First, I will discuss each of these variables individually and then I will put them together into sample workouts for you as they specifically relate to people living with lung disease, so that you can begin to develop your own personal exercise program. Part of the problem is that exercise recommendations are often too general in nature.
I can tell you whatever I want to tell you and regardless of what I recommend, you can still choose to do or not do whatever you want. Trust me when I say that I have seen and owned many very expensive clothes hangers in my time. Here is an exercise myth buster: Many people believe that the body requires a full day of rest between workouts. This is not actually the case. In fact, daily exercise is even more important for people who are sicker or more physically deconditioned. This may seem counterintuitive. However, there are several strong arguments in favor of daily exercise:.
At PWRC, our patients participate in formal cardiopulmonary exercise sessions two, three, or four days per week, depending upon their particular condition. As you get stronger and your workouts become longer and more intense, you may need more recovery time or to vary the types of workouts in order to prevent injury, ensure your safety and make sure you are getting the maximum benefit out of your program.
There are specific reasons for this. In fact, you may even do yourself harm when you do exercise because your body is not used to what essentially boils down to a random activity, increasing your risk of either musculoskeletal injury or a cardiovascular event. As I have mentioned previously, in addition to being the most important component for people living with pulmonary disease, aerobic exercise will still give you some degree of strength, flexibility and balance benefits as well. This schedule gives you the most equal spacing and balance between exercise and rest between each workout.
Since you would likely be doing the same or similar workout each day, your schedule might look something like this:. Again, this gives you the most equal spacing and balance between exercise and rest in between each workout. If you choose Option 2, you will be doing each workout three times in every two-week cycle. By adding a fourth day of exercise, you are now potentially doubling the dose of a twice-per-week program and also further increasing the potential variety of your routine. This lends itself to a very nice split program in which you do workout A two times per week and workout B two times per week.
In this type of a routine, you would benefit by splitting your workout by exercise or muscle group. For example, during workout A, you might prioritize the treadmill and during workout B, the elliptical machine or Nu-Step. This gives you the greatest variety of exercise and also, ensures that each muscle group has adequate rest, decreasing your chances of overtraining or developing an overuse injury.
By exercising five times per week, you are giving yourself a great deal of benefit in terms of dosage and variety of exercise. Because you will be including an additional day of exercise, I would recommend doing Workout A on three alternating days and Workout B on two days in between and then reversing them the following week. If you still want to be active on the other days, I would suggest doing something that you truly enjoy like walking, swimming or taking your grandkids to the park as opposed to a formal regimented gym or rehab workout.
Always start with the minimum effective dose of exercise—in this case, two days per week—before gradually increasing in order to greatly minimize the chance of any musculoskeletal injury, cardiovascular event, or any other adverse effect that could potentially be associated with exercise. When it comes to the intensity of exercise, we are referring to how hard you are working or the percentage of your maximum actual or predicted workload.
There are many ways to measure the intensity of your workout including both objective and subjective criteria. However, the objective data is only half the story. By taking all of these factors into consideration, we are able to maximize your safety and ensure the greatest effectiveness within each workout. This method is often very effective, but it can also be equally ineffective depending upon how the numbers are derived. Let me explain why I say this.
Your maximum heart rate is the maximum number of times your heart can beat per minute when you are working at your highest level of exertion or activity. It is based primarily on your age and level of conditioning. As a general rule, as we age, our maximum heart rate decreases and as another general rule, the more conditioned we are, the lower your heart rate will be, both at rest and at any given workload.
In clinical or medical settings, we cannot and should not be using the theoretical maximum heart rate. For that reason, it is strongly recommended that the patient undergo a comprehensive cardiovascular workup prior to beginning an exercise or rehabilitation program, especially in these special cardiopulmonary populations. However, here is where things get interesting and tricky and confusing.
When it comes to pulmonary patients, even the actual maximum heart rate does not always apply either. For example, that year-old man might have to stop the test because he is too short of breath to continue even though his heart rate is only as opposed to his age-predicted maximum heart rate of However, this is not effective in a pulmonary population or in any patient who is limited by their symptoms prior to being limited by their cardiovascular condition or hemodynamic performance. Another point to make is that many of the medications used to treat pulmonary patients can have a stimulant effect.
As a result, in addition to the increased work of breathing and deconditioning, pulmonary patients can sometimes have elevated heart rates, both at rest as well as during exercise. One MET equals 3. In English, this means that for each metabolic equivalent or MET, your body utilizes 3. We can determine the exact MET level at which a person is working either by direct measurement using what we call expired gas analysis or by using predicted values. During a cardiopulmonary stress test, the actual milliliters of oxygen that are consumed by that patient per minute are measured.
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We can also reasonably predict the approximate MET level of various activities, including different treadmill intensities, based upon data that has been collected from thousands of exercise tests and activity measurements from thousands of subjects. For every 1. In other words, they use ml of oxygen per minute under resting conditions, or at 1.
