Chronic Obstructive Pulmonary Disease - COPD

What is Chronic Obstructive Pulmonary Disease?

Chronic Obstructive Pulmonary Disease otherwise known as COPD is a chronic inflammatory lung disease that causes obstruction of airflow from the lungs that is not fully reversible (1). COPD is the leading cause of avoidable hospital admissions affecting over 1 in 4 Australians aged over 75 years old (1). 7.5% of Australians aged over 40 years old are affected by COPD that is of at least moderate severity (1). It’s typically caused by long term exposure to irritating gases or a matter like cigarette smoke. Emphysema and Chronic bronchitis are the two most common conditions that contribute to COPD. Chronic bronchitis is inflammation of the lining of the bronchial tubes, which carry air to and from the air sacs (alveoli) of the lungs (1). It is categorised by a daily cough and mucus production. Additionally, the inflammation in the small airways leads to injury and scar tissue formation which narrows that airway lumen (1). Emphysema is a condition in which the alveoli at the end of the smallest air passages (bronchioles) of the lungs are destroyed as a result of damaging exposure to cigarette smoke and other irritating gases and particulate matter. In addition to the enlarged air spaces it also reduces the area available for gas exchange. 

How Exercise can help?

Dyspnea (shortness of breath) is the most common side effect of COPD and most notable exercise limiting symptom which leads to exercise avoidance (2). Research suggests that breathlessness related fear/anxiety is one of the most common barriers to exercise and participation in daily life activities (3). However, not performing regular exercise such as aerobic and resistance training can cause your muscles to become weak. Weak muscles use MORE oxygen and are less efficient which results in making breathlessness worse. This is a vicious cycle of inactivity. Pulmonary rehabilitation aims to reverse the cycle of inactivity and breathlessness and is the most effective non-pharmacological management to improve symptoms of COPD. Exercise aims to make your muscles stronger so that they use oxygen more efficiently making activities of daily living such as showering, hanging out the washing, walking or gardening easier. 

Benefits of exercise include:

 How much exercise is enough?

Benefits of exercise come from adaptations in the musculoskeletal and cardiovascular system resulting in reducing stress on the pulmonary system during exercise (1). Resistance training and cardiovascular training are shown to have benefits in managing the decline of hospitalisations and improving symptoms of COPD (1). 

It is recommended that people living with COPD exercise for 30 minutes a day. Interval exercise is considered more beneficial than constant load exercise as patients with COPD cannot sustain long enough periods of training to have true physiological training effects (4). This means that, that 30 minutes can be broken into 3 x 10 minute sessions if needed, at an intensity of 3-4 of the Borg dyspnoea scale. You do not need special equipment to perform strength exercise and improvements have been seen by just using your body weight, with things such as sitting and standing up from a chair, or you could use household items such as water or milk bottles to add weight to an exercise (5). Because individuals with COPD may experience great shortness of breath whilst performing those activities of daily living involving the upper body, it is beneficial to focus on muscles of the shoulder girdle when performing resistance training (1). It is also important to note that inspiratory muscle weakness is present, thus inspiratory muscle training is recommended. This will help with exercise tolerance and getting back to do those activities of daily living without experiencing as much shortness of breath.

Assessment and how an exercise physiologist can assist:

• Provide an in-depth assessment of medical history to see the whole picture.
• Explain lung function tests and educate how we can help. 
• Assesses an individual's functional capacity and prescribes safe and effective exercises based on these outcomes.
• Provides an exercise program that takes a graded approach, depicts a clear direction towards your goals and works within your current lifestyle.
• Follow up where required to ensure you are moving in a positive direction

Tips:

• Make sure you bring your inhaler/appropriate medication with you to wherever you exercise. 
• Don’t forget to take your prescribed medicine from the doctor before exercises
• Check if you have had any changes in symptoms such a sputum colour changes
• Make sure you drink enough fluid (water helps break up congestion)
• Reminder to clear your airway everyday if necessary to avoid infections.
• Overall, exercise based rehabilitation is a highly effective, safe, non-invasive treatment of COPD that will increase exercise capacity and improve quality of life. 

1. Morris NR, Hill K, Walsh J, Sabapathy S. Exercise & Sports Science Australia (ESSA) position statement on exercise and chronic obstructive pulmonary disease. Journal of science and medicine in sport. 2021;24(1):52–9. 

2.. Charususin N, Sricharoenchai T, Pongpanit K, Yuenyongchaiwat K, Namdaeng P, Laosiripisan J, et al. Beneficial Effect of Water-Based Exercise Training on Exercise Capacity in COPD Patients—a Pilot Study. Frontiers in rehabilitation sciences. 2021;2.

3. Lewthwaite H, Li PZ, O’Donnell DE, Jensen D. Multidimensional breathlessness response to exercise: Impact of COPD and healthy ageing. Respiratory physiology & neurobiology. 2021;287:103619–103619. 

4.  Louvaris Z, Chynkiamis N, Spetsioti S, Asimakos A, Zakynthinos S, Wagner PD, et al. Greater exercise tolerance in COPD during acute interval, compared to equivalent constant‐load, cycle exercise: physiological mechanisms. The Journal of physiology. 2020;598(17):3613–29.

5.. Patel S, Palmer MD, Nolan CM, Barker RE, Walsh JA, Wynne SC, et al. Supervised pulmonary rehabilitation using minimal or specialist exercise equipment in COPD: a propensity-matched analysis. Thorax. 2021;76(3):264–71. 

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