EXERCISE FOR COPD SUFFERERS

It is difficult to write with confidence about exercising at home. COPD patients often vary widely in terms of age, the severity of their breathing problem, their blood oxygen levels, and whether or not they have other chronic illnesses, such as heart disease or arthritis, to name but two.

However, after giving up smoking and taking the prescribed medication, exercise in any form is vital if you wish to improve the quality of your life. If you just sit in a chair all day, your muscles will waste away in a few months, your breathlessness will increase and then it's downhill all the way. John's father did not have COPD but when he was in his late 80s he developed a fear of falling. "This fear arose from the fact that two of his friends had fallen and both ended up in hospital, and one of them had died. So this fear was in a sense justified, but he solved it by spending most of his time in a chair. Within a short time he developed leg ulcers and had no choice but to move into a nursing home. There he spent all of his time in a chair and the bed within two feet of it. He died within six months of a heart attack and with no quality of life whatsoever".

Exercise is safe and well-tolerated in COPD patients provided that it is tailored to an individual’s need.

TIP - USE YOUR RESCUE INHALER (SAY VENTOLIN or BRICANYL etc) BEFORE YOUR EXERCISE NOT AFTER OR DURING. THE REASON FOR THIS IS THAT IF YOU ARE OUT OF BREATH YOU WILL NOT INHALE AS DEEPLY AND THEREFORE THE MEDICINE WILL NOT SETTLE IN YOUR LUNGS. CONSULT YOUR GP WHETHER OR NOT YOU CAN EXERCISE SAFELY.

TIP - IF YOU HAVE HAD NO EXERCISE DURING THE WINTER DO NOT START AN EXERCISE PROGRAMME WITH HEAVY EXERTION IN THE SPRING. THAT MIGHT LEAD TO A HEART ATTACK!! START SLOWLY AND BUILD UP.

FURTHER TIPS FROM JOHN :

1) Pursed-lip breathing. This is helpful for some patients. It also may help you to bring rapid breathing and anxiety under control. Personally I have found it very helpful in raising my blood oxygen (02) levels and ridding my lungs of carbon dioxide (CO2). It involves breathing in quickly through the nose and then breathing out more slowly through the mouth until you fully empty your lungs . I practice this for at least 30 minutes a day and when I am walking or climbing the stairs. Try it and see if it helps you. Walk up a step or two breathing out, pause & inhale, move on again breathing out.

2) On exercise. letting your oxygen levels fall well below 90% (sats.) occasionally will not harm you. If, however, you do this many times a day, day after day, then it will eventually place too much strain on the heart and internal organs. Imagine living at base camp on Everest indefinitely! I know that people can adapt to high altitude where the oxygen levels are low, but your lungs are compromised and you cannot adapt. One of the best purchases I ever made is a pulse oximeter. This allows me to monitor my oxygen levels both at rest and with exercise, and use oxygen where appropriate on exercising.

3) Bending down or stretching too far can often lead to breathlessness. Avoid it where possible - keep your essentials on a table in front of you or within easy reach. If you have to pick something up from say the floor or above you use a grabbing device or sit down on the floor to rummage.

4) If taking a bath makes you very breathless, use oxygen while having one. Alternatively you might find it easier to just use a shower. Unless you sweat profusely and/or are prone to unpleasant body odours, it is not necessary to have a bath every day. I know some of you may throw up your hands in disagreement with this but in my opinion twice a week should be sufficient. The idea here is to make living with breathlessness easier and conserve your energy.

The reason for a lot of the conservation of energy measures is to make life more acceptable and therefore more enjoyable. You should do at least 20 minutes a day of concentrated exercise but you can't be expected with severe COPD to keep this up all day! I get quite tired in the evening and this shows when I climb up the stairs to the bedroom, and also in the morning before I've done some warm up exercises. Therefore the last thing I want to do is to struggle with sheets and blankets, either inside the bed or on making it in the morning. I use one duvet for the summer and two when necessary at other times of the year. It makes life easier!

If you or your partner/carer notice your lips going blue or indeed anywhere going blue and if you nave no oxygen ring 999 immediately. If you have oxygen use it but no more than 2 litres a minute unless otherwise instructed by your consultant or respiratory team. And if you have never experienced this before ring your GP immediately. One carer wrote in and said that this happened to her husband after walking only 50 metres. Urgent referral is then necessary for a possible prescription for ambulatory oxygen.

