Pulmonary Disease A Patient Guide

Better Living with

Obstructive Pulmonary Disease
A Patient Guide
Second Edition
November 2012

Queensland Health

Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide

Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide is a joint project of the
Statewide COPD Respiratory Network, Clinical Practice Improvement Centre, Queensland Health
and The Australian Lung Foundation, COPD National Program.
This work is copyright and copyright ownership is shared between the State of Queensland (Queensland
Health) and The Australian Lung Foundation 2012. It may be reproduced in whole or in part for study,
education or clinical purposes subject to the inclusion of an acknowledgement of the source. It may not be
reproduced for commercial use or sale. Reproduction for purposes other than those indicated above
requires written permission from both Queensland Health and The Australian Lung Foundation.

The State of Queensland (Queensland Health) and The Australian Lung Foundation 2012.
For further information contact Statewide Respiratory Clinical Network, Patient Safety and Quality
Improvement Service, e-mail: PSQ@[Link] or phone: (07) 36369505 and The Australian
Lung Foundation, e-mail: enquiries@[Link] or phone: 1800 654 301. For permissions
beyond the scope of this licence contact: Intellectual Property Offi cer, Queensland Health, email:
ip_offi cer@[Link] or phone (07) 3234 1479.
To order resources or to provide feedback please email:
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Queensland Health Statewide Respiratory Clinical Network and The Australian Lung Foundation, COPD
National Program Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide, 2012.

ISBN 978-0-9872272-0-1
pulmonary
disease

Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide

chapter

Exercise and physical activity

This chapter will help you to understand:

Why it is important to maintain or improve your fi tness.
How you can benefi t from exercise and physical activity.
each week.

What the recommended guidelines for exercise are.

What to do if you are unwell.
How you can maintain your fi tness level.

Why is it important to maintain

or improve your fitness?
People who have chronic lung conditions
are often less active, can have reduced
fi tness and reduced muscle strength. By
exercising regularly, a persons fi tness
and muscle strength can be maintained

or improved.
People who have chronic lung
conditions and who exercise regularly,
such as by walking or cycling for more
than two hours per week, can improve
their health. As a result, they will feel
better, keep well and are more likely to
stay out of hospital.

How can you benefit

from exercise and
physical activity?
Exercise will help to:
Make your heart stronger
and healthier. Improve
your arm, body and leg

Increase the number of

activities that you are
able to do each day or
muscl
e
streng
th.
Improve
your
breathing.
C
l
e
a
r
s
p
u
t
u
m
fr

o
m
y
o
u
r
l
u
n
g
s
.
R
e
d
u
c
e

y
o
u
r
b
r
e
a
t
h
l
e
s
s
n
e
s
s

d
u
r
i
n
g
d
a
i
l
y
a
c
t
i
v
i
t
i

11

es.

Improve
your
balance.
Imp
rov
e
you
r
mo
od
and
ma
ke
you
feel
mo
re
in
con
trol.
Make you
more
independent.
Assist your

weight programs.
control.

Therefore, to
maintain the
Improve health
and
benefits
of
maintain
pulmonary
your
rehabilitation,
bone
is
very
density. it
important to
keep
The benefi ts
exercising. If
from
your exercise
pulmonary
program
rehabilitation
stops,
you
, such as lose fi tness
improvement and
muscle
s in exercise strength very
performance quickly.
or quality of
life,
have
been shown
to
decline
gradually
over 12 to 18
months after
completing
these

The State
of

Talk to your
doctor,
physiotherapi
st or The
Australian
Lung
Foundation
about
local

programs
available
to
you to help
maintain your
exercise
program,
such as the
Lungs
in
Action
classes.

People
who
exerci
se
regular
ly can
reduce
their
need
for
hospit
al
admis
sion.

Queensland The Australian Lung

(Queensland Foundation 2012 42
Health) and

Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide

What
are the
recom
mende
d
guideli
nes for
exercis
e?
What is involved in
an exercise
program?
An exercise program
should include:

1. An aerobic program
which involves a
walking program as
this is the most
relevant exercise for
daily living. Other
types of aerobic
exercise can include
cycling, riding an
exercise bike or even
using a rowing
machine. You could
use these exercises
to add variety to your
program or when you
have diffi culties with
walking.

2. A

strength training

program, which will

keep your muscles
strong and prevent
some of the effects
of having a chronic
lung condition.

