from Chapter 8

Exercise, Breathing Techniques, and Other Physical Therapies

The primary aim of physical therapeutics for chronic obstructive pulmonary disease (COPD) is to help you improve your breathing, help restore functionality, increase your vitality, and improve your quality of life. Exercise and physical therapeutics consist of activities such as walking and other aerobic exercises, pursed-lip breathing, diaphragmatic breathing, yoga, qigong, tai chi, and massage therapy.

Physical activity is an essential part of maintaining health in general, and when it comes to building up the health of an individual with COPD, exercise and physical therapies should always be performed to the extent that an individual can tolerate. The sedentary lifestyle that often accompanies COPD will ultimately contribute to a deterioration in functional capacity, cardiovascular function, and skeletal muscle mass. In order to avoid further health complications that can result from a sedentary lifestyle, it is essential for you to maintain aerobic fitness and strength to the extent that you are able.

Exercise or physical therapeutics will not reverse the damage of COPD, but exercise will enable your muscles to be able to extract oxygen from the blood more efficiently. Once that has occurred, you will experience less shortness of breath when you exert yourself.

Unlike therapeutic protocols such as diet and nutrition, nutritional supplements, and herbs, the degree to which COPD patients can become involved with exercise or physical therapies will always depend upon the status of their condition. Many COPD patients are elderly, and perhaps fragile or debilitated, and these are factors that will limit how much and what kind of exercise they can do. It is very important to consult your doctor before beginning any exercise program.

WALKING AND OTHER AEROBIC EXERCISE

Aerobic exercise is physical activity that makes the heart and lungs work harder to meet the body’s increased need for oxygen. Aerobic exercise also enhances the circulation of oxygen through the blood. Daily walking is one of the best aerobic exercise activities for a COPD patient. Walking will help your circulation and increase your stamina, and it will help build activity tolerance. Start out by walking half a block or less. Every other day, you should increase your walking distance a little bit. After a few months, you could be walking up to a mile without gasping for air. While you are walking, you should inhale through your nose and exhale through your mouth using the pursed-lip breathing technique (discussed below).

Other aerobic forms of exercise that have a positive effect on COPD are treadmill walking, bicycling or stationary cycling, and swimming. As many daily activities also require the use of the arms and the upper body, it is advisable to include endurance and strength training for your upper body in your exercise program. Consult with your physician or physical therapist to find out what types of endurance or strength training are most appropriate for your situation.

BREATHING TECHNIQUES

Two special breathing techniques especially helpful for people with COPD are pursed-lip breathing and diaphragmatic breathing. Pursed-lip breathing is a good method for helping to control dyspnea (shortness of breath). Diaphragmatic breathing helps improve the ability of the lungs to expand.

Pursed-lip Breathing

Pursed-lip breathing is one of the easiest ways to control episodes of breathlessness. It is a quick and easy way to slow down your pace of breathing so as to make each breath more effective. Pursed-lip breathing helps to prolong exhalation, which then helps to slow down your breathing rate. It also helps to improve the ventilation of the lungs, keeps the airways open longer, and decreases the work of breathing. All of these factors contribute to easing your shortness of breath and helping you to relax.

Perform pursed-lip breathing as follows: While relaxing your shoulders and your neck, inhale (take a normal breath) slowly through your nose while keeping your mouth closed. Then purse your lips (position your lips) as if you were going to whistle. Slowly and gently exhale through your pursed lips. After you learn this technique, with a little practice, you may utilize it whenever you find yourself having shortness of breath. Always make sure that your exhalation phase (breathing out) is longer than your inhalation phase (breathing in). If you are using pursed-lip breathing while engaged in an activity, always make sure you exhale during the strenuous part of the activity.

Diaphragmatic Breathing

Diaphragmatic breathing helps your lungs expand so that they take in more air. This breathing technique will help to strengthen your diaphragm as well as help to decrease the work of breathing by slowing down your breathing. When you practice this breathing technique, keep your chest, shoulders, and neck as relaxed as possible. The aim is to keep your upper body still and rely solely on your diaphragm.

Diaphragmatic breathing is performed as follows: Lie on your back on a flat surface, such as the floor or your bed, with a pillow under your knees and your head. Your knees should be slightly bent. Place your left hand on your upper chest and your right hand on your abdomen. This will enable you to feel your diaphragm move as you breathe. With your hands in place as just described, inhale slowly through your nose so that your stomach moves out against your right hand. You should be able to feel your right hand on your abdomen moving out. Your left hand on your chest should not move at all. Then tighten your stomach muscles and let them move back in as you exhale with the pursed-lip technique. As you are exhaling, you should be able to feel your right hand on your abdomen moving in, and your left hand on your chest should still not be moving at all.

After you have perfected diaphragmatic breathing while lying down, you can then do it while relaxing in a chair, or even standing. Diaphragmatic breathing should be practiced 5 to10 minutes, 3 to 4 times a day.