READ THE PATIENT/CARER STORIES  BELOW.

Various groups of COPD patients may be identified.

(a)Those with COPD with little bronchitis and no other medical complications and who do not desaturate below 90%. This group may find exercising easier and motivation may be the obstacle to a better quality of life; try to be positive about things, keep a record of your efforts and you will see how much better you feel and that will motivate you. This of course applies to all groups. My motivation slips a little in the winter months of January and February but when spring comes it is a totally different story

(b)Those with COPD and frequent bronchitis. This group might find exercising difficult if it causes an increase in coughing. Persevere and do it when you can and for short intervals. Rest and start again.

(c)  Those with COPD on very limited incomes. This group may not be able to afford expensive home equipment and will have to rely on walking and simple exercises taught in pulmonary rehabilitation.

(d)Those with COPD, with capital or larger incomes. This group will be able to afford the equipment outlined below and use it when its raining or in the winter.

(e)Those with COPD and heart conditions. I am very reluctant to suggest exercises for this group. You should discuss exercise with your GP, or consultant and respiratory and heart hospital department  and ask for a personal exercise plan.

(f)   Any patient who desaturates below 90% on exercising. This group should ask for ambulatory oxygen. IF YOUR NORMAL OXYGEN LEVELS ARE BETWEEN 91 -93% IT IS VERY LIKELY THAT YOU WILL EXPERIENCE FALLS WELL BELOW 90%. INSIST ON OXYGEN

(g)Patients with COPD who have arthritis or other disabling conditions. Simple exercises are probably best for this group, even with a walking frame. However, I should welcome advice from COPD patients (or physiotherapists) with arthritis and how they cope with exercise.

The first and best thing you can do is to find a pulmonary rehabilitation class. Here you will be taught basic exercises that you can do anywhere and they will be tailored to your condition. You will learn about COPD and whether or not your blood oxygen levels (Pa02) fall significantly during exercise (desaturate). Patients with just COPD will find that exercise is determined by your breathlessness and not your pulse rate.

FOR FOLLOW UP EXERCISES OR IF YOU CANNOT ACCESS A PULMONARY REHABILITATION PROGRAMME QUICKLY, THE ABOVE DVD WILL WORK WONDERS FOR YOU. ALL EXERCISES ARE SIMPLE AND CAN BE PERFORMED ANYWHERE. BUT YOU CAN USE OXYGEN IF YOU HAVE TO, ALTHOUGH THE DVD DOES NOT MAKE THAT CLEAR. YOU SHOULD BE ABLE TO GET ONE FROM YOUR GP/REDPIRATORY NURSE OR HOSPITAL. IF SUBMIT A PROFILE FOR MY NEW COPD FRIENDSHIPS SITE AND I'LL SEND YOU ONE FREE!!!! 

When I did a pulmonary rehabilitation course back in 2002 nobody seemed bothered about my drop in oxygen levels. Some respiratory department /nurses still don’t. I have no idea why, except before February 2006, ambulatory oxygen cylinders were quite heavy and therefore the weight outweighed the advantage of delivering oxygen to patients! The new lightweight cylinders are ideal. And of course companies now supply concentrators with 15 m plus of tubing which allows you to exercise in the garden, up and down the stairs or doing housework if you suffer from severe oxygen loss on movement.

Exercising while your oxygen levels are falling below say 88% every few minutes is not only going to leave you exhausted but act as a total disincentive and place excessive strain on your internal organs. Don’t do it – ask for ambulatory oxygen. You don’t need to be on oxygen all the time, just for exercising, and don’t be put off if someone says it’s addictive. It is not.

I’ve used oxygen for exercise for quite some time now and it does make life more pleasurable. However, keeping up with the exercises can be a chore and that’s why Breathe Easy groups can give some psychological support. You need to make a diary of your efforts and seek to improve it week by week.

Again the DVD above will help.

Patients on oxygen 24/7 (LTOT) will also benefit from the new lightweight cylinders, and allow them to exercise or travel outside the home. 

How do I start?

Well first try some warm up exercises.  I was taught the following.

Do exercises gently and slowly. Try not to overstretch a joint. Warm up to music and wear comfortable clothing.

(1) Turn your head to the right, and then back to the middle, now to the left.

(2) Bring your shoulders forward and then up, back and down.

(3) With your elbows bent raise your arms and make large circles with your elbows.