Strength training
should
include
exercises
for
your arms, torso
and legs (see
page 49).

3. A

stretching
program, which
can help you to
maintain your fl
exibility
(see
page 48).

Exercise
guidelines
Exerci
se
regula
rly
aim
for 4
to 5
sessio
ns per
week.
A
i
m
t
o
e
x
e
r
c
i
s
e
f
o
r
a
t
l
e
a
s
t
2
0
t
o
3
0
m
i
n
u
t
e
s

p
e
r
s
e
s
s
i
o
n
.
Aim for
moderate
intensity.
Wear
comfortab
le
clothing
and
footwear.
E
n
s
u
r
e
y
o
u
d
r
i
n
k
e
n
o
u
g
h
f
l
u
i
d
s
w
h
i
l
e
e
x

erc
isi
ng.

What if I am on
oxygen?
If you have low
oxygen levels in the
blood and are
prescribed oxygen
therapy, then when
you exert yourself,
wearing oxygen can
help you tolerate the
exercise more easily.
When exercising, be
careful to avoid
tripping and falling
on your oxygen
tubing.

Never turn your

oxygen up higher
than prescribed for
exercising unless you
have discussed this
with your doctor or
physiotherapist first.

General
precautions
Avoi
d
stren
uous
exer
cise
if you
have
a
fever
, an
infect
ion
or
the
com
mon
cold.

ons that
open the
breathin
g tubes
or
airways)
before
exercisin
g.
U
s
e
r
e
c
o
v
e
r
y
p
o
s

Restar

t your

progra

m at a

lower

intensit

y if
your

exercis

e
routine

is

interru

pted.

Do not
exercise
immediatel
y after a
big meal.

Do not
exercise
in
extreme
heat or
cold.
Take
your
broncho
dilators
(inhaled
reliever
medicati

e
b
e
a
t
h
l
e
s
s
n
e
s

s (see

Interval
exercise
54).
programs have
many
advantages.
Getting started with
These include
your exercise
helping you to
program
tolerate
your
You may fi nd it better to
exercise routine
exercise using an interval better as well as
program rather than
enabling you to
trying to exercise
exercise at a
continuously.
higher intensity,
which
should
For example, an
give
you
a
interval program might
greater
be: walk for one to two
minutes, rest for one improvement in
minute and then walk your fi tness.
page

again. You may need

to repeat this interval
many times to achieve
at least 20 minutes of
total walking time.
43

An
exercise
program is
an
important
part of
your
manageme
nt of your
respiratory
condition

Chapter 11:

Exercise and
physical
activity

Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide

Borg scale

How often should

you exercise?
Exercise should be part
of your weekly routine,
and you should plan
enough time to fit this
into your week.

You should exercise

for a minimum of 4 to
5 days per week.
Anything less will not
allow you to gain
health benefi ts or
improve your fi tness.
y

How hard
o
should you
exercise? ur
When
attending
your
pulmonary
rehabilitatio
n program,
your
physiothera
pist will
assess your
exercise
tolerance at
the start of
the
program.
From this
assessment
, you will be
prescribed a
program at
the right
level for
you.
There
are
many
ways
to
prescri
be a
trainin
g
intensit
y for

e
x
er
ci
s
e
pr
o
gr
a
m
:

1. You
r
leve
l of
bre
athl
ess
nes
s
can
be
me
asu
red
duri
ng
an
acti
vity
and
rate
d

These scales
can be used to
guide training
intensity and to
set personal
goals for
exercise. You
should aim to
exercise to a
level where your
breathlessness
is at a moderate
to somewhat
severe level as
highlighted in
the scale below.
agai
nst
the
Bor
g or
mo
difi
ed
Bor
g
scal
e
(se
e
the
follo
win
g
diag
ram
).
The
high
light
ed
sect
ion
is
the
targ
et
trai
ning
inte
nsit
y.

therapi
st can
set you
an
exercis
e
progra
m at
60% to
80% of
an
exercis
e test.
The
exercis
e test,
such
as a
six
minute
walkin
g test
or
shuttle
walkin
g test,
may
have
been
undert
aken at
the
start of
your
progra
m.

2. Your 3. Exercis
physio

ing at a

percent
age,
such as
60% to
80%, of
your
maximu
m heart
rate.
This
method
is
generall
y not the
best
way to
measur
e
training
intensity
for
people
who
have
lung
conditio
ns as
usually
they are
limited
by their
breathle
ssness.

