Within each edition of Fitpro Network, the magazine for personal trainers, they ask an expert to answer a training-related query, and in the April/May 2012 edition they examined training a client with COPD. We thought we’d share the question and answer with you. Q: A new client has chronic obstructive pulmonary disease (COPD). What do I need to be aware of when training them and how much impact can exercise have on their condition? A: According to the NHS, COPD is the name for a collection of lung diseases including chronic bronhistis, emphysema and chronic obstructive airways disease. People with COPD have trouble breathing in and out, with these breathing difficulties being due to varying degrees of damage to the lungs, usually caused by smoking.1 COPD can progress to become a life-threatening respiratory condition. According to the World Health Organization,2 COPD is the fourth leading cause of death worldwide. There are approximately 900,000 people in the England and Wales with COPD, of which more than 250,000 die each year. The consequences of COPD may be quite serious – daily activities can become very difficult as the condition gradually worsens over time. Symptoms can include a chronic cough, dyspnoea (breathlessness with even the slightest exertion), wheezing, muscle weakness (muscle wasting occurs in about 30% of those with COPD), plus high and low blood pressure. Even though physical activity will have no effect on the life expectancy of the individual, according to the 2008 GOLD report,3 there are many reported benefits of exercise on the overall quality of life. These include a reduction in symptoms improved muscular capacity, lower risk of hospital admission and mortality, and improved ability for functional tasks. These benefits highlight the importance that those with COPD perform some form of physical activity. It is also important that you inform the client’s GP as anyone with more than mild COPD will be under direct specialist supervision. One form of activity that is generally recommended is that of ventilatory training (e.g.,PowerBreathe). It is thought that including this type of training as well as cardio training benefits the individual more than just performing ventilator training in its own. As can be seen in the guidelines, the use of a dyspnoea scale is recommended. This particular scale gets the individual to rate their own level of discomfort. The scale is a sliding one; zero indicates a discomfort level of nothing at all, three is moderate, five is severe and 10 is maximal. Those with more severe COPD generally have limited aerobic capacity and poor posture, therefore several very short periods of activity with rest in between and upper-body strength exercises should be encouraged. The primary goal is usually to begin with aerobic-type activities and then gradually introduce resistance-type activities. Trainers should be familiar with warning signs of any cardio respiratory problem such as worsening dyspnoea, swollen ankles and high resting heart rate. If in any doubt, cease all physical activity and seek medical advice. FN Morc Coulson Morc is senior lecturer in health-related exercise and programme leader of sports and exercise sciences at the University of Sunderland. His book Exercise for Special Populations is out now. References 1. www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease/Pages/introduction.aspx 2. World Health Organization (2009), WHO Disease and injury country estimates, http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html Retrieved 11 June 2010. 3. GOLD (2008), Global initiative for chronic obstructive lung disease, Pocket guide to COPD diagnosis, management and prevention: A guide for health care professionals, Medical Communications Resources Inc. 4. American College of Sports Medicine (2009), Exercise management for persons with chronic diseases and disabilities (3rd edition), Human Kinetics, Champaign, IL. END....Fitpro Network | April May 2012 Analysis from controlled trials reported improvements following the use of inspiratory muscle training (IMT), and guidelines such as those issued by NICE for the management of COPD, acknowledge that this form of breathing training has a part to play in the treatment of COPD. Read more about IMT and COPD or view which model of POWERbreathe for COPD is available.