# Exercise as it relates to Disease/Resistance Training and Chronic Obstructive Pulmonary Disease
## What is COPD & How is it Treated?

Chronic Obstructive Pulmonary Disease (COPD), often referred to as Chronic Obstructive Lung Disease (COLD) or Chronic Obstructive Airway Disease (COAD), is a degenerative disease of the lung characterised by chronic airflow problems. The most common cause of COPD is tobacco smoking while environmental exposure to noxious gases; air pollution and childhood infections all contribute to an increased risk. Symptoms include coughing, shortness of breath and mucus production.
The most widely used pharmacological treatment for patients with COPD is the inhalation of short and long term acting Bronchodilators. Long term oxygen therapy (LTOT) is the most effective non-pharmacological treatment for increasing survival rates in severe cases.

## Exercise Capacity & COPD

COPD sufferers often experience a reduced exercise capacity due to the restricted airflow to the lungs. Reduced exercise tolerance will also increase the difficulty in performing daily tasks and participating in events and lead to a higher utilisation of health care resources.
Peripheral muscle weakness is a common occurrence amongst COPD patients and contributes to a reduced exercise capacity. Debate continues over the root cause of the peripheral muscle weakness though the two main causes are thought to be the systemic impact of the disease (oxidative stress, systemic inflammation, hypoxia, malnutrition) and treatment (oral corticosteriods) or the sedentary life style that most patients live. Some evidence exists that higher levels of muscular strength are correlated with increased health-related quality of life (HRQL).

## Resistance Training for COPD Patients

The most effective way to combat muscle weakness in COPD patients is through a well planned resistance training program using either free or machine based weights. Subjects should be thoroughly screened by an accredited Exercise Physiologist for other health conditions prior to commencing any resistance training program to ensure that any comorbidities that may exist are accounted for in the program design.
The table below summarises the training protocols used in a variety of studies that looked at the effect of resistance training on COPD patients.
| Study Author | Frequency & Duration | Intensity (%1RM) | Sets | Repetitions |
| Bernard et al. | 3/wk for 12wks | 60-80 | 2-3 | 8-10 |
| Clark et al. | 2/wk for 12wks | 70 | 3 | 10 |
| Ortega et al. | 3/wk for 12wks | 70-85 | 2-4 | 6-8 |
| Simpson et al. | 3/wk for 8wks | 50-85 | 3 | 10 |
| Spruit et al. | 3/wk for 12wks | 70 (+5 each week) | 3 | 8 |
Based upon the training protocols shown above and taking into consideration individual fitness levels and the principle of overload a training program for a COPD sufferer should initially consist of:
* 2–3 days per week of resistance training
* 2-4 exercises per day
* 2-3 sets of 8-10 repetitions of each exercise
* ~60% of a 1RM (actual or calculated)
As the exercise capacity of the individual increases the number of days, number of exercises, sets/reps and intensity can all increase incrementally. Correct technique should be emphasised especially in the initial phase of training. This will reduce the risk of injury while increasing the effectiveness of the exercise program.

## Further reading

* The Australian & New Zealand Guidelines for the Management of COPD
* Lung Foundation Australia - COPD Risks, Diagnosis, Management
* Australian based COPD support groups
* Find your local Exercise Physiologist

## References

* ↑ Mario Cazzola, Claudio F. Donner, Nicola A. Hanania (2007). One hundred years of chronic obstructive pulmonary disease (COPD), Respiratory Medicine, V101:6, pp1049-1065.
* ↑ Vestbo, Jørgen (2013)."Definition and Overview". Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Global Initiative for Chronic Obstructive Lung Disease. pp. 1–7.
* 1 2 Hanania N, Ambrosino N, Calverley P, Cazzola M, et al. (2005). Treatments for COPD, Respiratory Medicine, V99:2, ppS28-S40.
* ↑ Gosselink R, Troosters T, Decramer M, (1997). Exercise training in COPD patients: the basic questions. European Respiratory Journal, V10, pp2884-2891.
* ↑ Decramer M, Gosselink R, Troosters T, et al, (1997). Muscle weakness is related to utilisation of health care resources in COPD patients. European Respiratory Journal, V10, pp417-423.
* ↑ R Gosselink, T Troosters, and M Decramer, (1996). Peripheral muscle weakness contributes to exercise limitation in COPD. American Journal of Respiratory and Critical Care Medicine, V153:3, pp. 976-80.
* ↑ T Troosters, (2004). Endurance versus strength training in chronic obstructive pulmonary disease. Chronic Respiratory Disease, pp40-41.
* ↑ Toral MJ, Ortega F, Cejudo P, et al, (199). Peripheral muscle strength in stable COPD patients: correlation with respiratory function variables and quality of life. Archivos de Bronconeumología, V35, pp117-121.
* 1 2 Bernard S, Whittom F, LeBlanc P et al. (1999). Aerobic and strength training in patients with chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, V159, pp896-901.
* ↑ O’Shea S, Taylor N, Paratz J, (2004). Peripheral Muscle Strength Training in COPD: A Systematic Review. Chest Journal, V126:3, pp903-914.
* ↑ Clark CJ, Cochrane LM, Mackay E, et al., (2000). Skeletal Muscle Strength & Endurance in Patients with Mild COPD and the Effects of Weight Training. European Respiratory Journal, V15, pp92-97.
* ↑ Ortega F, Toral J, Cejudo P, et al., (2002). Comparison of effects of strength and endurance training in patients with chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, V166, pp669-674.
* ↑ Simpson K, Killian K, McCartney N, et al., (1992). Randomisied controlled trial of weightlifting exercise in patients with chronic airflow limitation. Thorax, V47, pp70-75.
* ↑ Spruit MA, Gosselink R, Troosters T, et al., (2002). Resistance versus endurance training in patients with COPD and peripheral muscle weakness. European Respiratory Journal, V19, pp1072-1078.