Danger

signs
If you
experience
any of the
following
symptoms
when you
are
stop and
rest
immediatel
y:

Training zone

exercising,

Nausea
.
Chest
pain.
Dizzine
ss or
feeling
faint.
Extrem
e
shortne
ss of
breath.
Excessi
ve
wheezi
ng.
Coughi
ng up
blood.

G.
e
Psych
ophysi
o
cal
t
bases scale
Modified Borg
of
h
0 Not shortpercei
of breath e
ved
r
0.5 Very veryexertio
slightly
n. Med
Sci
1 Very slightly
a
Sports
c
2 Slightly Exer.
t
1982:1
3 Moderately
i
4:37781;
4 Somewhat severe v
Mahler
i
5 Severe D. The
t
measu
i
6
rement
of
e
7 Very severe
dyspn
s
oea
8
during
9 Very veryexercis
severe t
e in
h
10 Maximal patient
a
s with
t
lung
Adapt
diseas
ed
e.
y
from:
Chest.
o
Borg
1992;1
u
G.
01:242
Percei
-7
ved
c
exertio
W
a
n as
h
n
an
indicat
a
or of
t
c
somati
h
c
a
o
stress.
Scand
r
o
J
e
s
Rehab
e
Med.
s
1970;2
?
:92-9;
o
If you
Borg
m

are

and
shoul
NB. These
d
symptoms
promp
are not
t you
normal
to

seek Note:

should

medic Those
al
with
attenti heart
on.
failure

always h

car

discuss the

exercise ir

tea

options he

m.

Queen
The
sland
State (Quee
of

bored
with
walkin
g or
are
looking
for
variety,
you
can
always
consid
er
other
alterna
tives
that
might
interest
you.
You
might
like to
consid
er
garden
ing,
bush
walkin
g,
dancin
g, Tai
Chi,
playing
golf,
lawn
bowls
and
waterbased
exercis
e.

nsland T
Health) h
and
e

wit

alth

A ralian Lung
u Foundation
st 2012 44

Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide

After an
illness, you
can take
several
months to
regain your fi
tness level and
muscle
strength. This
is true of all
people who
experience an
illness and
What if you are subsequent
loss of fitness.
unwell?
But it is
particularly
If you fi nd it hard to do true for those
your usual exercise
with COPD.
program, this can be
an early warning sign What
that you are becoming should you
do to
ill.
When you are unwell,
your body is working
harder to fi ght off the
infection, and your
breathing may
become more diffi
cult. Therefore, you
should not be
exercising as hard as
you would normally.

Why do you
lose your
fitness when
you are
unwell?

prevent
losing your
fitness
after a flare
up?
The
severity of a
fl are up will
affect the
exercise
level you
are able to
do.

Generally,
the aim is
not to
People who have
exercise as
COPD and who are
hard as
unwell or have a fl are usual.
up of their symptoms: Instead,
you could:
Are less active in
their day and spend
more time sitting or
lying down, and
less time standing
and walking than
they would normally
do.

Lose muscle
strength and
conditioning
as a result of
this inactivity.

Walk at a
slower
speed
(that you
can
tolerate)
and use
more rest
breaks.
Ride
an
exercise
bike

rather
than going
for a walk.
You
are
moving
less body
weight
while
riding an
exercise
bike;
therefore,
it should
be easier
to do.
Do a
strength
training
program
for your
arm and
leg
muscles.

It is important
for you to
resume an
exercise
program
promptly
following a fl are
up.

How can you

maintain your
fitness?
As discussed
earlier, maintaining
your physical fi
tness has been
shown to improve
your health.

By completing a
pulmonary rehabilitation
program, you should
have established an
exercise routine that is
suitable for you. Once
you have completed
your pulmonary
rehabilitation, it is
important to continue
with your exercise
routine.
There are a variety
of options available
that can assist you in
maintaining your fi
tness, including:

1. Enrolling in a
maintenance
exercise program
following the
completion of
your pulmonary
rehabilitation
program. For
information on
a maintenance
exercise
program, such
as The
Australian Lung
Foundations
Lungs in Action
classes,

contact:
The
Australia
n Lung
Foundati
on
(phone:
1800 654
301, or
[Link]
foundatio
[Link]
).

2. Joining

continue to
exercise
regularly.

