Most people do not think much about breathing until it becomes difficult (i.e., when you’re exercising, when you come down with a cold, etc). When you have a breathing disorder, you’ll suddenly find yourself thinking about your lungs in ways you never did before, and you'll no longer take breathing for granted. Knowing what goes on inside the body helps. The more you understand about how the lungs work, the better you’ll be at figuring out how breathing disorders affect you and your clients.
Breathing disorders such as chronic bronchitis, emphysema and asthma are conditions associated with chronic obstructive pulmonary disease (COPD) and are the most common diagnosed diseases related to respiratory dysfunction. Chronic bronchitis is an inflammatory condition caused by persistent production of sputum due to a thickened bronchial wall, which in turn creates a reduction of airflow. Emphysema is a disease of the lungs that affects the small airways. An enlargement of air spaces accompanied by the progressive destruction of alveolarcapillary units leads to elevated pulmonary vascular resistance, which in most cases can contribute to heart failure. Asthma is usually brought on by a spasmodic contraction of smooth muscle around the bronchi that produces swelling of the mucosal cells lining the bronchi and an excessive secretion of mucous. Constriction of airway paths associated with asthma results in attacks that may be caused by allergic reactions, exercise, air quality factors and stress.
Pulmonary diseases affect the respiratory system’s ability to transport oxygen during exercise to the tissue level via the cardiovascular system. The systematic breakdown that occurs as a result of inadequate oxygen supply creates a greater than normal demand on the function of the cardiorespiratory system, in some cases markedly reducing exercise tolerance.
The major signs or symptoms of COPD include the following:
- Dizziness or fainting (syncope)
- Unusual fatigue or shortness of breath with usual activities
- Shortness of breath at rest or with mild exertion
- Rapid heart rate (palpitations or tachycardia)
- Pain and/or discomfort in the chest, neck, jaw, arms or other areas that may be due to lack of blood flow
It is important for personal trainers to understand these signs and symptoms. If an individual exhibits these signs or symptoms, it is the role and responsibility of the personal trainer to take appropriate action, and if you are ever unsure of what the appropriate action is, refer your client elsewhere.
COPD steals your energy, which has a ripple effect through the rest of your body during everyday activity and exercise. For clients with healthy lungs, normal breathing doesn’t take a lot of energy. In fact, clients with healthy lungs only use energy to breathe when they inhale to inflate the lungs (exhaling is a passive activity because healthy lungs are elastic and can push the air out on their own). With COPD, the lungs can lose that elastic quality, so you have to use extra energy to force air out of the lungs. In other words, your client has to use twice the energy just to breathe. The gas exchange is less efficient, so your client’s body doesn’t have as much oxygen to fuel itself, and your client becomes tried more quickly. Some clients will even use more calories to breathe, which may sound good but is not as it leaves fewer calories for energy and exercise. Unfortunately, the energy drain can also make it harder for clients with COPD to get the nutrition they need. The digestion process itself takes a great deal of energy, so COPD clients often do not feel like eating (medication can also affect appetite), which can be very unhealthy.
As we all know, exercise has many benefits. It makes your heart and circulatory system stronger, helps control blood pressure and improves the heart’s ability to pump blood, which in turn means more oxygen and energy. The lack of oxygen and sufficient calorie intake (as stated before) may lead to a loss of muscle mass and strength. This is why exercise is such a critical component of a comphensive treatment plan for any severity of COPD. Aerobic exercise like walking or riding a stationary bike helps to bring more oxygen into the body and tone the muscles. This kind of conditioning has been shown to reduce symptoms like shortness of breath and improve overall quality of life, no matter the severity of your client’s COPD. A regular exercise regimen improves sleep quality, which increases energy and promotes better posture, balance and flexibility. The list of positives for regular exercise in COPD sufferers goes on and covers everything from emotional to physical strength and everything in between.
Before starting any COPD exercise program, an evaluation of physical activity and exercise patterns should be completed. This evaluation needs to include identifying the specific activity and the frequency, volume and level of intensity of that activity. Also, you'll need to document any potentially harmful signs or symptoms associated with the activity, particularly shortness of breath or chest pains. Any musculoskeletal concerns related to joint discomfort or chronic pain should also be identified.
Every effective exercise program needs to take into consideration proper regression and progression. With clients who have COPD, every exercise should be a regression (the level of regression will be dependent on the individual's fitness level). The following aerobic exercises are listed in order from LEAST to MOST likely to induce an attack such as exercise-induced asthma or exercise-induced bronchitis.
- Pool Swimming
- Low Intensity - The moisture will help keep the air passage from drying, which can cause an attack.
- Low Intensity - It is very easy to keep the heart rate consistent when walking.
- Low to Moderate Intensity - The intensity can be easily controlled while cycling.
- Treadmill Running
- High Intensity - The body needs more oxygen for this activity, so you most progress to this point.
- Outdoor Running
- High Intensity - A lot of oxygen is needed to run outdoors, plus the outside temperature could cause an attack. This is the last aerobic progression.
Any progression beyond this could be to increase the intensity further by introducing weight training. The key is to pay close attention to your client's breathing. The weight training program to follow looks like this:
- Light Weight/Moderate Reps
- Low Intensity - Helps to build a foundation.
- Basic Movements (i.e., push, pull, bend, twist, lunge, squat)
- Help to improve posture, which will make it easier to breath.
- Body Weight Movement
- Low to Moderate Intensity - You can control the intensity by adding speed and reps.
- Isometric Exercise/Continual Resistance
- Low to High Intensity - Push muscles to endurance failure, which is great for calorie burn and strength building.
- Circuit Training
- High Intensity - Perform both aerobic and anaerobic workout. This is the last progression point.
The key is keeping the workout intensity controlled until your client has progressed to a higher intensity. Like any client, progress should be gradual, but with clients who have COPD, this will take longer. A tip is to keep heart rate consistent (i.e., try not to let it dip or spike). Most attacks occur due to dry, cold air or when a high volume of oxygen is needed in a short period of time, so keep that in mind when training outside or during high intensity workouts.
Clients who have COPD use more energy to do less. Even relatively passive activities like reaching for something on a shelf or bending to pick something up from the floor takes more energy. So much of the body’s resources are diverted to the task of breathing, eventually there’s next to nothing left over for other activities. The right combination of nutrition and exercise can and will fend off attacks and improve your client's overall quality of life.
- Berge, William E. & Gordon, Debra L: “Allergy & Asthma Relief” 2004. Reader’s Digest Association Inc.
- Earle, Roger W. & Baechle, Thomas R.: “NSCA’s Essentials of Personal Training” 2004. Human Kinetics
- Felner, Kevin & Schneider, Meg: “COPD for Dummies” 2008. Wiley Publishing Inc.
- Nagourney, Eric. “Athletes’ Asthma Tied to Sweat Levels” Sep 23, 2008. The New York Times.