If that 50 kg person exercises for 1 minute and uses ml of oxygen, their body uses double the amount of oxygen as it did at rest. In other words, this person was exercising at twice the level of exertion as compared to resting conditions, or 2. Instead, you can use the treadmill MET chart and age-predicted treadmill intensities I have provided for this purpose in chapter 6: Treadmill Named for its creator, Dr.
The original scale ranges from and represents a subjective measure of how hard the person is working. A rating of 6 is equal to rest or very, very light exertion and a rating of 20 is equivalent to maximum exertion. Each number also corresponds to a description in words ranging from very, very light all the way to very, very hard. There is also a modified version of this scale that ranges from , but in my opinion, the scale works better and is the one we use at PWRC.
Similar to the RPE Scale, the Dyspnea Breathlessness Scale can be used to quantify the degree of shortness of breath a person is experiencing. This scale also ranges from , where a rating of 6 corresponds to none or very, very mild breathlessness and 20 corresponds to very, very strong breathlessness. This information can then be correlated with more objective measures, like heart rate, blood pressure and oxygen saturation in order to determine safe and effective exercise parameters. This is assuming all things being equal, which they almost never are. As an example, if someone has known heart disease or pulmonary hypertension, we might make an adjustment to the below numbers to minimize the risk of a problem.
So, as an example, if we had an year-old patient, we would allow him to go to a maximum heart rate of If you are eighty years of age or older, we will generally allow your systolic blood pressure go to a maximum of millimeters of mercury. We generally try to keep diastolic pressures under 95 mm Hg. In many cases, this means that we have to use supplemental oxygen but in doing so, our patients are able to get a much better workout, as compared to room air and it is these more challenging workouts that lead to the greatest short- and long-term benefits.
How much time you spend exercising is going to be dependent upon multiple factors and can vary from person to person, and sometimes even day to day. It will depend on your medical condition, your current level of fitness, and your degree of motivation which, as you know, can be either your best friend or your worst enemy. I know this is a big range, but it will make more sense later, when I give you sample workouts for 20 minutes, 30 minutes, 45 minutes, 60 minutes, and even a minute workout for you exercise junkies.
In my experience with patients, the most effective workouts are between 30 and 60 minutes in duration with short rest breaks interspersed throughout the workout. If you can only tolerate 10 minutes of exercise or less at a time, you really need to be exercising two to three times per day. Keep in mind that these workout times are in addition to all of the other activities you do in your daily life. When we talk about the type of exercise, we are referring to the broad, general categories into which exercise can be divided.
These five categories include breathing retraining, aerobic exercise, strength training, flexibility exercises, and balance training. For example, when we talk about strength training, the physiological impact involves increasing the size of the muscles and the force with which they can contract. When we talk about the functional impact, we are referring to the application of this force during everyday activities e. I will try to make this connection between physiologies and function whenever possible so that you have a clear understanding of how different exercises impact your everyday life.
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In reality, the majority of exercises and activities that we do involve a combination of two or more types of exercise. In other words, even when you are doing what is traditionally considered to be aerobic exercise, you will still get secondary gains in strength, flexibility, and balance as well. Similarly, when doing strength training, you can also gain some aerobic and balance benefits, and finally, when you are doing stretching or flexibility exercises, you can also gain strength and aerobic benefits. For example, walking is usually considered to be an aerobic activity, with elements of balance, strength, flexibility and breath control required as well.
However, when walking uphill or climbing stairs, a greater degree of muscle force is required making it more strength-intensive. My point in mentioning this is to say that you will get at least some benefit in multiple areas during most physical activities. With this in mind, our goal is to create a program that incorporates each of these types of exercise that will give you the maximum benefit in the most areas with the least amount of time and effort.
In other words, we want you to work smarter, not necessarily harder. Breathing retraining includes diaphragmatic breathing, pursed-lip breathing, paced breathing, and recovery from shortness of breath. Although they are covered in Chapter 3, I wanted to mention them here in the context of exercise in order to keep things in their proper perspective and chronologic order. These techniques provide you with greater breath control, which is why they are the first thing we teach our patients during their initial exercise session. When you first begin learning and practicing these breathing methods, the techniques themselves are the actual exercises.
It is this vigorous exercise that will ultimately decrease your shortness of breath, allowing you to walk more and potentially improving your lung function in the process. They will typically be lower in intensity than anaerobic exercise. Think tortoise, rather than hare, because if the intensity of the exercise is too great, you will be unable to sustain it long enough for it to be aerobic. For anyone living with a cardiovascular or pulmonary disease, aerobic exercise is, by far, the single most important type of exercise. Aerobic exercise helps your body become more efficient at using oxygen and you, less short of breath.
This can occur by:. Examples of aerobic exercise include walking, jogging, cycling, swimming, and dancing, among others. To help you make the best choices for your own workout, I will take you through the pros and cons of each type and tell you what and why we do what we do with our patients. Walking is one of the best possible exercises you can do, for a number of reasons. Most importantly, as human beings, walking is our primary mode of locomotion.