(4) Hands on hips, circle your hips round and round.

(5) Stretch your fingers down the side of your leg, back to the middle, now down the other side.

(6) Place one foot in front of the other, with both feet pointing forward. Gently bend the front knee keeping your heels on the floor. This will stretch the calf of your back leg. Repeat on the other side.

(7) Do that again with one foot in front of the other, circle your toes on the front leg. Now swap the position of your feet and repeat.

(8) Finish off by walking on the spot until you begin to feel moderately breathless.

My thanks to Jayne Trott for the above. All groups should be able to manage this.

After the warm-up exercises  you might try the following.

For example you might start by having a walk say to the end of the street and back or just the nearest lamppost. Do that a few times and then add to the distance. Write it down and reward yourself somehow – but not with a cigarette! Walking is an excellent form of exercise with or without oxygen. As your muscles develop, so they will become more efficient at using oxygen and so you will become less breathless or/and use less oxygen.

Now you will be on your way. Try adding some more exercise. If you have stairs, try stepping up and down on the first step for 2 minutes a day, then double it and so on. It’s quite a good idea to develop your arm muscles. Start say with two bags of sugar sitting down (that’s a kilo in each hand and lift them up and down, and repeat). There is no need to order special weights. After a week or two you could try something heavier. Be careful though. If you use something heavy just lift it one hand at a time, for example off a table. Or if you have a garden, try mowing the lawn, a few minutes at a time. Sit down and rest. Start mowing again. Soon you will find stripes on the lawn everywhere. Just think of that achievement with or without oxygen!

Why haven’t you mentioned gymnasiums or health clubs?

Well if you are elderly, you might not want or afford to go to one. Some local authorities or local groups organise and supervise classes. Ask your GP practice about that or ring up PALS or NHS Direct (SEE FINDING OUT). However, some people love going to a Health Club and find exercising with other people a great incentive. If you can afford it and are relatively fit enough (you know what I mean!) you will be able to use all their equipment and avoid having to improvise as I have suggested above. If you do, wash your hands frequently and avoid people with colds – going on a quiet afternoon helps. THERE IS A DANGER OF PICKING UP GERMS ETC ON EQUIPMENT, DOOR HANDLES ETC.

I have some money put aside and would like to exercise at home – can you recommend any equipment to buy?

First and foremost, especially if your oxygen levels have not been measured, I would buy a pulse oximeter. I bought mine two years ago and use it constantly to make sure I am exercising with blood oxygen levels (sats.) above 90%. It also makes sure I only use the minimum amount of oxygen. This costs around £300 but you can find cheaper ones now at £80. Your local Breathe Easy Groups have newsletters which may also contain advertisements for second hand ones.

Secondly I suggest you purchase an exercise bike (see picture in my companion site www.copdpatientdiary.co.uk  under April 2006.

– again you can try to find one second hand, otherwise they cost up to £400 new.

Thirdly you could purchase a walking machine – cheaper from Argos or again buy second-hand.

Lastly most people can afford to buy a PEDOMETER for under £30. You just put it in a pocket and it measures the number of steps that you take in a day. It would be great if you could manage 10,000!!

The point about buying these machines is that you can exercise indoors when it’s cold outside in winter or raining. But you can do without them by walking as much as you can during the week, going up and down a staircase and doing the basic exercises you have been taught on the Pulmonary Rehabilitation course or demonstrated on the DVD.

How much exercise should I be doing?

Well you could start with 30 minutes three times a week. If you have difficulties walking then try doing it 5-10 minutes at a time - use a walking frame if necessary to avoid falling. Rest for an hour or so then do another 5-ten minutes. After a few weeks try to increase the amount of time that you exercise – ideally to 30 minutes a day. As you improve, you could look forward to walking for longer periods or increase the intensity of your work-out – for example brisk walking. I know that sounds a bit ambitious. As you know by now I have severe emphysema and 30 minutes a day on the exercise bike (6 miles) is quite enough for me. But last summer outside with my oxygen, I was out walking on and off for a whole afternoon. It was far more entertaining and interesting than watching a TV programme opposite my indoor exercise bike. IF YOU CAN WALK FOR THIRTY MINUTES WITHOUT STOPPING IT WILL DO YOU MORE GOOD THAN JUST STOPPING EVERY 10 MINUTES.

EXERCISING IN THE EDEN BIOMES HAS TRANSFORMED MY LIFE