Exercise helps COPD patients

Therapy can ease symptoms

Q: I was recently diagnosed with emphysema. My inhalers are helping, but I still get winded when I walk. Do you think that a rehab or exercise program would help me?

A: Doctors used to think that people with chronic obstructive pulmonary disease (COPD), the medical name for emphysema and chronic bronchitis, had little hope of improvement, even with medication and oxygen therapy. But research and experience have shown otherwise, which is good news for the 11 million Americans who have COPD. Whether your condition is moderate or advanced, if you have breathlessness and other symptoms even when using medication, chances are you will benefit from pulmonary rehabilitation.

Pulmonary rehabilitation is a comprehensive program conducted by a team of specialists, such as physical and respiratory therapists. It can take place in a hospital, rehabilitation facility, outpatient clinic or in your home. Most programs last about six weeks, but they can vary to meet your needs.

The most important part of pulmonary rehabilitation is aerobic exercise, which boosts your endurance and strengthens your muscles, lessening your symptoms and improving your tolerance for activity. It usually involves walking on a treadmill or cycling on a stationary bicycle. The particular exercises you do will depend on your tolerance for exercise and the condition of your joints, bones and muscles.

If you can't walk due to severe breathlessness, you may start off on a stationary bicycle or make cycling motions while sitting in a chair. If you can walk but have little endurance, you may use the treadmill, slowly increasing the time and intensity of your workout. Many rehabilitation programs also offer strength and flexibility training. That's because people with COPD often have weak arm, leg and trunk muscles that limit physical activity. Strength training may be done by lifting weights, using weight machines or pulling on elastic bands. Flexibility training consists of stretching exercises.

Exercise therapy has many benefits, according to an analysis of several trials published by the American College of Physicians in 2003. The research found that patients who had exercise therapy experienced less shortness of breath and fatigue, had greater exercise capacity (they could walk farther, for example), could do more day-to-day activities and felt better emotionally. But the benefits last only as long as you keep doing the exercises, and that means for the rest of your life.

Making the transition to exercising on your own is one of the most important aspects of your rehabilitation. Some pulmonary-rehab programs offer maintenance sessions that you can attend periodically so that a health professional can assess your progress. Even if such sessions aren't available, you'll have to continue exercising on your own either at a gym or community center or in your home.

The second element of pulmonary rehabilitation is breathing retraining. People with COPD often find that they can't get enough air to be active. Breathing retraining offers strategies to improve breathing efficiency, which will lessen your symptoms. It may include paced breathing, pursed-lip breathing and diaphragmatic breathing.

With paced breathing, you inhale just before you start a physical activity — getting out of a chair, for example — and then exhale slowly as you do it. The therapist also may suggest you purse your lips as you breathe out to slow down your exhalation. Diaphragmatic breathing is a technique musicians use to fill their lungs to capacity by making the abdomen move out as they inhale. It helps you to use your breathing muscles more efficiently and makes paced breathing more effective. Many patients who use these techniques report having more stamina and less breathlessness.

The third piece of pulmonary rehabilitation is learning how to take an active role in managing your illness. For example, you will be taught how to use medication and oxygen therapy correctly. Patient-education sessions may also review how to recognize COPD flairs (called exacerbations) and when to call for assistance, so early treatment can keep you out of the hospital. It may also explain how to avoid substances that can irritate your lungs and provide practical advice for healthy travel and good nutrition.

Keep in mind that pulmonary rehabilitation is not a cure for COPD. Nor will it slow the progression of the disease. But it can reduce your symptoms, increase your strength and improve your endurance. If you have been missing work or have been unable to tackle daily activities because of the disease, rehabilitation can help you manage your symptoms well enough to return to work or resume other activities. If your disease is advanced, it can help you take on tasks, such as getting dressed on your own, that may have become difficult or impossible. With some supervision, education and steady effort on your part, you should be breathing easier. That's what rehabilitation is all about.

The Harvard Medical School Adviser is researched and written by the faculty and staff of Harvard Medical School. Visit www.health.harvard.edu/adviser.