Exercise and COPD

Providers

Lyn Menchin CNS2

Rocco Micco Physiotherapist

Dyspnoea

Dyspnoea or “breathlessness” is the invisible final pathway for many suffers of lung disease

Dyspnoea creates behavior and psychological responses in people

These responses limit exercise in many COPD patients

Pulmonary Rehab Program

A multi-disciplinary exercise program for people with lung disease

Tailored to suit each individuals ability and needs

Designed to maximize individuals Goals

Targeted to optimise psychological and physical wellbeing

Lismore ProgramCarroll Centre St Vincent’s

Four programs a year Two exercise sessions a week One education session a week Over an eight week program Twelve clients per program Carers, family and partners

encouraged to attend education sessions

Exercise Program

Breathing Techniques Warm Up / Stretches / Walking Exercise Circuit

Cardiac Strength Endurance

Cool Down Stretches Relaxed Breathing HOME PROGRAM

Psychological Barriers to Exercise

Fear of breathlessness

Fear escalates into panic and helplessness

Increasing dyspnoea

Sudden panic stimulates the adrenals and sympathetic nervous system as well as the central limbic structures

Which in turn amplifies the sensation of respiratory discomfort

Emotional Impact..

Of COPD can be equal to or greater than the physical symptoms

suffers feel like they are “a burden”

Embarrassment Fear Altered body

image Guilt Altered role in

the family Shame Loss of control

and independence

Isolation

Altered relationships and friendships

Panic Frustration Anxiety Loss of intimacy Depression Inability to work

loss of income

Managing the Psychosocial Impact

Goal setting

Good communication Involving your patients in the

decision making Education leads to self efficacy

promotes self management

Managing Psychosocial Impact

Encourage people to develop there own coping strategies

Encourage pharmacological as well as non pharmacological

Relaxation

Counselling

Social work

Financial Advice

Referrals as needed

Emotional Benefits of Exercise

Very Subjective people feel “ Better Happier ”

They enjoy the socializing associated with Pulmonary Rehab

They enjoy the peer interaction and start to rethink there illness

They realize its ok to become breathless they can still exercise just pace themselves

They find a new self confidence

Their perception of the disease burden changes when they realize they can exercise

Common Psychological Benefits Improved Mood

Reduced Stress

Improved Self- Esteem

Pride in Accomplishments

Improved Body Image

Increased Energy

Improved Confidence

Decreased Anxiety

Decreased Fear

Decreased depression

Association of Applied Sportpsychology

Physical benefits of Exercise in COPD

Increased functional exercise capacity (1), (4)

Increased muscle strength (2), (3) Decreased dyspnoea (3), (8) Decreases risk factors of associated

co-morbidities (8)

Possible benefits……..????

Stabilisation or improvement in pulmonary function (9),(10), (13)

Benefits differ between individuals with COPD

WHY?

Complex range of individual responses to exercise based on age, gender, Phx, genetics

COPD is a complex and poorly defined condition that potentially includes a multitude of physiological processes in various systems of the body.

Difficult to ascertain accurately what factors are driving disease progression in any given individual

The multisystem effects of Exercise remain elusive

“ ~50% of protection afforded by physical activity remains unexplained” (5)

. P. Darrell Neufer et al 2015

Evidence that exercise has a systemic anti-inflammatory effect (6), (12)

To what extent does this benefit individuals with COPD?

Does regular physical activity modulate inflammation and tissue remodelling and assist in disease stabilisation?

Long term benefits of exercise for people with COPD difficult to accurately ascertain

Most studies have 6-12 week interventions which show benefits gradually decline over 12-18mths (7)

Long term maintenance of progressive exercise programmes difficult d/t a variety of factors

L.F.F Reis et al.

41 individuals with diagnosed COPD, 96 week pulmonary rehab programme, 3x per week

Ongoing improvements in 6mwt, dyspnoea, hemodynamic and lipid profile

We know that regular exercise has many benefits for individuals with COPD but it is likely that the reasons for these benefits are multi-factorial and individually specific

QUESTIONS???

References

1) Pulmonary rehabilitation for chronic obstructive pulmonary disease (Review) The Cochrane Library2006 issue 4

2) Skeletal muscle strength and endurance training in patients with mild COPD and the effects of weight training. C.J. Clark, L.M. Cochrane, E Mackay , B. Paton, European Respiratory Journal 2000 15:92-97

3) Low intensity peripheral muscle conditioning improves exercise tolerance and breathlessness in COPD. C.J. Clark, L. Cochrane, E Mackay , , European Respiratory Journal 1996 9:2590-2596

4) Home-based pulmonary rehabilitation improves clinical features and systemic inflammation in chronic obstructive pulmonary disease patients. Eloisa Sanches Pereiera do Nascimento et al, International Journal of COPD 2015: 10 645-653

5) Understanding the cellular and molecular mechanisms of Physical Activity-induced Health benefits. P. Darrell Neufer et al. Cell Metabolism 22 July 7 2015 4-11

6) The anti-inflamatory effect of exercise. Anne Marie, W. Peterson and Bente Klarlund Pedersen. Journal of Applied Physiology 2005 98: 1154-1162

7) Pulmonary Rehabilitation: Summary of an Evidence –Based Guidline. Andrew L Ries MD MPH. Respiratory Care September 2008 Vol 53 No 9.

8) A long-term pulmonary rehabilitation program progressively improves exercise tolerance, quality of life and cardiovascular risk factors in patients with COPD. L.F.F Reis et al. European Journal of Physical Rehabilitation Medicine 2013;49:491-497

9) Effect of Aerobic Exercise Training on Pulmonary Function and Tolerance of Activity in Asthmatic Patients. Reza Farid et al. Iranian Journal of Allergy, Asthma And immunology 4(3) September 2005

10) Exercise Training Decreases Ventilatory Requirements and Exercise-Induced Hyperinflation at Submaximal Intensities in Patients with COPD. Janos Porszasz et al.CHEST 128(4) October 2005

11) Regular Physical Activity Modifies Smoking-related Lung Functyion Decline and Reduces Risk of Chronic Obstructive Pulmonary Disease. A population-based Cohort Study. Judith Garcia-Aymerich et al. American Journal of Critical Care Medicine Vol 175. 458-463 2007

12) Exercise as Mean to Control Low-Grade Systemic Inflammation. Neha Mathur and Bente KlarlundPederson. Mediators of Inflammation. 2008. ID 109502

13) The Effects of Traditional Chinese Exercise in Patients with Chronic Obstructive pulmonary disease: A Meta-Analysis. Xiaotian Luo et al. PLOS One september2016

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