Lung Disease & Exercise

It used to be that patients with lung disease were discouraged to exercise. They were told to live quietly and not strain.

That all changed with research into the benefits of exercise for chronic lung disease patients, beginning in the 1960s. Today it is widely recognized that one of the most beneficial things a patient with lung disease can do for himself or herself is regular exercise.

The types and benefits of regular exercise for lung disease are several.

Aerobic Exercise

First, “aerobic exercise”, that gets the heart and respiratory system working over an extended time is absolutely the best type of exercise for lung patients. Its primary benefit is to improve a patient’s endurance and lessen patient’s sensation of shortness-of-breathe (SOB). Better endurance and less breathing difficulty allows patients to do more and feel better. Examples of these exercises are walking, treadmill, bicycling, stationary cycling, swimming, water aerobics, and upper-lower body exercisers like Nordic Track, etc. Fitness experts often recommend target heart rates for specific periods and other complicated formulas. But for lung patients, we recommend only a few simple rules to go by:

  1. First, frequency and consistency matter. Every day, for aerobic exercise, is best. But three days a week, at least, will really help.
  2. Pace yourself, and take breaks. Lung disease patients are limited by how much air they can get in and out of their lungs and how much oxygen they can put into their blood. When exercising, muscles pull oxygen out of the blood. When muscles pull oxygen out of the blood faster than lungs can put it in the blood, an oxygen deficit occurs. That is the oxygen level in the blood goes down below a critical level (usually an oxygen saturation of the blood of 90%). When that occurs, patients feel very SOB and the low blood oxygen is not good for the body. So to avoid that situation we recommend slowing down or taking a break if feeling more than mildly SOB. Most patients eventually, through trial and error, figure out the pace at which they can exercise effectively and comfortably. The pace is the exercise level at which the lungs can move enough air in and out and put enough oxygen in the blood to support the exercise. Pace is different for everybody, and may change over time. If you have advanced lung disease, you may need a pulmonary rehab (see separate article on Pulmonary Rehabilitation) program to help you determine your appropriate pace.
  3. We recommend the time goal for aerobic exercise to be 30 minutes. Certainly longer can be done and, for the most part, helps even more.  However, lung patients may be able to go only a short time or distance, before needing a rest. That is perfectly OK. We recommend that patients not get over short-of-breath, and get themselves into trouble. Use your common sense, and stop for a break when you feel that you are getting more than mildly stressed. Chronic lung disease patients often need several breaks to get all of their aerobic work in.
  4. It is not uncommon for patients to be only able to do a few minutes when they start. Again, that is fine. Don’t get discouraged, but set as a goal to increase your time or distance just a little every week.
  5. If you need oxygen to exercise – do it. It does not diminish the benefit of exercise at all. In fact, it is far better to exercise with oxygen, than not to exercise with no oxygen! Consult your doctor as to how much oxygen to use.

Strengthening Exercises

Second, strengthening exercises build individual muscles and muscle groups, and can help patients with chronic lung disease to be more “functional”. In advanced lung disease, muscle proteins (building blocks that muscles are made of) are sometimes broken down by the disease process itself, and also by a process called “disuse atrophy”. Disuse atrophy occurs when you don’t use muscles.  If you don’t use muscles you naturally lose muscle size and strength. Lung patients often avoid tasks that require some muscle exertion, because such activities make them “short-of-breathe”. Lack of muscle use results in muscle loss, which causes further decreased ability to work and exercise. For example, if a lung patient stops doing regular household chores, say vacuuming, because it makes him or her “winded”, then eventually the patient loses some arm, back and leg strength that comes from the muscle exercises of vacuuming. Less strength means that the patient may shy away from some other tasks, such as cooking, that involve some lifting or stirring, which they are no longer strong enough to do. So you can see that lung disease can lead to a cycle of muscle loss followed by more disability, followed by more muscle loss, etc. A situation develops whereby a patient is less and less able to do what they need and want to do. Activity level declines, and so does quality of life. Strengthening exercise can help break the downward spiral. So again a few simple rules:

  1. We recommend exercises that work several muscle groups at once, such as those use medicine balls.
  2. Exercising individual muscles or a small number of muscle groups is fine and good, but we do recommend a balanced workout of the upper, lower, and core muscle groups. This approach is best for optimizing function.
  3. Light weights and more repetitions are better than heavy weights and fewer repetitions.
  4. We recommend using a personal trainer, or structured strength building classes from certified professionals and programs, at least to begin with. It may not be financially feasible for everyone to do so. But a few sessions with trainer can help you set up your own program, and often the YMCA, or other community based centers, have very inexpensive programs.
  5. Pacing and breaks apply here too.

The Importance of an Active Lifestyle

We also encourage our patients to be as active as they can. An active lifestyle, outside of formal exercise time, is good medicine as well. The more active patients are, the more they are able to do, and in general, the more they are able to enjoy life.

Pulmonary Rehab

Finally, for patients with advanced lung disease, especially those needing oxygen, we strongly recommend a “pulmonary rehab” program to get started. See the article on “Pulmonary Rehabilitation”.

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