4. Exercising

communitybased
walking
group.
These
walking
groups are
based at
your local
parks or
shopping
centres. For
further
information
regarding
the walking
groups
available in
your area,
contact
your local
council,
your local
shopping
centre or
The
Australian
Lung
Foundation
(phone:
1800 654
301, or
[Link]
[Link]
[Link]).

3. Joining

a
local gym or
community
group.
This can
provide
you
with
some
support
while you

regularly with
someone
else.
This is
anoth
er
simple
way to
commi
t
to
mainta
ining
your fi
tness.
This
option
can
work
quite
well,
providi
ng the
individ
uals
have
similar
exerci
se
goals.

5. Participating
in

home

exercise
program.
Some people
may prefer to
exercise

on

their own.

A home
exercise
program can
be effective if
you make
this part of
your daily
routine.
Using an
exercise
recording
sheet or an
exercise
diary can
help to make
this a regular
commitment

(see the following

aerobic exercise
recording sheet and

strength
training sheet
on pages 46

45

and 47,
respectively).

Chapter 11:

Exercise and
physical
activity

Aerobic exercise recording sheet

To use your exercise recording sheet, write your
prescribed exercise program in the columns as follows:
the type of aerobic exercise (for example, walking or
riding an exercise bike) in the Mode column, the
distance or speed of the exercise (for example, 500
metres) in the Distance column and the total exercise
time or the intervals (for example, two sets of 10
minutes) in the Time column. Once you have completed
the exercise, tick the box corresponding to the day of

Example

the week that you completed the exercise.

Mode

Distance

Walk

500 metres

The

State of Queensland (Queensland Health) and The Australian Lung Foundation 2012

Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide

Example

46 47 Chapter 11: Exercise and physical activity

Strength training sheet

To use your strength training sheet, write your prescribed
exercise program in the columns as follows: the exercise to be
performed (for example, squat) in the Mode column, the load
(for example, no added weight) in the Load column, the
number of sets and repetitions of each exercise (for example, 2
sets of 10 repetitions) in the Number column. Once you have
completed the exercise, tick the box corresponding to the day
that you completed the exercise. Samples of strength training
exercises are shown on pages 49.

Mode

Load

Number

Squat

no weight added

2 x 10 repetitions

Sun Mon

Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide

Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide

Examples of a stretching program

These stretches should be performed a few times

each week. A stretching program should be performed

before and after the aerobic and strength program.

4. Shoulder stretch
Gently pull on your elbow with your other
hand until a stretch is felt in the shoulder

Hold for 20 seconds

Repeat two to three times

1. Side neck stretch

Slowly tilt head
towards one shoulder

Hold for 10 seconds

Repeat two to
three times
Repeat toward
other shoulder

2. Shoulder rotation
Place hands on your shoulders as shown
Slowly make forwards and backwards
circles with your elbows
Repeat fi ve times each way

Move your
hands away
from your
back

Hold for 20
seconds
Repeat two
to three
times

5.
Tric
eps
stre
tch
G
e
n
t
l
y
p
u
l
l
o
n

3. Thoracic stretch
Hold hands behind
your back as shown

r
a
i
s
e

d elbow until a stretch is felt in the arm

Hold for 20 seconds

Repeat two to three times

6. Side stretch
Reach one arm straight over your head
Lean to that side as far as is comfortable

The State of Queensland (Queensland

Health) and The Australian Lung
Foundation 2012 48

Hold for
20
seconds
R
e
p
e
at
t
w
o
to
th
re

t
i
m
e
s

Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide

pist as they
forwards
can feel
give you
until you
a stretch
in
exercises
the back
that of
are
your thigh
appropriate

7.
Qu
ad
ric
ep
s
str
etc
h
Pull
your
foot
toward
s your
buttoc
k until
a
stretch
is felt
in the
front of
your
thigh
Hold
for 20
second
s

to

Hold for
20
strengthen
seconds
your
balance.
Repeat two to
three times

9. Calf
stretch
Place hands
on a wall or a
bench
Slowly lean
forwards until
you feel a
stretch in the
back of your
calf
Hold for 20
seconds
Repeat two to
three times

