Rehabilitation guide
COPD (chronic obstructive pulmonary disease) is a lung condition in which the airways are permanently narrowed; its main signs are breathlessness, cough and tiring easily. Breathlessness puts people off moving, and inactivity weakens the muscles and makes breathlessness worse. Pulmonary rehabilitation aims to break that cycle: in a review of 65 trials it reduced breathlessness and fatigue and increased walking distance.
In COPD the airways narrow and the air sacs in the lungs are damaged; air gets in but cannot fully get out. In high-income countries more than 70% of cases are due to tobacco smoking; household and outdoor air pollution are also important causes.
The disease does not go away completely, but stopping smoking, avoiding air pollution, having your vaccines, taking your medicines regularly and pulmonary rehabilitation can ease the symptoms.
Pulmonary rehabilitation is a programme that combines individually tailored exercise training with breathing techniques and education about living with the condition. In the Cochrane review of 65 randomised controlled trials (3,822 patients), rehabilitation reduced breathlessness and fatigue and improved emotional wellbeing and the sense of control over the condition; the distance walked in 6 minutes increased by 44 metres on average. The programme does not reverse the damage in the lungs; by strengthening the muscles and building stamina, it lets you do more with the same lungs.
The effect of rehabilitation after a flare-up was examined in 20 trials (1,477 patients): quality of life and walking distance (62 metres on average) improved clearly, and hospital readmissions fell. Because the readmission results varied from trial to trial, the evidence for that finding was rated as moderate.
In a trial of 166 patients in Australia, an 8-week home programme consisting of one home visit by a physiotherapist followed by a weekly telephone call gave results equivalent to the hospital-based programme in the short term. The results after one year were not enough to show that the home programme was equivalent; to keep the gains, you need to keep exercising.
Getting out of breath during exercise is not harmful; it is expected. The target is a moderate level of breathlessness: you can still talk, but not comfortably. Before starting a programme, get the approval of your chest doctor; if you use oxygen, your doctor sets the flow for exercise.
Exercises at home
Breathe out on the effort and do not hold your breath. If your breathlessness increases, stop, recover by leaning forward and using pursed-lip breathing, then carry on.
Take a calm breath in through your nose. Purse your lips as if blowing out a candle and breathe out slowly, taking about twice as long as you took to breathe in. Do not force it or puff out your cheeks. Use it when walking, climbing stairs and whenever you feel breathless.
5–10 breaths, whenever needed during the dayWhen your breathlessness increases, sit down, lean your upper body slightly forward and rest your forearms on your thighs. Relax your shoulders and use pursed-lip breathing until your breathing settles. If you are standing, you can do the same leaning against a wall or a worktop.
Until your breathing settlesSit towards the front of a sturdy chair. Breathe out as you stand up and breathe in as you slowly sit down. Use your hands for support if needed; as it gets easier, cross your arms over your chest.
8–10 reps, 2 setsHold on lightly to the worktop. Breathe out as you lift both heels together and rise onto your toes; breathe in as you slowly lower.
10–15 reps, 2 setsFix the resistance band to something secure at chest height. Breathe out as you pull your elbows back and draw your shoulder blades together; breathe in as you slowly return. Do not hunch your shoulders up towards your ears.
10 reps, 2 setsWalk at a pace that makes you moderately breathless. When it gets hard, stop and rest with pursed-lip breathing, then carry on. Add a few minutes to the total time from week to week.
20–30 minutes a day in total, with breaksIf you have chest pain, dizziness, palpitations or blue lips, stop exercising and see your doctor.
Video
From the YouTube channels of the American Lung Association and NHS inform, Scotland’s national health information service.
A short video showing how the technique is done.
An information video on the place of exercise in COPD.
No. Getting out of breath during exercise does not harm your lungs; staying inactive, on the other hand, weakens the muscles so that the same task costs you more breath. A moderate level of breathlessness is the target. If you are clearly more breathless than usual or have signs of a flare-up, put off exercise that day and consult your doctor.
Rehabilitation does not reverse the damage in the lungs. With stronger muscles and more stamina, you can walk further with the same lungs and do everyday tasks with less breathlessness. In the review, the distance walked in 6 minutes increased by 44 metres on average.
Yes. In a trial of 166 patients, an 8-week home programme run with one home visit by a physiotherapist followed by weekly telephone calls gave results equivalent to the hospital-based programme in the short term. What matters is that the programme is tailored to you and followed up regularly.
Usually yes, but your doctor decides what the oxygen flow should be during exercise. Do not change the setting yourself; plan your programme together with your doctor and physiotherapist.
See a doctor without delay if you have any of the following:
Sources
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