If you cannot walk, this will severely limit your ability to get around and to participate in various activities of daily living, diminishing your overall quality of life. Walking is multi-systemic and involves all exercise modes, not only enhancing aerobic capacity but also improving your strength, flexibility and balance and decreasing your shortness of breath in the process. It is also easily modifiable with respect to speed and duration, based on the individual. Be sure to walk in a safe place like a gym, track, mall or supermarket.
Walk where the air is clean and avoid temperature extremes. If you are in a hot climate, walk early in the morning before the sun is at its strongest, or in the evening when the sun is starting to go down.
If you live in a cold environment, walk indoors if the temperature is below approximately 36 degrees. Finally, if you are supposed to be using an assistive device like a walker or cane, please do. The same goes for any prescribed orthotics, where applicable. Jogging and running have many of the same benefits of walking, but with a few caveats. The biggest difference between walking and jogging or running is that when you walk even quickly , you always have at least one foot on the ground. When you jog or run there is at least a brief period during each stride actually two when both feet and the rest of your body are off the ground.
As a result, there is a greater mechanical load every time your foot hits the floor. These factors increase the impact and potential stress on your body, particularly the musculoskeletal system joints, tendons, ligaments , significantly increasing your chances of injury. Both of these activities can range from fairly mild to very vigorous, so they can potentially generate even greater benefits with respect to aerobic capacity. However, this increased intensity also comes with some increased risk, which is why we usually recommend walking instead of jogging or running for the majority of our patients.
The treadmill is my single favorite piece of exercise equipment for many reasons. Second, the treadmill provides mechanical assistance to ambulation walking by bringing your leg backward with each stride. This reduces the amount of force needed to overcome the resistance exerted on your body by the ground.
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Finally, and this is so important, holding on to the arm rails closes the chain, allowing the muscles of the thorax and the entire upper body pecs, lats, traps, serratus to work in their reverse actions, assisting the diaphragm and allowing you to breathe easier. I will address the treadmill in much greater detail as well as give you several sample workouts in Chapter 8: Treadmill Riding a bicycle is another great exercise that most people can participate in in one form or another.
Its various parameters body position, speed and resistance can all be modified based upon your cardio-respiratory fitness and any musculoskeletal limitations you may have, making it an effective workout tool for almost anybody. However, this also makes the recumbent bike less physically and metabolically demanding than the upright bike. Compared to the recumbent bike, there is also a strong postural component to the upright bike.
In addition to the work of the lower body, the muscles of the thorax chest, back and abdominals have to work harder to keep you upright, balancing anterior front and posterior back and left and right to prevent you from falling over. As a result the upright bike is more physically and metabolically demanding than the recumbent bike. In other words, the upright bike requires more muscle activity, thereby increasing its value as an aerobic exercise. Another consideration in choosing one bike versus another is the impact of body position on respiratory mechanics.
As a result, the diaphragm has less room to contract downward and in fact, can be pushed upwards, further increasing the intra-abdominal and intra-thoracic pressures. These increased intra-abdominal and intra-thoracic pressures further compress the lungs, making it more difficult for you to take a deep breath. This is particularly true for overweight individuals, especially if they have a lot of soft tissue fat in the midsection. Another one of my favorites, the elliptical machine is one of the most popular exercise machines on the market and for good reason.
The elliptical offers a very effective full-body workout with many of the same aerobic benefits as jogging or walking with far less impact on the joints.
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Elliptical machines can be done using only the lower body while holding on with the arms or upper and lower body at the same time. It is significantly more strenuous to do both arms and legs as opposed to just using your legs and requires a greater balance and coordination. Beginners should start using the lower body only for a less intense workout. As you feel more comfortable, you can add the arms, increasing the time and intensity as your fitness level improves.
Be careful especially when getting on and off the machine. One of the greatest benefits of this type of design is that people of all fitness levels can use it, even if they are not capable of full weight bearing. The Nu-Step is extremely comfortable and consistently a favorite among patients. In most cases, you can pedal forwards or backward and the resistance can be adjusted in order to increase or decrease the tension, increasing or decreasing the intensity of the workout. The UBE is one of the best exercise machines on the market and almost always the first exercise we introduce our patients to in their initial session.
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Always warm up and cool down properly. Use proper form to avoid injuries and maximize gains. You can learn good form through a class or one-on-one sessions with a certified exercise professional. Breathe out when you are lifting or pushing; breathe in as you slowly release the load or weight. Never hold your breath while straining. This action, called the Valsalva maneuver, can temporarily raise your blood pressure considerably and can be risky for people with cardiovascular disease.
Don't lock your joints; always leave a slight bend in your knees and elbows when straightening out your legs and arms. Don't be so eager to see results that you risk hurting yourself by exercising too long or choosing too much weight. And remember that it's important to rest muscles for at least 48 hours between strength training sessions. If you've been sick, give yourself one or two days off after recovering. If you were ill for a while, you may need to use lighter weights or less resistance when you first resume exercising.