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.

The Telegraph – Do breathing exercises help with long-term asthma?

POWERbreathe MedicThe Telegraph online lifecoaches looked at health tips for long-term asthma sufferers.

The question of how effective breathing exercises would be for long-term asthma sufferers was raised and it was suggested that some people have found the Buteyko breathing technique helpful in reducing the level of symptoms.

For those asthma sufferers whose symptoms may be brought on by exercise, our very own POWERbreathe was suggested as a way of preventing this by exercising the inspiratory muscles (your breathing muscles) to reduce breathlessness.

If you have asthma and are using the POWERbreathe Medic or another POWERbreathe model to help relieve your asthma symptoms then we’d love to hear from you and share your experience with others. Please simply leave a comment here. Thank you.

Exercise benefits to overcome Dyspnoea for COPD sufferers

Dyspnoea is the term used to describe a shortness of breath. The medical term is shortness of breath derived from a particular medical condition including asthma, bronchitis or pneumonia. Anyone who suffers from these conditions will be prone to severe dyspnoea and will require the need of some form of respiratory support to help them breathe with ease and more comfortably.

Chronic obstructive pulmonary disease (COPD) causes the breath to shorten causing you to struggle with your breathing. Symptoms will be rapid up and down movement of the chest as the person will be struggling to take breath. Suggested treatment for COPD includes medication that will reduce any swelling in the airways as well as pulmonary rehabilitation. However, exercise is also a good remedy as part of your rehabilitation. Adopting some breathing techniques will enable you to breathe more comfortably, with ease and also benefit you in other ways.

Improves your circulation

Participating in some sort of aerobic exercise can aid your breathing. Aerobics is a fast paced workout which elevates your heart rate while you are exercising thus improving your circulation. Better circulation in your body will deliver more oxygen efficiently to your muscles and tissues in your body. COPD sufferers will tend to have oxygen levels below maximum capacity which can lead to oxygen deprivation and serious problems. Regular aerobic exercise under medical supervision can regulate a fast heartbeat associated with COPD.

Strengthen your muscles

Muscles can be strengthened by undertaking weight bearing exercise. This is particularly useful if you are a swimmer or walker. Working out with hand weights is great for strengthening muscles throughout your body. Not only do you strengthen your muscles but you also strengthen your heart, your lungs and your diaphragm and help them become stronger day by day. If these organs are not functioning properly then this form of workout is extremely important.  By remaining strong and active you will be more independent for longer periods of time. However, remaining inactive your muscles will weaken putting you at risk of accident and injury.

Management of weight

If you are overweight this can lead to severe problems with your breathing particularly if you suffer from COPD or chronic lung disease. Excess fat tends to appear mid body as people put on weight. Carrying this extra weight around causes problems for the diaphragm as more pressure is exerted on the diaphragm, which is the muscle that controls your breathing.  Regular exercise can help you shed the excess weight, which in turn will lead to breathing more comfortably and with ease.

Will I see a reduction in my symptoms

Anyone with a lung disorder such as asthma or COPD will know how difficult it is to breathe properly. It is imperative that you exercise as much as your condition allows, to see a significant reduction in the symptoms of your lung disorder. Exercise will improve your blood pressure, regulate your sugar levels and overcome the shortness of breath you experience.

Regular exercise is also a morale booster and confidence lifter if you suffer from COPD or a breathing difficulty due to being overweight.  Regular exercise will make you feel better within yourself and lift your mood and help you focus on positive emotions rather than negative ones such as depression, stress and anxiety. Exercising is an effective COPD treatment and is also effective for the treatment of Dyspnoea as well as any other medically related breathing condition.

 

Causes of shortness of breath

Many causes contribute to shortness of breath, the most common being underlying respiratory or heart problems. This article provides a look at shortness of breath.

Significance

Shortness of breath is also known as dyspnoea and is defined as air hunger, or the sensation of having the urge to breathe caused by a lack of oxygen in the blood. Shortness of breath that is caused by exercise or strenuous activity is relatively normal and is not associated with pathology in healthy individuals. It is when shortness of breath is indicative of a serious, underlying disease that it becomes an issue of significance.

Types

There are a number of risk factors associated with the development of shortness of breath, with smoking the most common factor. Other risk factors include second hand or passive smoke, occupational and environmental exposure and allergies. A genetic history of hereditary heart disease or hereditary lung disease such as cystic fibrosis can also expose someone to episodes of shortness of breath.

Considerations

Shortness of breath is a common complaint and is often associated with heart or lung problems that are either acute (sudden) or chronic (long-term) in nature. For example, sudden shortness of breath in a reasonably healthy individual may be a sign of pnuemothorax (air between the lungs and chest wall), which is a medical emergency. In a patient who has recently had surgery, sudden shortness of breath may indicate pulmonary embolism (a mass of undissolved matter that blocks the vessels in the lungs), which can also be an emergency.

