The Benefits of Exercise for COPD Patients
- Page 1 - COPD Athlete Russell Winwood shares how exercise has helped him
- Page 2 - Tips for getting started with exercise as a COPD patient
- Page 3 - COPD-friendly exercises to try
My Story
If dedicating 10 percent of your waking hours to exercise meant the other 90 percent would be significantly better, would you do it?
When you are diagnosed with COPD, your life is turned upside down; suddenly what you might have mistaken for just being unfit is diagnosed as an actual lung disease. There are so many questions and it can seem like things will only get worse from here.
I'm not a doctor or respiratory specialist, but I’d like to tell you my experience of living a fantastic life despite my COPD — through the power of exercise.
Background
I was diagnosed with COPD in 2011. I’d been training for a triathlon for about three months and had noticed my times were getting slower and I could no longer keep up with my training partners. I was constantly getting chest infections, which in turn were limiting my exercise capacity.
The build-up of scar tissue in my airways from a combination of childhood asthma, repeated chest infections and years of social smoking had reduced my lung capacity to between 22 and 30%. My specialist told me it was likely that at some stage in the future I'd need a double lung transplant.
Rebuilding
I hit rock bottom once I was diagnosed. I stopped exercising. I constantly felt tired and short of breath. By 10 each morning, I wanted to go back to bed. It was incredibly frustrating for a normally active person like me.
While prescribed medication was helping control my shortness of breath, what I really I wanted was to restore my energy levels to a point that I could exercise again. Actually, it wasn’t just something I wanted; for both my physical and mental wellbeing it was something I needed.
My wife, Leanne, investigated a few complementary and alternative therapies and I tried salt therapy with no success. Then Leanne heard about a Chinese medicine practitioner who had apparently helped many people with chronic illness, so we decided to give him a try. He advised there was no guarantee the treatment would work and that I’d have to take a course of medicines over at least six months and gradually my energy levels might improve.
The practitioner gave me a mixture of herbs to be taken with boiling water twice daily, along with 10 tablets. I was very skeptical about this ‘magic potion’ but in hindsight, that was very narrow-minded of me. There may be limited evidence and plenty of skepticism on the effectiveness of traditional Chinese medicine, but it definitely worked for me, raising my energy levels at least to a point where I could start exercising again.
Skepticism is a good thing when it comes to medical treatment, but my experience and the experience of others' shows these treatments can help, and probably need a bit more consideration by western medicine in terms of chronic and respiratory diseases.
The Challenge
While Chinese medicine might have given me the kick I needed, if you ask me what the number one thing making a difference to my quality of life is, I’ll tell you it's exercise. Regular exercise means feeling great; not exercising means poor breathing and poor health – something I have proven regularly over the last three years.
Before I was diagnosed I had entered the Australian Ironman event to be held in May 2012 , and while my respiratory physician had some misgivings about me continuing with my plans to race, he set me some guidelines to follow in training for the event.
Through some exercise testing we found that when my heart rate reached 150 bpm, my oxygen levels started to drop and I would become hypoxic. This became the most important rule of my training program – do not go over 150 bpm for too long.
I had five months to train before the event, and armed with my exercise program and my Chinese medicine I recommenced my training.
People with COPD often tell me they can't run, swim or ride a bike and that they can’t even walk 20 meters without getting puffed. My answer to that is to walk that 20 meters, then recover and walk 20 more.
We all have different starting points but the same principle applies: building exercise capacity takes time and a lot of effort.
The Work
Training for my first Ironman involved many slow walks, slow rides and slow swims. My swims involve the use of a pool buoy, which is a device placed between your inner thighs to help keep you afloat from your waist down. This makes swimming easier as I don't have to worry about kicking, and allows me to concentrate on my stroke.
I can’t swim more than 25 meters when kicking as I become hypoxic, but without kicking I can swim up to 4500 meters. In all of my races I have completed the swim without kicking.
After five months of training six days a week (about 18 to 22 hours a week), my fitness and energy levels surpassed both mine and my doctor’s expectations. I was feeling great!
Race day arrived and I had 17 hours to complete a 3.8 km swim, 180 km bike ride and a 42.2 km run. What a feeling it was crossing the finish line in 16 hours 50 minutes. I don't know if anyone else with stage IV COPD has ever achieved this, but I'm living proof it can be done.
In the following months I gave my body some time off to recover and reduced my exercise regime to once or twice a week, thinking I was doing the right thing. Unfortunately nothing could be further from the truth – my reduced fitness from lack of exercise resulted in weight gain, more breathlessness and greater fatigue.
This made me realize that in order to have a good quality of life and to control my COPD – rather than let it control me – I had to have a goal to work towards, and an exercise plan that would have me exercising between 15 and 20 hours a week.
