# Exercise as it relates to Disease/Exercise as a component of treatment for COPD
## Background - What is COPD?

Chronic Obstructive Pulmonary Disease (COPD) is a term used to account for a number of lung conditions that are; irreversible, gradually worsen, and cause breathing difficulties and dyspnea (breathlessness).

### What are the Main Types of COPD?

* Emphysema - The elastic fibres of the air sacs (alveoli) and breathing tubes (bronchi & bronchioles) are irreversibly destroyed causing an inability to breathe regularly or empty the lungs of air.
* Chronic Bronchitis - Increased mucus production (sputum) due to the constant swelling and irritation of the breathing tubes (bronchi & bronchioles).

### Causes of COPD

* Cigarette smoking - The main cause of COPD. 15-20% of smokers will develop severe lung conditions.
* Exposure to pathogens - Long term exposure to fumes, cigarette smoke, chemicals or dust
* Genetic - A very rare condition caused by alpha-1 antitrypsin deficiency may cause COPD between the ages of 20-50.

## Exercise as a Component of Treatment for COPD

If suffering from COPD, exercise can help you learn to use the lung capacity you have more efficiently. Attending exercise groups run by certified Exercise Physiologists can be inexpensive, improve your quality of life and increase your understanding of the disease as well as allowing you to meet people in the same situation and develop a support network. Pulmonary rehabilitation exercise programs are also beneficial as they can help you acquire the tools to be in control of your breathing, instead of your breathing controlling you and causing extra anxiety and stress. This will allow you to retain your independence and complete daily household tasks .

### What Benefits will I see from Exercise?

| Exercise Will Increase Your | Exercise Will Decrease Your |
| Sleep quality | Shortness of breath |
| Muscular strength, endurance, flexibility & balance | Levels of anxiety, stress and depression |
| Ability to retain independence and complete household tasks | Blood pressure |
| Bone Density and circulation | Muscular strength loss |
| Cardiopulmonary Endurance | Risk of heart disease |
| Energy levels | Blood sugar levels |

### Recommendations for Exercise

There are four main recommended exercise types:
| Exercise Type | Benefits | How Much |
| Stretching | lengthens muscles increases flexibility prepares muscles for exercise decreasing your chance of injury | within 15 minutes immediately prior to commencing exercise immediately post exercise |
| Cardiovascular / Aerobic Interval Training | improves respiratory endurance strengthens the heart and lungs enables body to use oxygen more efficiently may improve breathing maintain a healthy body weight which will decrease the risk of heart disease and diabetes interval training which allows rest times between efforts is recommended for COPD patients | working up to 20 – 30 minutes of exercise 2-3 times per week |
| Progressive Strength / Resistance Exercises | increase strength of respiratory muscles increases upper, lower body and core strength maintains functionality for daily tasks maintains bone health reducing chances of osteoporosis | specific range of exercises for each muscle group selected by an exercise physiologist starting with 1 set with 8-10 Repetitions twice a week working up to 3 sets of 6 - 10 Repetitions three times a week |
| Breathing Exercises | Pursed Lip Breathing - sealing the lips and breathing through the nose while exercising, this may reduce breathlessness during and post exercise effort. Diaphragmatic Breathing - method of breathing used to strengthen the diaphragm,decrease breathing rate and therefore oxygen demand and decrease effort needed to breathe. | during exercise exercises may be performed as much as COPD patient desires the more regularly the better |

### Guidelines you Should Know Before Getting Started

An exercise evaluation by a certified exercise physiologist(EP) is highly recommended to assess your current cardiovascular capabilities and any other conditions that may be present eg. cardiac issues. The EP will conduct a range of fitness and medical tests and determine an appropriate exercise program tailored just for you!
* http://www.essa.org.au/essa-me/how-can-an-accredited-exercise-physiologist-help/

## Further Information / suggested reading / Support Groups

* COPD in Australia The Australian Lung Foundation
* The COPD-X Plan - Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease 2012 COPD-X
* COPD Facts COPD Statistics
* Support Groups for COPD Support Groups

## References

* ↑ http://www.asthmaaustralia.org.au/COPD.aspx
* ↑ http://www.asthmaaustralia.org.au/COPD.aspx
* ↑ http://www.asthmaaustralia.org.au/COPD.aspx
* ↑ Salvi SS & Barnes PJ 2009. Chronic obstructive pulmonary disease in non-smokers. Lancet 374:733-43
* ↑ http://www.thoracic.org/clinical/copd-guidelines/for-patients/what-is-chronic-obstructive-pulmonary-disease-copd.php
* ↑ http://www.webmd.com/lung/copd/pulmonary-rehabilitation-for-copd
* ↑ http://my.clevelandclinic.org/disorders/chronic_obstructive_pulmonary_disease_copd/hic_diaphragmatic_breathing.aspx
* ↑ Puhan, M. A., Schünemann, H. J., Frey, M., Scharplatz, M., & Bachmann, L. M. (2005). How should COPD patients exercise during respiratory rehabilitation? Comparison of exercise modalities and intensities to treat skeletal muscle dysfunction. Thorax, 60(5), 367-375.
* ↑ Woods, K., Bishop, P., & Jones, E. (2007). Warm-up and stretching in the prevention of muscular injury. Sports Medicine, 37(12), 1089-1099.
* ↑ O'Donnell, D. E., Webb, K. A., & McGuire, M. A. (1993). Older patients with COPD: benefits of exercise training. Geriatrics, 48(1), 59.
* ↑ Storer, T. W. (2001). Exercise in chronic pulmonary disease: resistance exercise prescription. Medicine and science in sports and exercise, 33(7; SUPP), S680-S686.
* ↑ Gosselink, R. (2004). Breathing techniques in patients with chronic obstructive pulmonary disease (COPD). Chronic Respiratory Disease, 1(3), 163-172.
* ↑ http://www.acsm.org/docs/current-comments/exerciseforpersonswithcopd.pdf