmonary rehabilitation program. Even though there are varying degrees of COPD, aerobic exercise has been shown to improve exercise capacity just as it does in a healthy person. At first it may be difficult to commit to exercise as Emphysema effects the respiratory system and this can make the exercise that much more difficult for the individual. Even getting the individual to start small could significantly reduce some of the symptoms that they are suffering from.

### Exercise Benefits

Aerobic and strength training of the upper and lower limbs and the respiratory muscles has been shown to be beneficial. High-intensity endurance training has been shown to lead to physiological gains in aerobic fitness, and both high and low intensity endurance training has lead to gains in exercise endurance even for those with advanced disease. Other benefits of exercise has been shown to lead to:
* Significant improvements in health-related quality of life
* Reduced depression and improved cognitive function
* Reductions in COPD exacerbation and time spent in the hospital
When prescribing exercise to people with Emphysema, it is important to know their limitations. Mostly, these limitations are caused by the disease and therefore is important to know the severity of their disease as it will limit their exercise capacity.

### Recommendations

Aerobic and strength training of the upper and lower limbs and the respiratory muscles has been shown to be beneficial. Light to moderate physical activity, 30mins a day, every day, is beneficial for improving the quality of life. Persons who follow an individualised progressive exercise program can often increase their functional capacity 70% to 80% after six weeks of training.

## Further reading

* Emphysema Fact Sheet
* Lung Volume Reduction Surgery vs. Medical Therapy

## References

* ↑ http://emedicine.medscape.com/article/298283-overview
* ↑ http://thorax.bmj.com/content/61/12/1031.extract
* ↑ http://who.int/mediacentre/factsheets/fs310/en/
* ↑ http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/D52CC9949E64E0EFCA257B2E000D74DA
* 1 2 3 4 5 6 7 8 http://www.nhlbi.nih.gov/health/health-topics/topics/copd/signs.html
* 1 2 3 4 5 http://chealth.canoe.ca/channel_condition_info_details.asp?disease_id=51&channel_id=2022&relation_id=16451
* 1 2 http://www.nhlbi.nih.gov/health/health-topics/topics/copd/causes.html
* 1 2 3 4 5 6 7 8 http://www.rehab.research.va.gov/jour/03/40/5sup2/pdf/Rochester.pdf
* ↑ http://erj.ersjournals.com/content/6/9/1362.full.pdf+html?sid=734b639f-aa42-42d7-a6e8-ff30074636c7
* 1 2 http://www.acsm.org/docs/current-comments/exerciseforpersonswithcopd.pdf
* ↑ http://www.chemistinfo.net/Emphysema.htm
* ↑ http://www.ncbi.nlm.nih.gov/m/pubmed/12759479/
* Demirjian BG. Emphysema. Updated 2012 September 17 [Cited 2014 September 23] Available from: http://emedicine.medscape.com/article/298283-overview
* Turino GM. Emphysema in COPD: consequences and causes. Thorax [Internet]. 2006 [Cited 2014 September 23]; 61(12): 1031-1036. Available from: http://thorax.bmj.com/content/61/12/1031.extract
* World Health Organisation. 2014, The 10 leading causes of death in the world, 2000 and 2012, Fact Sheet [Cited 2014 September 20]. Available from: http://who.int/mediacentre/factsheets/fs310/en/
* Australian Bureau of Statistics. Released 2013 March 15, ABS House, 45 Benjamin Way Belconnen, ACT, 2617. [Cited 2014 September 20]. Available from: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/D52CC9949E64E0EFCA257B2E000D74DA
* National Heart, Lung, and Blood Institute. What are the Signs and Symptoms of COPD [Internet]. Department of Health and Human Services, USA. [Updated 2013 July 31; Cited 2014 September 21]. Available from: http://www.nhlbi.nih.gov/health/health-topics/topics/copd/signs.html
* MediResource. C.Health [Fact Sheet]. Updated 2014 September 29 [Cited 2014 September 29] Available from: http://chealth.canoe.ca/channel_condition_info_details.asp?disease_id=51&channel_id=2022&relation_id=16451
* National Heart, Lung, and Blood Institute. What Causes COPD [Internet]. Department of Health and Human Services, USA. [Updated 2013 July 31; Cited 2014 September 21]. Available from: http://www.nhlbi.nih.gov/health/health-topics/topics/copd/causes.html
* Rochester CL. Exercise training in chronic obstructive pulmonary disease. Journal of Rehabilitation and Development [Internet]. 2003 September/October [Cited 2014 September 29]; vol. 40(5): 59-80. Available from: http://www.rehab.research.va.gov/jour/03/40/5sup2/pdf/Rochester.pdf
* Wakayama K. Kurihara N. Fujimoto S. Hata M. Takeda T. Relationship between exercise capacity and the severity of emphysema as determined by high resolution CT. European Respiratory Journal [Internet]. 1993 [Cited 2014 September 21]; vol. 6: 1362-1367. Available from: http://erj.ersjournals.com/content/6/9/1362.full.pdf+html?sid=734b639f-aa42-42d7-a6e8-ff30074636c7
* American College of Sports Medicine (Dressendorfer RH. Haykowsky MJ. Eves N.). Exercise for Persons with Chronic Obstructive Pulmonary Disease [Internet]. Indianapolis: American College of Sports Medicine [Cited 2014 September 23] Available from: http://www.acsm.org/docs/current-comments/exerciseforpersonswithcopd.pdf
* ChemistInfo. Emphysema Fact Sheet. Available from: http://www.chemistinfo.net/Emphysema.htm
* Fishman A. Martinez F. Naunheim K. Piantadosi S. Wise R. Ries A. Weinmann G. Wood DE. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. New England Journal of Medicine [Internet]. 2003 May 22 [Cited 2014 September 25] Vol. 348(21): 2059-2073. Available from: http://www.ncbi.nlm.nih.gov/m/pubmed/12759479/