CHRONIC OBSTRUCTIVE PULMONARY DISEASE
COPD collectively refers to conditions that severely affect lung function. The three most common conditions that result in COPD are asthma, emphysema, and chronic bronchitis. These conditions all affect the ability to successfully bring air into and out of the lungs and exchange gases between the lungs and blood. COPD is diagnosed by evidence of airway obstruction as measured by spirometry.
It is estimated that there are more than 17 million Americans with COPD and it is the fourth leading cause of death in the United States. It is expected that COPD will become the third leading cause of death within the next decade.
Asthma is a disease of the airways of the lung. When a person is symptomatic, it is known as an asthma attack, although the disease is still present when the person is asymptomatic. A wide range of different stimuli, such as allergens, irritants, temperature/humidity, exercise, or emotional stress can bring on symptoms. These stimuli cause the following changes:
The smooth muscle that controls the diameter of the smaller airways in the lung spasm, constrict the airways and increase resistance to air flow.
The bronchial tubes become inflamed and cause a reduction in airway diameter and obstruct air flow.
The lining of the bronchial tubes release large quantities of mucous and obstruct the airways.
These changes to the airways of the lung result in wheezing, shortness of breath, and coughing. If an asthma attack does occur during exercise, these symptoms can greatly limit exercise tolerance and cause discomfort and fear in the older client. Table 11.4 lists strategies to follow if an asthma attack occurs.
These exercise EXAMPLES are INFORMATION ONLY and are not intended to be instruction, advice, or incorporated into any individual exercise program. Use of or experimentation with any of the EXAMPLE EXCERCISES will be solely at your own risk. Always consult a Physician before beginning any exercise program. It is highly recommended to seek the advice of a Certified Personal Trainer, especially one with Senior Fitness experience.
Exercise Recommendations for Asthma:
Always take daily medication before exercise.
2. Always ensure have rescue inhaler on hand in case of an exercise-induced asthma attack.
3. Begin each exercise session with an extended warm-up and end each exercise session with an
extended cool-down. Abrupt increases or decreases in exercise intensity may cause an asthma
5. Some older clients with asthma may require frequent breaks while exercising. Relax and breathe
slowly and deeply during breaks.
6. If exercising outdoors, be cautious of cold and dry weather. These conditions may increase the
possibility of an asthma attack.
Chronic bronchitis is a disease of the large upper airways of the lung. The most common cause of chronic bronchitis is cigarette smoking. The airway becomes inflamed and the mucous cells produce excessive and very thick mucus. These issues lead to symptoms that include chronic cough and abundant sputum production.
Emphysema is a disease of the distal airways of the lung. As with chronic bronchitis, the most common cause of emphysema is cigarette smoking. The alveoli of the lungs are irreversibly damaged due to excessive mucous production. This causes the alveoli to rupture, leading to a loss of surface area for gas exchange and extensive scarring, which reduces the ability for oxygen and carbon dioxide to effectively diffuse in and out of the blood.
Exercise improves the alveolar gas exchange, enhances cardiovascular function, and improves muscular endurance of the respiratory muscles . However, exercise tolerance may be severely affected in older adults with chronic bronchitis or emphysema.
Dyspnea is common an should be monitored during exercise. The American College of Sports Medicine recommends using the dyspnea rating scale during exercise. It is much like the modified Borg scale for Rating of Perceived Exertion, but this scale is used to judge the amount of dyspnea present while exercising. Use this scale to determine rest intervals during exercise and to determine the correct exercise intensity.
Dyspnea Rating Scale
0.5 Very, very slight
1 Very slight
4 Somewhat severe
7 Very severe
10 Very, very severe
Exercise Recommendations for COPD:
If participating in a respiratory therapy program work with a Certified Personal Trainer. Your trainer can read any reports or recommendations from physicians or respiratory therapists to construct the safest and most effective exercise program.
Some people with COPD tend to hyperventilate during exercise, which can interfere with optimal gas exchange. Emphasize diaphragmatic breathing, pursed lip breathing exercises, and recovery intervals. Also, direct attention to proper breathing during the extended warm-up and cool-down periods.
Avoid high-intensity and isometric exercises that may cause dyspnea. Emphasize deliberate movements and proper form during exercise.
Be aware of posture. Emphasize shoulder and thoracic spine mobilization in order to address upper cross syndrome. Good posture will greatly improve breathing mechanics and reduce dyspnea.
Credit: American College of Sports Medicine
National Academy of Sports Medicine: SENIOR FITNESS SPECIALIST MANUAL
©2014 NASM National Academy of Sports Medicine
©2014 ACSM American College of Sports Medicine