The British and American Thoracic Societies’ guidelines on pulmonary rehabilitation support the multi-discipline approach to exercise prescription. They recommend that individuals address educational, psychosocial, and behavioural factors. For anyone affected by Chronic Obstructive Pulmonary Disease (COPD), exercise has been seen as a key component within their rehabilitation programme.
The key to success is in the skill of designing an exercise prescription that stimulates the cardiovascular and musculoskeletal system to the point that physiological adaptation occurs. Exercise prescriptions should be designed to reverse the damaging influence of de-conditioning and other systemic manifestations of COPD that affect skeletal muscle. They will also need to be structured around the physiological limitation of the individual.
These include:
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Inability to deliver an increased oxygen supply to peripheral muscles
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Restriction on the lung mechanics - dynamic hyperinflation and flow limitation
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Exercise induced pulmonary hypertension
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Muscle dysfunction - reduced muscle strength and endurance, impaired muscle oxidative capacity, muscular atrophy, reduced fibre capillarisation, increased fatigue, a lower lactate threshold and increased O2 requirements during exercise
Interval training
The American College of Sports Medicine recommend that a moderate intensity of 40% to 60% VO2 peak is sufficient to improve cardiorespiratory fitness. However, the favoured method of monitoring is through the rate of perceived exertion and dyspnea. A frequency of 2 to 3 times a week should be sufficient to improve fitness, although optimal frequency is 3 to 7 times, with a recommended duration of 20 to 30 minutes. As a result of a lower than average VO2 peak, people with COPD will experience significant barriers to achieving the recommended 20 to 30 minutes of activity.
Therefore it is important to adapt a prescription accordingly by addressing appropriate areas of exercise. One area to consider is interval training, as the 20 to 30 minutes can be broken down into smaller timeframes of more appropriate sessions. These bouts may be as long as 2 to 3 minutes, or as short as 30 seconds. With interval training, higher work rates can be observed with lower symptom scores. One benefit of interval training as stated by Vogiatzis et al,. (2004) is that interval training programmes elicit fewer symptoms of breathlessness during an exercise session, Sabapathy et al,. (2004) states this is a result of less dynamic hyperinflation during exercise.
Resistance training
As mentioned, for individuals affected by COPD, muscular dysfunction has a significant role to play in symptoms and restrictions observed with strength, endurance and maximal exercise capacity. As with a healthy person, strength training carries many benefits for individuals restricted by COPD. Resistance training will improve exercise capacity by optimizing muscle function and conditioning even though the person has progressive, degenerative abnormalities in lung function. Therefore strength training of the upper and lower body is appropriate and feasible for many people with COPD. Both resistance and endurance training have similar effects on peripheral muscle ability, exercise capacity and health-related quality of life. Current guidelines for strength training state that exercise programmes need to be balanced and relevant to the requirements of the individual.
By Richard Marsh – Future Fit Training's Technical Specialist
Richard Marsh's Profile
Richard’s professional career has spanned 14 years, during which time he has developed from the role of the fitness trainer into club management to his current position as Technical Specialist. Richard has constantly studied throughout his professional career and finds everything to do with exercise science fascinating. Richard’s passion for exercise physiology is such that he can normally be found talking about it in his own inimitable way!
To date, he has developed a number of courses for Future Fit Training that vary from practical courses such as the torso training workshop and Personal Trainer courses to the theory based GP and Exercise Referral programme and NVQ Level 3 awards.
Generally, it is thought that all Richard does is read, but in his spare time he likes nothing more that getting away and spending time on his bike or with his new found love ‘golf.’ It can be said that Richard’s greatest loves include conspiracy theories, '24' and most of all ‘Star Wars’. He can normally be found immersed in a book or looking for some obscure fact linking the Star Wars universe together. He claims to be able to feel the force and would like nothing more than sipping a glass of Corellian spiced ale in the cantina with Han Solo and discussing how Greedo missed!!!!