The Benefits
Since my first Ironman I have completed two more, both in 2014. The training I've had to do for these races was enormous, but my fitness level and breathing were the best they've been in years.
I’ve learnt more about my airways and breathing exercises for COPD that allow me to swim, cycle and run more efficiently. My lung function results haven't changed, and I can still only reach 225 on my peak flow meter on a good day, but I can do so much more with my life now.
I know many people with COPD would find this many hours of exercise a week hard to comprehend, but consistent exercise has allowed me to build up to this level. There are obviously limitations on what people can achieve because of their own circumstances, and being on oxygen has its own challenges when designing an exercise program.
But regardless of your starting point, an exercise program planned in consultation with your respiratory specialist and coach is going to have a positive effect on your health.
In three years I have gone from being worried about what my future holds to being excited about the years ahead and the adventures life will take me on. If COPD was looking for a fight it picked the wrong person, because I will go the distance!
Getting Started With Exercise as a COPD Patient
If exercise is important for people without COPD, isn't it even more important for people with COPD?
A key ingredient for improved quality of life for people with COPD is improving respiratory muscle strength. Many studies into endurance exercise have found significant benefits in strengthening respiratory muscles which in turn lead to greater exercise capacity.
A combination of aerobic and anaerobic exercise programs can be created for most COPD patients that can significantly improve both skeletal and respiratory muscle strength and endurance.
Many people with COPD become panic-stricken at the mere suggestion of an exercise program since it would make them even more breathless than normal. But the golden rule of entering into any exercise is to start slowly and work within your boundaries.
So, if you’re not already incorporating exercise into your lifestyle, then maybe it's time. Here's how to get started.
See Your Doctor
Before you start on any exercise program, it's important to check with your doctor about what your limitations are. The biggest mistake a COPD patient can make is starting an exercise regime without knowing what they are capable of.
Before I first started training for events my doctor had me undergo exercise stress testing to see what my lungs could tolerate. The stage of your COPD and your history of exercising in most cases will govern where your starting point is.
After your doctor has received the results of your exercise stress test they will be able to point you in the right direction.
Nutrition
Whether you have a chronic disease or not, nutrition is an important part of exercise and should not be ignored. To get the most out of our bodies we need to fuel them properly so we have the energy required to exercise regularly. It's important with nutrition to develop an eating plan that is not only full of good quality foods, but foods you enjoy.
Eating good quality food should be part of your lifestyle and not just a fad. A nutritionist will be able to make planning your new way of eating easier.
Many people associate nutritional food with eating a lot of tasteless food that doesn't satisfy their appetite. This may have been somewhat true in the past, however today with all the research into nutrition and available recipes, I’ve found not only is it easier to have a good eating plan but the available recipes are tasty and satisfying.
Accountability
Having measures in place to make yourself accountable for exercise is a good way to make it habit. Whether it's committing to exercise with friends, gym classes, or entering events.
We all need something to make us follow through with what we set out to achieve. When I was able I used to train with my friends either by going on bike rides or running together.
Now that I can no longer keep up with them I've had to find new ways to make myself accountable, like entering events I have to train for and training with my wife. It's important to find a way to make yourself accountable, and if you can do that with company it's an added social bonus.
What Worked for Me
Starting out on an exercise program after being diagnosed with COPD was like going back in time. I had to learn about my body all over again, what it could do, how long it could do it for and the frequency I could venture out.
It all started with walking for me; short slow walks turned into long slow walks and so I progressed. Building your exercise capacity as a COPD patient is a much slower process than a healthy person, as your capabilities are limited by the amount of oxygen you have available to use.
My doctor had given me strict instructions not to elevate my heart rate over 150 bpm for any length of time; this was due to me becoming hypoxic above this level. So everything for me was slow, but as my fitness grew so did my tolerance to exercise and with that I was able reach new levels.
In time I was able to start cycling and then swimming; being able to do this motivated me to do more and make the decision to return to triathlons.
For me to reach this stage took a lot of discipline, hard work and determination. Exercise was no longer easy like it was before being diagnosed with COPD, laboring to breathe standing still is hard, so breathing under exertion has its limitations.
There's no doubt that the more you do the better you can do it, and while I still find exercising hard work, my body has adapted to working with a decreased oxygen supply.
The most important thing I've learned in regard to exercising with COPD is you have to have consistency. Exercise can't be just an eight-week program, it has to be part of your lifestyle at least three or four days a week of activity — for me it's seven days a week.
COPD-Friendly Exercises to Try
It's important when starting exercise to find something you enjoy, as this will mean you will find it easier to incorporate your activity into your daily life.
Mobility is a factor to consider as well; if you’re confined to a wheelchair or your home then you will have to start with exercises that are safe to do depending on your circumstance.
