The Benefits of Exercise for Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease or COPD is the third leading cause of death in the world. It is a devastating disease that leads to poor quality of life.

Due to shortness of breath, people with COPD limit their physical activity. As a consequence, the muscle mass gets smaller and leads to more weakness.

There are two types of COPD: Chronic bronchitis and emphysema.

In Chronic Bronchitis, the partial obstruction is produced by the airways’ inflammation and excess mucus production.

In emphysema, the collapse of air sacs in the lungs causes the obstruction.

The obstruction makes it difficult to exhale. That is why people with COPD tend to exhale longer.

Some of the inspired air within the lungs tends to stay there in COPD and accumulate. That results in less space available for incoming fresh air and oxygen.

COPD and Muscle Weakness

The frequent occurrence of dyspnea or shortness of breath leads to inactivity, which may last for days and further deconditioning.

Chemical changes happen to the muscles. Citrate synthase and 3-hydroxyacyl coenzyme A dehydrogenase enzymes decrease in the lower limbs.

This lowers the lower ability of the muscles to use oxygen for fuel. Making the muscles get tired easily.

A physical change also happens to the muscle fibers. The two major types of skeletal muscle fibers are the Type 1 and Type 2 muscle fibers.

Type 1 muscle fibers need oxygen for fuel. They are what we use for physical activities that we do for several minutes. Examples are walking, slow running, and breathing.

Type 2 fibers are anaerobic. Anaerobic means they don’t use oxygen as a fuel source. Lactic acid is a by-product of anaerobic metabolism.

Type 2 fibers are used for sudden movements and for lifting heavy objects. Since they are anaerobic, they can only work well for a short period of time, just like sprinting or lifting something hefty.

The decrease in the muscle enzymes mentioned above makes the Type 1 fibers and fatigue easily and are not used. This gives the COPDer a sensation of fatigue, and hence they rest more than move.

Any muscle fibers get smaller or atrophy once they are not used.

As the Type1 fibers get less in number, the Type 2 fibers predominate.

The predominance of Type 2 muscle fibers during regular activity produces more lactic acid. The higher acid levels also result in fatigue at lower levels of physical performance.

This leads to a vicious cycle of being short of breath – being sedentary – further weakening the muscles and more shortness of breath.

The deconditioning happens not only to the muscles of the arms and legs but also to the respiratory muscles, including the diaphragm.

That is why it is necessary to break the vicious cycle. The good news is that there is a way.

COPD and Comorbidities

People with COPD may have other conditions like diabetes, hypertension, obesity, and heart disease. All of these conditions can benefit from a higher level of physical activity.

The easy fatigability promotes a sedentary lifestyle that will worsen blood sugar control, atherosclerosis, and elevate the blood pressure.

How to Improve the Lung Functions with Physical Activity

Pulmonary rehabilitation is very effective in improving lung functions.

Lower extremity endurance activities like cycling and walking on a treadmill have been proven effective in scientific studies to reduce dyspnea among COPD patients.

Sessions should at least be twice a week or, better yet, 3 times a week.

Three 45-minute sessions on a stationary cycle ergometer like the one shown below for 6 weeks have shown improvement in exercise capacity.

With endurance activities, the deconditioned muscles become reconditioned and start to get larger again, leading to greater exercise capacity.

Muscle biopsies done after exercise programs have shown elevated oxidative enzymes, including citrate synthase and 3-hydroyacyl-CoA that increases the muscle fibers’ ability to use oxygen.

The muscles improved ability to use oxygen means the lungs do not have to work as hard as before to deliver oxygen. This results in less air hunger.

Bodyweight exercises and lifting weights have also shown greater increases in muscle strength compared to endurance exercises alone. This is particularly useful in those with muscle atrophy and deconditioning.

Resistance training and endurance training have been combined and shown greater improvements in health status.

Resistance training can be done with 1 lb dumbbells, cans of soup, or small beans or rice bags.

An important thing to remember is that the rehabilitation should be performed at the highest tolerable intensity. This will maximize the training time for a greater training effect in a shorter period of time.

What else to do to make COPD better?

Quit smoking
Medication compliance
Use supplemental oxygen if prescribed.
Eat well
Sleep well.
Use your CPAP if you have sleep apnea.
Talk to your doctor before starting on any exercise program.

Below is an example of Pulmonary Rehab Home Program

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COPD and Muscle Weakness

COPD and Comorbidities

How to Improve the Lung Functions with Physical Activity

What else to do to make COPD better?

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