Exercise Guidelines for Chronic Obstructive Pulmonary Disease

Having explored the exercise intolerances for chronic obstructive pulmonary disease (COPD), we now look at some exercise guidelines for this clinical cohort.

Exercise Guidelines for COPD

• Aerobic exercise should be prescribed at least 3 to 5 days/week with a 4 to 6 rating on the Borg dyspnea 10-point scale [1]. This scale rates the difficulty of your breathing. At number 0 your breathing is causing you no difficulty and progresses to number 10 where your breathing difficulty is maximal.
• Resistance exercise is recommended 2-3 days/week with 8-10 repetitions and loads of 50 to 85% of one-repetitions maximum. People with COPD complain of higher levels of dyspnea when performing activities of daily living with their upper extremities compared with lower extremities because the accessory muscles of inspiration are activated. Thus, upper body resistance training is recommended to improve the function of the accessory muscles of inspiration and reduce dyspnea.
• Combining endurance and resistance training appears to be the most valuable option to treat limb muscle dysfunction in stable patients with COPD. The benefits of exercise typically increase as the training load is gradually progressed.
• As with any population, COPD patients should stop exercising if they experience pressure or pain in the chest, neck, arm, or jaw that might signal inadequate blood flow to heart tissue.

Adjunct Modalities

Inspiratory Muscle Training

Inspiratory muscle training is recommended for people with COPD to increase ventilatory muscle strength and endurance. The most commonly used method is inspiratory pressure threshold loading, where patients breathe through a device that permits air to flow through it only after a critical inspiratory pressure has been reached. It is recommended to use this method at least 3 times/week for at least 15 minutes at a minimum of 30% of their maximal inspiratory pressure.

Neuromuscular Electrical Stimulation

Neuromuscular electrical stimulation (NME) which elicits muscle contraction using electric impulses can be used to counteract limb muscle dysfunction in patients with very severe COPD (Abdellaoui et al, 2011). NME may help improve or maintain muscle structure with little impact on the cardiorespiratory system. NME may be particularly useful in periods of exacerbation during which whole-body exercise training may be difficult to accomplish.

High-intensity Interval Training

High-intensity interval training (HIT) includes short periods of very intense exercise interspersed with periods of recuperation. HIT produces less dyspnea and leg fatigue and may facilitate the tolerance to training while yielding similar improvements in exercise capacity and health-related quality of life as continuous training (Beauchamp et al, 2010).

[1] This is because heart rate is not a reliable indicator of exercise tolerance for people with COPD, intensity is normally monitored by dyspnea or ratings of perceived exertion.