The inability to breathe comfortably while sitting up may be seen in people who have chronic heart disease or chronic obstructive pulmonary disease (COPD), while complaints of sudden shortness of breath may be associated with a heart attack or congestive heart failure.

Dyspnoea that is accompanied by wheezing is often seen in emphysema, chronic bronchitis or asthma. Moreover, shortness of breath that is noisy may denote an airway obstruction by a tumour or a foreign body. Dyspnoea can also be caused by anaemia, or haemoglobin deficiency, as the body tries to compensate for not having enough oxygen.

Whatever the reason that is producing the shortness of breath it must be determined in order to treat the underlying cause.

Identification of shortness of breath

More often than not people who experience shortness of breath tend to ignore it, thinking that it will eventually go away. However, if this is ignored then it can lead to complications including hospitalisation or even death. It is important that if you are experiencing shortness of breath you seek medical attention. Other symptoms that may accompany shortness of breath include flaring nostrils, sweating, and anxiety.

Shortness of breath should be evaluated by a Doctor. Relief of symptoms, in severe cases, may also be achieved by the administration of oxygen or other medication, depending upon its cause. To conclude, shortness of breath is one of the most common symptoms of respiratory or heart disease and is often accompanied by other signs and symptoms. It is imperative that early recognition and treatment for dyspnoea are paramount to overcome the problem of shortness of breath.

Breathing exercises for your sports training

Breathing is a process which is critical to humans to stay alive as it is a process that helps us function properly. A process that does not require thinking it is just automatic and part of everyday life.  Breathing allows us to bring oxygen into our bodies then use the oxygen as energy. Although a simple process, there are many ways breathing can be inefficient for our bodies.

By adopting some simple breathing exercises we can improve the quality of our breathing and make it work more efficiently for us. Breathing is critical and without breath we will not survive. However, adopting some breathing exercise can help us maintain and regulate our breathing.

Breathing exercises have a dual purpose. By breathing properly it allows the body to get more oxygen with less effort, making every physical and mental activity more efficient throughout the day. Breathing exercises also help the body, mind and soul relax when under stress or when clarity is needed. Stress can be literally blown away with the breath and your breath is the safest of all places to focus your consciousness.

Breathing exercises can be done just about anywhere at any time. However, it is always best to choose a quiet place where you can sit or stand comfortably with your spine straight. Make sure you keep your eyes and chin on level with the horizon. It is important that you are in relaxed and loose clothing.

Learning Breathing

Learning breathing is important and the steps below explain some techniques for breathing exercises.

  1. When you are breathing it is imperative that you pay attention to your breath. Don’t try and alter the breathing pattern, just observe it.  If you do find yourself becoming distracted, gently focus back to what you are doing.  Every day, try and increase the length of time that you can do this and you will be on your way to great progress.
  2. Sit on a chair with your head bent down toward your knees. Inhale through your nose the deepest breath you can, making sure your belly presses into your legs and your body rises up. Your rib cage should get very wide. Exhale through your nose. Repeat this twenty times. Once complete sit up slowly, as you may be slightly dizzy from the breathing.
  3. Squeeze more air out on exhalation by using the muscles in between your ribs (the intercostal muscles). Exhale, and then squeeze more air out. Do this whenever you think about it. This will eventually lengthen the exhalation so that it matches inhalation and will encourage the body to draw in more and more air.
  4. Focused exhalation will encourage your body to bring more breath in. Breathing is like a cycle. You exhale to begin breathing which is the top of the circle. Inhaling finishes the breath and is the bottom half of the circle.  Make sure to squeeze your rib muscles and push all the air out of your lungs. Then breathe in to “reset” and begin the breath cycle again.

Stimulating Breath

Stimulating breathing exercises should be done in the morning to wake you up. If you feel tired as the day progresses, take a few minutes and stimulate your breath to increase your physical and mental energy. A great way of doing this is by practising some Yoga techniques. Put your tongue in the yogic position, on the ridge of hard tissue behind palate of your teeth. Yoga says that the energy systems of the body, positive and negative, connect at those two positions – the tongue and roof ridge. The technique is to breathe rapidly in and out through the nose with the mouth lightly closed. This should be as fast as possible and both your inhale and exhale should be noisy. Progress starting at 15 seconds and increasing by 5 seconds per day until you reach 1 minute.

Quickly Calming Breath

This is the breathing exercise that you should adopt if you are upset and want to calm yourself down quickly.  Observe the way you are breathing but don’t try and change it.  Focus on how you can make your breath deeper, quieter and slower, more importantly regulate your breathing pattern.  Focus on inhaling and exhaling and keep going until you notice a change in your breathing pattern and you feel at ease with yourself.

Breathing exercises are extremely important in everyday life as it helps calm you down and reduce stress and tension. In our everyday life we face many situations that put us under pressure. Anyone who participates in stamina related sports will know how important breathing exercises are for sports training. An athlete will suffer shortness of breath during training but by following these breathing exercises they will be able to control their breathing.

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