Methods for Improving Exercise Tolerance in COPD

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If someone were to ask what keeps you from exercising when you have chronic obstructive pulmonary disease (COPD), chances are you would say breathlessness (dyspnea). In COPD, dyspnea and muscle fatigue are the primary deterrents to starting an exercise program. This is unfortunate because the best way to improve exercise tolerance and decrease breathlessness in COPD is to be active.

If you're finding it difficult to exercise with COPD, put a few of these methods to the test to help increase your endurance, energy, and overall wellbeing.

Before Beginning Exercise

If you have COPD, it's important to visit your doctor before beginning any new exercise program to assess your general health and review your medications. In addition, your doctor will likely have you perform an exercise tolerance test (ETT).

Also called a stress test, an ETT determines your exercise capacity—i.e., it measures your ability to endure exercise and/or the maximum workload achieved during the exercise period.

An ETT involves walking on a treadmill at varying levels of speed while being connected to an electrocardiogram (ECG) and having your blood pressure and heart rate monitored. You will be assessed in rest/lying down and standing positions before beginning, and after activity as well.

After the test results have been interpreted, your doctor will give you guidelines for starting an exercise program. Be sure to ask lots of questions so you are clear about how long you should exercise for and how often, the types of exercises to do and to avoid, and if you will need to make any changes to your medication timing or dosages.

When exercising, be sure to follow your doctor's instructions precisely and reach out if you have any questions, concerns, or pain during exercise.

Types of Exercise to Try

Your doctor should be able to help you develop an exercise program that includes stretching, strength training, and cardiovascular exercise, along with some light interval training, depending on your abilities.

Flexibility Exercises

Stretching and yoga exercises include the slow lengthening of the muscles, which, when done regularly, increases your range of motion and flexibility. These should be done before cardiovascular exercises to prepare the muscles for activity and prevent injury and after exercising to cool down and prevent muscle strain.

Strength-Training Workouts

Strength training involves repeated muscle contractions or tightening until the muscle becomes tired. This usually involves weight training or body weight exercises. In patients with COPD, upper-body strengthening exercises are especially helpful in increasing the strength of respiratory muscles.

Strength training also results in less dyspnea than cardio workouts and may be better tolerated by people with COPD.

Aerobic Workouts

Cardiovascular or aerobic exercises, such as walking, jogging, cycling, rowing, dancing, and water aerobics, use large muscle groups to strengthen the heart and lungs and improve the body’s ability to use oxygen. While this may be difficult at first for people with COPD, research shows getting regular cardiovascular exercise can improve your breathing and decrease your heart rate and blood pressure.

Interval Training

During interval training, you repeat sequences of high-intensity exercise interspersed with light exercise (most studied in COPD) or rest.

For example, you may run for 30 seconds, walk for 1 minute, then run for 1 minute, and walk for 2 minutes, and repeat the cycle for a total of 10 minutes, which allows you to catch your breath after more vigorous exercise.

Interval training in COPD results in positive training effects for some patients and is often used as part of a pulmonary rehabilitation program.

Assistive Therapies

From oxygen therapy to electrical stimulation, there are several tools that can help people with COPD improve their exercise tolerance over time.

Non-Invasive Positive Pressure Ventilation

Although somewhat impractical due to the standard tight-fitting nasal or full-face masks needed to use it, studies have shown that people who exercise regularly using non-invasive positive pressure ventilation (NIPPV) may have a training advantage over those who don't.

Not only does NIPPV allow COPD patients to exercise longer, but they are able to achieve a higher workload during exercise sessions than when they exercise unassisted.

Using NIPPV at night may be a far more practical answer. Studies suggest that when combined with pulmonary rehabilitation, patients who use nocturnal NIPPV show improvements in the six-minute walk test, FEV1, dynamic hyperinflation, and arterial blood gases. Patients may also see an improvement in their physical function, social function, mental health, and vitality.

Electrical Stimulation

COPD patients who have better-preserved muscle strength and function may benefit from high-frequency neuromuscular electrical stimulation (hf-NMES), which has been found to improve exercise capacity by allowing patients to tolerate a higher level of exercise intensity. It may also improve breathlessness.

The best way to approach hf-NMES is to use it before tissue wasting occurs (common in advanced COPD), although it may be beneficial for patients who are severely disabled with incapacitating dyspnea as well.

Electrical stimulation can be used in the home, or as part of a formal, pulmonary rehabilitation program.

Oxygen Therapy

Studies suggest that long-term oxygen therapy (LTOT) may improve exercise endurance, decrease the perception of dyspnea, and decrease lung hyperinflation in patients with normal blood oxygen levels, allowing patients to train at higher levels of intensity. Target levels of oxygen saturation as measured by pulse oximetry should be greater than or equal to 90%.

There is ongoing speculation about which delivery method—nasal cannula or transtracheal—is best during exercise. Proponents of transtracheal oxygen delivery maintain their belief that it works best, but talk to your doctor about what may be best for you.

Treatments

Treatments that can help with exercise tolerance include medications such as bronchodilators and pulmonary rehabilitation.

Pulmonary Rehabilitation

Pulmonary rehabilitation is an important part of COPD treatment and is recommended for all patients who are in the moderate to very severe stages of COPD.

Pulmonary rehabilitation programs include some exercise training, breathing techniques, and health education to help you get a well-rounded plan to combat respiratory issues.

Aside from reducing breathlessness and anxiety, and improving quality of life, among other benefits, pulmonary rehabilitation can improve respiratory muscle strength when combined with general exercise, increasing exercise tolerance.

Medication

There are a number of medications available that have been shown to improve exercise tolerance and reduce exercise-induced breathlessness in COPD.

The most studied options include:

  • Albuterol: One of the characteristics of COPD is airflow limitation. Dynamic hyperinflation is a major consequence of airflow limitation during exercise in COPD and an important contributor to breathlessness. Short acting bronchodilators such as albuterol have been shown to be especially effective in increasing exercise tolerance when combined with pulmonary rehabilitation.
  • Spiriva: Combined with pulmonary rehabilitation, the anticholinergic/muscarinic antagonist bronchodilator Spiriva (tiotropium) improves exercise endurance, breathlessness, and health status compared to using pulmonary rehabilitation alone.
  • Salmeterol: A long-acting beta-agonist, Salmeterol improves breathlessness during exercise but does not necessarily increase exercise duration.
  • Nebulized ipratropium bromide: Compared to a placebo, nebulized ipratropium bromide (a long-acting anticholinergic) increases exercise endurance time, reduces dyspnea and decreases dynamic hyperinflation. Additionally, after using ipratropium bromide, patients in clinical studies showed an increase in FEV1, FVC and inspiratory capacity (the volume of air that can be inhaled after normal exhalation).

Guidelines with regard to the best management of COPD change often, and it's helpful to review your medications on a regular basis to make sure you are receiving optimal therapy.

For example, it's now recommended per 2020 guidelines that people who experience shortness of breath and/or exercise intolerance receive a combination of both a long-acting beta agonist (LABA) and a long-acting anticholinergic/muscarinic antagonist (LAMA) inhaler rather than either one of these alone.

A Word From Verywell

People with COPD have a reduced capacity for exercise/physical activity due to dyspnea and fatigue, which stems from an inadequate oxygen supply within the body. Over time, even the slightest tasks, such as getting dressed, can cause difficulty. Fortunately, research shows that getting regular exercise can reduce COPD symptoms, improve energy, increase endurance, and help you feel better overall. Talk to your doctor about ways to increase your exercise tolerance.

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