I have a client with Pulmonary Fibrosis. I've been working with her for about a month now, and she is improving her strength and core stability. I've been training her with more functional exercises to improve her daily life combined with multi-joint circuit training and core and balance training. The circuit training is good for her because it works her heart a little for cardio, but I was wondering what other types of exercises I can do with her that would raise her heart rate up so she can improve her cardio output. I tried to have her walk on a treadmill at a slow pace, but it seemed like if I had her do anything more, she would have had a problem. So now I am doing more circuit training with her to get her heart rate going. Do you have any suggestions of other things I can try with her to improve her cardio?
Thank you for your question. It sounds as though a combination of multi-joint circuit training involving functional exercise and core and balance training is working really well for your client. The difficulty with training a client with Pulmonary Fibrosis is trying to raise your client’s aerobic fitness levels without overstressing her respiratory and cardiovascular systems.
With Pulmonary Fibrosis, scarring of the lungs occurs, and the air sacs in the lung become replaced with fibrotic material. There are many thoughts on the cause to this, and the main outcome to this scarring is that it becomes very difficult for the body to transfer oxygen into the bloodstream. Some of the more common symptoms include shortness of breath (particularly with exertion), chronic cough, fatigue and weakness, discomfort in the chest and loss of appetite. Typically the primary issue is concerned with ventilation problems; however, the individual will often show a reduction in muscle function, oxygen delivery and cardiac function that will lead to exercise limitations. Because of these physiological changes and exercise limitations, choosing the right exercises can sometimes be difficult.
The current treatment and management of Pulmonary Fibrosis is usually a multidisciplinary approach in which the expertise of the client's specialist, GP and physiotherapist are integrated. Often, the goals for a patient with Pulmonary Fibrosis will involve maintaining her current fitness levels and slowing the progression of the condition. Corticosteroids are often prescribed for the patient in order to help him or her deal with the inflammation. Rehabilitation and education programs are often carried out by physiotherapists to teach the patient how to breathe more efficiently and to perform daily activities with less breathing problems. And in more severe cases, oxygen supplementation is provided to help the individual deal with everyday life a little easier. Diagnosis usually involves a chest X-ray, pulmonary function tests and sometimes a lung biopsy.
The difficulty in exercising the client with Pulmonary Fibrosis comes with trying to find a method of raising the client’s cardiac output without placing too much stress on her respiratory and cardiovascular systems. Normally, those with Pulmonary Fibrosis are asked to continue carrying out regular low level activities such as short walks to help maintain their current fitness levels. I would suggest a joint discussion with the client’s health care providers to try and determine suitable aerobic goals and a program that will allow the client to achieve this. Other areas that might be worth looking at in order to help the client deal with her condition better is to address her flexibility, especially the accessory breathing muscles (i.e., pectorals, scalenes, sternocleidomastoid), which will most likely be doing a lot of extra work. Improving the flexibility of these muscles may help them to better function and aid in breathing.
It is very important that the client maintain a very healthy diet. Poor nutrition can lead to reduced ability to recover from exercise. It may also lead to reduced immune system function and therefore place her at a higher risk of developing other health related problems. Likewise, it is very important that you remain aware of the client’s psychological state as she is prone to becoming depressed and/or anxious. Research shows the following when it comes to exercising those with Pulmonary Fibrosis or similar respiratory disorders such as Chronic Obstructive Pulmonary Disease (COPD) and Emphysema:
- Postural drainage and breathing exercises can help prevent or delay respiratory failure and early disability.
- Exercise training showed in one study to have clinical benefits that lasted up to two years following a eight to 12 week training program. It helped to improve exercise capacity, dyspnoea and health-related quality of life.
- One study has shown that the type and intensity of training and muscle groups trained will affect the outcome of the training response. While both high and low intensity training will lead to an increase in exercise endurance, only high intensity training resulted in a physiological gain in aerobic fitness.
- It has also been suggested that higher intensity interval training will help reduce the degree of dyspnoea due to reduced demand on ventilation. While higher intensity training results in greater physiological change, determining the optimal intensity is going to be patient specific, and this should be guided by that of the GP or specialist.
Websites for Offering Information
- Butcher, S.J. & Jones, R.L. The impact of exercise training intensity on change in physiological function in patients with chronic obstructive pulmonary disease. Sports Medicine. 2006, 36(4), p.p. 307–25
- Mujovi, N. Matanovi, D. & Devecerski, G. Respiratory rehabilitation in patients with pulmonary sarcoidosis. Med Pregl. 2005; 58 Suppl 1: 75-7
- Nixon,P.G.F. Stress, Life Style and Cardiovascular Disease. A Cardiological Odyssey, The British Journal of Holistic Medicine, Vol. 1, April 84
- Rochester, C.L. Exercise training in chronic obstructive pulmonary disease. Journal Rehabilitation Res Dev. 2003; 40, p.p. 59 - 80