Repeat
two to
three
times

Balance
retraining

As you get
older, your
balance
8.
may
be
Ha
affected. As
ms
a
result,
trin
gyou may fi
str
nd it useful
etc
to do some
h
balance
retraining
Place
exercises.
your
Please
foot on
discuss
a block

balance
retraining

Slowly
with your
lean

physiothera

each session
is too much,
you can split
the exercises

Strength training
program

in half and do

There are many

different types of
strength training
programs available.
This is an example
of a strengthening
program. Please
discuss with your
physiotherapist or
exercise
physiologist about a
suitable program for
you to do.

days. For

Aim to do
three
sessions
per week of
the
following
strengtheni
ng
exercises.
Aim to achieve
muscle fatigue
between 6 and 10
repetitions. If you
have not achieved
muscle fatigue after
10 repetitions, then
you may need to
either add arm or leg
weights to the
exercise or increase
the weight of the arm
or leg weights.
If you find doing all
the exercises at

them on
alternate
example:

Day 1:
You may
choose to
do the
bicep
curl, wall
push up
or bench
press,
lateral
pull
down, leg
press or
squat,
and step
ups.

2 Day

strength
training
Skeletal
muscle
weakness is
present in
people with
COPD and
this
weakness
can affect
lower and
upper limb
strength.
Strengthenin
g these
muscles is
important as
these
muscles are
used on an
everyday
basis.

1. Biceps curl
Hold the arm
weight at
your side

2: You
may
choose
to do
the
should
er
press,
sit to
stand,
standin
g row
or
seated
row
and
lunge.

Curl arm
towards your
shoulder
Do 6 to 10
repetitions
for each arm
Do one to
three sets

Examples of
49

If too diffi
cult,
alternate
arms
Chapter 11:
Exercise and
physical
activity

Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide

2. Shoulder press
From the start
position (sitting or
standing), press
the arm weight
upwards to straight
arms

Do 6 to 10
repetitions
Do one to three
sets
Avoid this exercise if
you have shoulder
problems

4. Bench press
From the
start
position,
press the
arm
weight
upwards
to straight
arms
Do 6 to 10
repetitions

5. Standing row
Lean
forward onto
a chair or
bench
From the
start
position, lift
the arm
weight up to
your chest
Do 6 to 10
repetitions
Do one to
three sets

Do one to
three sets

6. Seated row
From the

3. Wall push up
From the start
position, lean
into the wall then
push up away
from wall
Do 6 to 10
repetitions
Do one to three
sets
To progress, move
feet away from the
wall

start position
and while
keeping
your back
upright, pull
your arms to
your chest

Do 6 to 10
repetitions
Do one to
three sets

7. Lateral pull down

Lean back slightly

Pull bar
down
towards the
front of your
chest

Do 6 to 10
repetitions
Do one to
three sets

The State of
Queensland
(Queensland Health)
and The Australian Lung
Foundation 2012 50

Better Living with Chronic Obstructive Pulmonary Disease A Patient Guide

on a seats
f
Do not bend
your

knees
o
beyond r 90
degrees w

8.
Sit
to
sta
nd

Do 6 to 10
r
repetitions
d

Sit on
the
edge
of your
chair

Do one to
u
three sets
n

t
To progress,
i
hold
hand
l
weights and
repeat

Stand
upright
Do 6 to 10 repetitions10. Leg press
F
r
Do one
to o
threem
sets
t

Progre
h
ss to
e
not
using
yours
armst
a
r
t

9.
p
Sq
uat o
s
i
Stand
with t
youri
legs o
n
should
er ,
width
apartp
r
e
Lower
yours
bodys
as
if
you l
are
e
sitting
g

exercise

k
n
e
e
s
a
r
e
s
t
r
a
i
g
h
t

Do 6 to 10
repetitions
Do one to
three sets

u
p
s
,
t
h
e
n

11. Step ups

This
activity
can be
either a
strength
or an
aerobic
exercise.

r
e
s
t

For strength:

1 Do 6 to 10
repetitions

2 Do

one
three sets

3 To
progre
ss
hold
hand
weight
s and
repeat
exerci
se
For aerobic:

1 D
o a
30
sec
ond
set
of
ste
p

r fi
tne
ss

to

f
o
r
12.
Lunge

o
n
e

Stand with a
wide stride

m
i
n
u
t
e

Bend both
legs until
forward thigh
is parallel
with the
ground

2 R
epe
at 5
to
10
time
s
dep
endi
ng
upo
n
you

Do 6 to 10
repetitions
Do one to
three sets

To progress,
hold
hand
weights and
repeat
exercise

51

Chapter 11:
Exercise and
physical
activity