SCHOOL OF HEALTH

SCIENCES

Exercise for Chronic

Respiratory Conditions

Lung Foundation Seminar

8th October 2016

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Pathophysiology - Effect on Airways

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More than just a lung disorder

Systemic Inflammation

COPD is a multi-component disease characterised by systemic inflammation

Respiratory System Side Effects

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Benefits of Exercise

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It’s not about…

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It’s about…

More

Less

Components of Exercise

Endurance (Aerobic) • Any prolonged rhythmic exercise that raises your breathing rate,

such as walking, swimming, dancing, and cycling. These are especially good for your heart, lungs and circulatory system.

Strength (Resistance) • Include lifting weights, climbing stairs, doing body weight

exercises. These will strengthen your muscles and improve balance, which will help to prevent falls, the leading cause of death from injury in people over 65.

Flexibility (Stretching) • Activities include stretching, yoga, Tai Chi, and Pilates. These keep

joints limber. Increased flexibility will allow you to continue to reach the top shelf in your kitchen and do simple day to day activities.

Therapeutic benefits of aerobic exercise

training for COPD patients.

Benefits

• Improved endurance

• Reduced

breathlessness

• Improved CV health

• Assist with weight

control

• Improve mood

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Recommendations for Aerobic

Training

Exercise

Component

Recommendation

Intensity 40-80% of maximal effort (Modified Borg 2-4/10)

Duration Aim for 30 minutes; broken into smaller durations if

necessary due to symptoms

Frequency 1-2 sessions 3-5 days/week.

Role of Interval Training

• Greater benefits to exercising muscle without overloading

the heart and lungs

• More severe COPD patients unable to sustain continuous

load

• Interval exercise is as effective as continuous exercise

Gloeckl et al. 2013 Eur Respir Rev

Exercise

Component

Recommendation

Intensity 80-100% of maximal effort (Modified Borg 4-6/10)

Duration Aim for 45-60 minutes; broken into smaller durations

eg. 30s of exercise, 30s of rest

Frequency 3-5 days/week.

What about resistance training

• COPD patients have high levels of skeletal muscle

wasting, dysfunction and peripheral muscle weakness

– Strength scores in COPD patients average ~80% of those in a

control population

– Cross section of thigh muscle averaged 76% of that of the

control

• Leads to decreased physical function, quality of life

and increased morbidity

Strength Gains

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Liao et al, 2015

Recommendations for Strength Training

Exercise

Component

Recommendation

Intensity 60-80% of maximal effort (Modified Borg 3-4/10)

Sets and

Repetitions

1 set of 8-12 repetitions initially; additional sets added

as strength improves.

Frequency 2-3 days/week.

6-8 exercises using large muscle groups

Recommendations for Flexibility

Training

Exercise

Component

Recommendation

Intensity Low to moderate

Sets and

Repetitions

30 seconds minimum for each static stretch; all major

muscle groups

Frequency 3+ days/week

Balance Training?

• COPD is associated with Increased falls

risk

• Reduced bone density increases risk of

fracture

• Balance training can reduce falls and

fracture risk

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What are Balance Exercises?

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Sample Home Exercise Program

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1. Warm up – A few minutes

2. Exercise – Duration ?

3. Stretch / cool down – A few minutes

Sample Exercise Program… with progression

• Walk every second day for 5-10 minutes

• Set an easy pace the first week, go a little faster the 2nd

week, stop and rest when needed.

• Introduce some light resistance exercises 2 x per week

• Walk FOUR times a week for 10-20 minutes at a

comfortable pace;

• Increase your sets or repetitions for resistance exercises

• Walk FOUR to FIVE times a week.

• Increase your pace as capable while aiming for up to 30

minutes of continuous walking;

• Start to pump or swing your arms;

• Do some resistance exercises every second day

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Weeks 1 and 2

Weeks 3 and 4

Weeks 5 and 6

… and beyond

Contraindications

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If you experience any of the following symptoms when you are exercising stop and rest immediately: • Nausea • Chest Pain • Dizziness or feeling faint • Extreme shortness of breath • Excessive wheezing • Coughing up blood

• Fact Sheets

• Practical Information for Patients and Carers

• Lung Foundation Australia www.lungfoundation.org.au

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Resources

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Lungs in Action

• Eligibility? – Patient with a chronic respiratory condition who has

completed pulmonary or heart failure rehabilitation with the last 12 months without any subsequent hospitalisations

• Referral Requirements? – From a GP or your pulmonary/heart failure rehabilitation

physiotherapist/accredited exercise physiologist

• Location (Tasmania) – Launceston, Hobart, Ulverstone

• Referral Forms – http://lungsinaction.com.au/health-professionals/participant-

eligibility/lfa-lia-entry-form-standard/

Need guidance & support?

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See an Accredited Exercise Physiologist AEPs specialise in individualised exercise programs for persons at high-risk of developing, or with existing chronic conditions (such as COPD, heart disease or diabetes) or injuries. Rebates are available through:

GP chronic disease management plan

Medicare (EPC items)

Department of Veterans Affairs (DVA)

WorkCover-NSW

Private Health funds

www.essa.org.au

How to find an Exercise Physiologist

http://www.essa.org.au

UTAS Exercise Physiology Clinic

Tamar Lane Mowbray – entry to campus from Foch Street

For more information contact:

Andrew Williams

Phone: 6324 5487

Andrew.Williams@utas.edu.au

Sibella King

Phone: 6324 4005

Sibella.King@utas.edu.au

Questions?

REMEMBER.. EXERCISE IS MEDICINE!

Balance Exercises

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