Training a client with COPD (Chronic Obstructive Pulmonary Disease)

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.

How POWERbreathe has helped me with Emphysema and my cycling

My name is Ben Hund and I was diagnosed with Alpha 1 induced emphysema and COPD, 3 years ago. What a nice wake up call! Fast forward to today and I finally feel like I have come to terms with this disease mentally and physically. A little background is in order.

I have always been extremely active and raced bicycles on and off for the past 6 years. Last year, I tried to race. By “trying to race”, I was able to hang with the pack for a lap, only to get dropped and to finish the race by myself. That wasn’t a lot of fun if you’re the least bit competitive! At the end of the season a friend who knew of my condition told me about POWERbreathe and I figured it couldn’t hurt to try it. I have been using it for the last three months. During this time I have done my winter training and the results have been amazing! Last year after a hard interval I couldn’t catch my breath. Now I am recovering and powering through the next interval. This was confirmed with my last pulmonary check up. Compared to last year all my numbers have improved. I’m entraining less air and diffusing more oxygen into my bloodstream.

Needless to say you won’t catch me without it. Thank You POWERbreathe!

Ben Hund

Emphysema – what it is and what causes it

When it comes to Emphysema not everyone is clear as to what it actually is and what causes it. Emphysema is a progressive lung disease that results in shortness of breath which in turn reduces your overall capacity for physical activity.

Emphysema is caused by damage that occurs to the small air sacs and small airways in your lungs. It is this damage that obstructs your airflow when you breathe out. At its most advanced stage, emphysema consumes a great deal of energy making the simple task of breathing much more difficult. This is a condition that develops over a period of years and you may not experience any symptoms of shortness of breath until the damage to your lungs has occurred. The emphysema treatment helps to relieve you of those symptoms of shortness of breath and helps avoid complications that can occur.

Causes of emphysema

When you inhale, air travels to your lungs through two major airways off the wind pipe (trachea) called bronchi. Inside your lungs, the bronchi subdivide like the roots of a tree into a million smaller airways (bronchioles) that finally end in clusters of tiny air sacs (alveoli). You have about 300 million air sacs in each lung. Within the walls of the air sacs are tiny blood vessels (capillaries) where oxygen is added to your blood and carbon dioxide — a waste product of metabolism — is removed. The air sac walls also contain elastic fibres that help the very small airways leading to the air sacs expand like small balloons when you breathe.

With emphysema, the walls of the alveoli are damaged by inflammation. Alveoli can lose their natural elasticity, become overstretched and eventually rupture.  Several adjacent alveoli may also rupture, forming one large space instead of many small ones.

Inflammation destroys these fragile walls of the air sacs, causing them to lose their elasticity. As a result, the bronchioles collapse, and air becomes trapped in the air sacs, which overstretches them and interferes with your ability to exhale. In time, this overstretching may cause several air sacs to rupture, forming one larger air space instead of many small ones. Because the larger, less elastic sacs aren’t able to force air completely out of your lungs when you exhale, you have to breathe harder to take in enough oxygen and to eliminate carbon dioxide.

The most common cause of this condition is cigarette smoke. It is most likely to develop in cigarette smokers, but cigar and pipe smokers also are susceptible, and the risk for all types of smokers increases with the number of years and amount of tobacco smoked. As soon as cigarette smoke reaches the bronchial tubes that is when the damage begins.

Bronchial tubes are lined with microscopic hairs which sweep away irritants and germs from the airways. However as soon as the smoke reaches these microscopic hairs the sweeping movement is paralyzed and irritants remain in the bronchial tubes and then infiltrate the alveoli, inflame the tissue and break down the elastic fibres.

Emphysema is a condition that can seriously hinder your physical activity, particularly if you are fond of sports. If you are a tennis player then your tennis performance can be drastically affected by emphysema. However, with emphysema treatment you can continue to breathe with ease and participate in your physical sports activity.

 

 

 

 

Running with COPD

When people are out running they can sometimes struggle when trying to draw in oxygen to cope with the demands the body is placing on them.  This would be normally be associated with someone who is physically out of shape. However, if the symptoms persist then it could be more medically related and it is advisable you contact your GP.

Whether you are a seasoned runner or new to running, breathing difficulties are quite common regardless of age or fitness so it is always advisable to get checked out as this could be a more serious condition such as COPD or asthma.

When out running, the respiratory system plays a critical role in the body’s proper functioning. During any type of vigorous physical activity, the muscles require a significant amount of oxygen. As a result, the respiratory system must work much more quickly and efficiently to deliver this oxygen. Air is pulled into the body through the mouth or nose, and then flows down the airways into the lungs. In the lungs, oxygen is exchanged for carbon dioxide. After this exchange, oxygen is transported to various parts of the body, while carbon dioxide is exhaled. Breathing problems such as COPD can be caused by a number of problems in the lungs or airways.

Some runners may suffer from chronic obstructive pulmonary disease (COPD). This refers to several different lung diseases, which make breathing an extremely difficult task, particularly if you are a keen runner. The three main conditions in the COPD category include emphysema, chronic bronchitis and chronic asthmatic bronchitis – all as severe as each other. Sufferers of COPD have an extremely difficult time breathing, even while they are resting. However, if the person attempts to run, the symptoms will likely become significantly worse. To ensure safety, a person with COPD should consult a physician for advice on COPD treatment. There are various treatments available for COPD sufferers including:

  • Quitting smoking if you are a smoker.
  • Taking medication to dilate airways and decrease airway inflammation.
  • Vaccinations against flu and pneumonia.
  • Oxygen supplementation
  • Pulmonary rehabilitation.

Taking advice from your GP or medical health advisor can help improve running performance if you are a keen runner or are looking at starting to run.