- Breathing Techniques — One of the most important things you can do for yourself is to learn how to control your breathing. This will help you if you’re having an exacerbation as well as when you’re exerting yourself. Breathing techniques are an important tool for me to use when running, cycling or swimming, as using oxygen efficiently is crucial for me when training in these disciplines. Again, your doctor should be able to help with this or suggest a pulmonary rehabilitation class that will teach you the techniques required.
- Stretching Exercises — Whether you’re restricted in your mobility or not, stretching exercises are a great way to start and end an exercise session as it can relax your muscles. Your doctor should be able to prescribe a series of stretches that suit your circumstance.
- Weights — One of the benefits of a weights session is, whether you’re mobile or not, the session can work for you. Weights can be purely for building strength to help with daily chores or can be adapted to a combination of strength and cardio to aid in cardio fitness.
- Walking — Whether you are outdoors or on a treadmill, walking is a great way to ease yourself into exercise. You are able to control your pace, distance and duration to suit your level of fitness. On a treadmill you can vary the incline to change the intensity of your workout in the same way walking up hills effects your intensity outdoors.
It's About Being Active
This is just a small sample of exercises that can be adapted according to the severity of your condition. It doesn't matter where you’re starting point is, because as soon as you start to become active your body will appreciate it.
In a perfect world, having your doctor and an exercise professional involved with your exercise program from the start will put you in a good place to make exercise a part of your life. If you are unable to find the appropriate people to help you start exercise, there are many national associations that can point you in the right direction.
Not enough emphasis is placed on fueling your body for exercise, but if your serious about improving your quality of life, nutrition places an important role. Exercising when not fueled correctly can often result in lethargic sessions with poor technique, which can result in injury.
There's a wealth of information online in relation to nutrition and some can be quite confusing. If you are finding it difficult to separate the good nutritional advice from the bad remember this rule: if it's processed try and avoid it, if it's natural eat it in moderation. This rule has served me well over the years.
Sustainability Is Key
Sadly, many people with COPD who start on the exercise journey find it too difficult to keep going and drop out. Feeling breathless can trigger anxiety attacks and make us question whether what we’re doing is really helping. What we have to realize is we are working our muscles and exerting ourselves, and being short of breath is normal in that situation.
Experience has taught me that it’s all about starting at a pace that you can cope with. I see too many people set too high an expectation, only to be frustrated they aren't getting the results they wanted in the time they expected.
It’s a similar story to the many people who turn up at the gym for the first time at the end of winter and tell their instructor that they want to have a perfect body by summer. Change takes time, commitment and patience; if we continue to burn ourselves out striving for unrealistic expectations, eventually we just give up.
The single most important rule of starting an exercise program is sustainability, because without a plan to sustain your program, you will not stick to it. A sustainable program should be written in consultation with your exercise instructor and your respiratory specialist. Together they can do a series of tests to determine your baseline exercise capacity. Keeping your oxygen levels in a safe range is very important when exercising, so you don’t become hypoxic and put too much stress on your heart.
Using exercise equipment in a controlled environment like a gym can be a good starting point, as equipment like treadmills, cross trainers and exercise bikes can be set at a low pace to start with. The other advantage of a gym is that you are limiting environmental factors such as air pollution and pollen. If you’re like me and have allergies to carpets and dust, then a gym with hard floors will be beneficial. Be thorough in your preparation and you'll start your exercise program at a level you can sustain and gradually build your exercise capacity.
Making a Change
When making a decision to start exercising for COPD, it can pay to write down the advantages and disadvantages and then make an informed decision.
Exercise strengthens our muscles and the stronger our muscles, the less effort we use to breath and the less breathless we become. Very easy really, except for the fact that exercise means being short of breath, and being short of breath is something that COPD patients like to avoid.
Exercising now is far more difficult than it was before I was diagnosed with COPD. When I'm not training for a race, I aim for 1.5 hours exercise a day — roughly 10 percent of my waking hours. Doing this allows me to work full-time in our two businesses without having to have daytime naps (as I did when first diagnosed with COPD) and to function relatively normally.
We know COPD is a degenerative disease, so we can’t significantly improve our lung capacity, but we can slow the process down by implementing lifestyle changes. Giving up smoking, having a heathy diet and exercise is the best way you can get on the road to achieving and maintaining a better quality of life.
While I still have my bad days, they are few and far between and I have much better control of my breathing.
Start the New You Today
If this post has motivated you to make a change, then do something straight away rather than just thinking, “That sounds like a good idea, I'll start next week."
Sit down and write an action plan and determine how much time you can devote each day to your plan. You may not be able to see a respiratory specialist as quick as you’d like but you can make other changes in your life, such as your diet or talking to a gym or fitness instructor or personal trainer about starting some simple stretching exercises to get you started.
In the Ironman events I’ve completed so far the most important tool I’ve had in training and on race day is my mind. Your mind tells your body what to do!
Success is guaranteed when failure is not an option.