# Exercise as it relates to Disease/The importance of exercise for patients with Chronic Obstructive Pulmonary Disease (COPD)
## What is COPD?

COPD is a condition caused by poor lung function which results in difficulty breathing$^{(1)}$. The two main types of COPD are:$^{(1)}$
* Chronic bronchitis: long term inflammation of airways
* Emphysema: loss of elasticity in airways

## Can I still exercise with COPD?

Yes! Patients with COPD are less likely to be active and limit activities that cause shortness of breath$^{(1)}$. BUT it is important to follow an exercise program to improve breathing and the ability to carry out daily activities$^{(1)}$.

## What is the best type of ‘cardio’ exercise for me?

With COPD, the amount of time in which you can comfortably exercise for may be reduced$^{(1)}$, so you may find that during long, continuous exercise you have to rest$^{(2)}$. This means that one of the best ways to exercise is interval training, which alternates periods of work and rest$^{(1)}$

## How can interval exercise help?

Interval training can improve your:
* ability to perform daily activities and quality of life$^{(1)}$
* feeling of breathlessness during exercise$^{(3)}$
* overall exercise time$^{(4)}$
* work interval time before you need to rest$^{(4)}$

## Exercise recommendations

Walking is a great way to get started because it is simple and no equipment is needed$^{(5)}$. The following program can be used as a guide but is important to have an individualized program made with the help of an exercise physiologist.
General 'cardio' program for a patient with COPD$^{(1)}$
| | Frequency: 3 days a week : Monday, Wednesday and Friday Intensity: warm up = mild, noticeable to patient but not to observer; work periods = mild, some difficulty, noticeable to observer |
| Week 1 | 5 min warm up 2 x 5 min work periods with 5 min light movement as rest. 5 min cool down. |
| Week 2 | Add an extra 10 min work period so the total exercise time is 30 mins (1 x 5 min, 1 x 10 min, 1 x 5 min). |
| Week 3 | Add an extra 10 min work period so the total exercise time is 40 mins (1 x 5 min, 1 x 10 min, 1 x 5 min, 1 x 10 min). |
| Week 4 onwards | Increase work intervals to maintain mild exertion, noticeable to observer. |

### Other tips that may be helpful to complete exercise

* Pursed lipped breathing$^{(2)}$, which involves sealing the lips and breathing through the nose, may help reduce the feeling of breathlessness during and after exercise.

## For more information

* The Australian Lung Foundation - Save your breath booklet Phone: 1800 654 301
* To contact local Exercise Physiologists - Exercise and Sports Science Australia (ESSA) Phone:(07) 3856 5622

## References

1. Wilson, M, Swank, AM & Felker, J. Exercise strategies for the individual with chronic obstructive pulmonary disease. Strength & Conditioning Journal. 26(3): 58-63, 2004.
2. Kortianou EA, Nasis IG, Spetsioti ST, Daskalakis AM, Vogiatzis I. Effectiveness of interval exercise training in patients with COPD. Cardiopulmonary Physical Therapy Journal. 21(3):12-19, 2010.
3. Vogiatzis, I, Nanas, S & Roussos, C. Interval training as an alternative modality to continuous exercise in patients with COPD. European Respiratory Journal. 20:12-19, 2002.
4. Vogiatzis, I, Nanas, S, Kastanakis, E, Georgiadou, O, Papazahou, O & Roussos, C. Dynamic hyperinflation and tolerance to interval exercise in patients with advanced COPD. European Respiratory Journal. 24: 385-390, 2004.
5. Leung, RWM, Alison, JA, McKeough, ZJ, Peters MJ. Ground walk training improves functional exercise capacity more than cycle training in people with chronic obstructive pulmonary disease (COPD): a randomised trial. Journal of Physiotherapy (Australian Physiotherapy Association). 56(2):105-112, 2010.
6. Spahija, J, de Marchie, M, Grassino, A. Effects of imposed pursed-lips breathing on respiratory mechanics and dyspnea at rest and during exercise in COPD. Chest. 128(2):640-650, 2005.