Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition characterized by shortness of breath, chest tightness, and cough¹. This disease of the lungs affects about 15 million Americans and even more people globally. It can impair the ability to perform daily tasks, like shopping. Thankfully, there are exercises that can be done to improve lung function and positively impact the lives of people with COPD. Read on to learn more about exercise and the huge difference it can make to counter the effects of COPD.

Why Is Physical Exercise Important for People With COPD?

It might seem counterintuitive at first – why would you exercise if you already have difficulty breathing as it is? You may even find yourself actively avoiding tasks that you anticipate will trigger the symptoms of COPD. This is definitely understandable, but here is another perspective to consider: a sedentary lifestyle will not only cause your respiratory muscles to weaken but also cause them to work harder and use more oxygen when they are needed. These add up and eventually lead to even more shortness of breath. 

This is where exercise comes in². While exercise will not reverse the lung damage that has already been done, it can strengthen the lungs and other structures in the chest as well as improve endurance. This will train the chest muscles to work more efficiently, which will reduce the effort of breathing. It is also worth mentioning that physical activity produces more “happy hormones” in the body, which is great for your mental well-being. The breathing improvements can be the impetus to start and the happy chemicals can be the motivation to maintain healthy habits. Here are just some of the numerous benefits of exercise³:

• Improves circulation in the body
• Lessens COPD symptoms
• Increase energy levels
• Improve endurance, leading to less breathlessness
• Strengthens both the heart and lungs
• Lower blood pressure and blood sugar
• Improves muscle tone and strength, balance, and flexibility
• Strengthens bones
• Reduces body fat to maintain a healthy weight
• Boosts self-esteem and promotes a positive body image
• Positively impacts mental health
• Better sleep
• Makes you feel more relaxed and rested

Even after just one exercise session, you might already feel a positive difference. Taking small but consistent steps will definitely get you far in the long run. It all begins with prioritizing your health and eventually making that commitment to stick to a healthy lifestyle. 

What Types of Exercises Are Good for People with COPD?

The most optimal type of exercise for patients with COPD is currently under investigation⁴. For now, more interest is placed on tailoring an exercise regimen to each patient’s individual cardiovascular and pulmonary needs. A good exercise program includes a warm-up, conditioning, and a cool-down phase⁵. 

Warming up helps reduce the stress on your heart and muscles by steadily increasing breathing, heart rate, and temperature so they can all adapt⁶. A good warmup begins with a gentle aerobic activity of a similar type to the exercise to be done, such as walking if you are going to run (if your main exercise will be walking, the warmup would be slower walking).

This raises the body’s temperature – this literal “warming up” wakens the muscles and enables them to work more efficiently with less risk of injury. If you are cold, this warming up can also include putting on warmer clothes or standing by a radiator before beginning to move. After raising your core body temperature, you should do some stretches focusing on the muscles you will be using. Stretch each muscle for around 30 seconds each. Then you can start your main exercise.

Cardiovascular Exercises

One category of exercise is cardiovascular, aerobic exercise involve large muscle groups and raising your heart rate, which are stimulated to improves how the body uses oxygen. Over time, aerobic exercise can decrease your blood pressure and improve breathing, and you might notice that you no longer get tired as easily. Examples of aerobic exercises include walking, jogging, jumping rope,  cycling, skating, rowing, and water aerobics. 

Strength Training

Another category is strengthening exercises. Muscles repeatedly contract against a heavy load, which will cause them to increase in size and use oxygen more efficiently. Research indicates this is particularly helpful for people with COPD, who report better overall endurance and lower endurance after a six-week progressive strength training course⁷. It may be easier to start with strength training than cardiovascular training, as focusing on only a few muscles per exercise puts less stress on your lungs, making them easier to start with.

Finally, it is recommended to cool down adequately after a workout. This will give time for your heart rate and blood pressure to slowly return to the resting state. Avoid sitting or lying down immediately after exercise, as this may cause lightheadedness and dizziness. Cooling down involves simply lowering the intensity of your exercise and doing the stretches you did earlier during the warm-up phase until your heart rate and breathing returns to normal. 

Questions to Ask Your Healthcare Provider Prior to Exercising

At this point, you may still have some apprehensions about exercising with COPD. To learn more about COPD as it relates to you, here are some questions you can ask your doctor before starting any exercise regime⁸: 

• What are the goals of the exercise?
• What exercises are best for me?
• How long and how often should I do them?
• Should I exercise using my additional oxygen?
• How does my medication affect exercise?
• What alarm signs should I watch out for?
• When should I see you again for a follow-up?

Having the answers to these questions will give you a better idea of how the exercise regimen will go. It will also tell you how to ensure that you do not push yourself too far over the limit and when to contact your doctor should you experience any adverse effects while exercising.

General Exercise Guidelines for People with COPD

While there is no hard and fast rule governing exercise for people with COPD, exercise in general has numerous benefits. A safe place to start would be to ask yourself what type of physical activities you enjoy and whether you want to work out by yourself or with a group⁹. 

Consider how exercise will fit into your schedule, keeping in mind your overall goals. Finances should also be kept in mind; it may not be a good idea to get a year-long gym membership right away without first trying out a few sessions.

A good rule of thumb is to slowly work towards high-intensity exercises with tolerable levels of breathlessness – this is the threshold that needs to be reached in order to bring about sufficient physiological change in the body and muscles. Interval exercises are a good way to do this and allow for heavy loads to be placed on the muscles with periods of lower intensity to recover. Therefore, they are able to perform a greater amount of work before exhaustion hits, which happens with prolonged or continuous exercise. 

Remember to set realistic expectations for yourself by starting slow and then steadily working your way up to longer and more vigorous exercises.

Other important tips include: 

• Learning to breathe through pursed lips¹⁰ – if you are doing a high-intensity exercise, breathing out forcefully may help 
• Stay hydrated by drinking plenty of water while exercising 
• If you are working out with oxygen, using an extra-long tubing can help give you more space to move without worrying about pulling your tank; you may also use a smaller portable tank if you prefer to move around outdoors 
• Develop an exercise routine that is steady and consistent, slowly building up over time. Stick to your routine, as it will eventually become a lifelong habit that will positively impact your health in the long run.

When Not to Exercise With COPD

People with COPD are generally free to exercise safely. However, you should skip the workout if you note the presence of the following alarm signs and symptoms¹¹:

• Fever
• Nausea
• Vomiting
• Chest pain
• Increased shortness of breathing
• Dizziness or lightheadedness

These could signal a negative reaction to exercise warranting immediate medical attention. Consult your healthcare provider immediately if you experience any untoward symptoms.

Summary

COPD is a progressive lung condition that lessens the air flowing into and out of the lungs, making it difficult to breathe¹². Symptoms include coughing, shortness of breath, and chest tightness that may worsen over time and limit day-to-day activities.

Exercise can positively impact the lives of people with COPD by increasing the strength and endurance of your respiratory muscles¹³. It can also help you feel better physically and mentally.

There is no fixed rule for exercise in COPD, so it is prudent to consult your doctor before starting any regimen. That way, you can collaborate and decide on the regimen best suited for you and your health needs. Couple regular exercise with a healthy diet, quitting smoking, adequate sleep, and plenty of water to fully maximize the benefits of including exercise in your routine. If you feel any alarm symptoms, consult your doctor immediately.

1. National Heart, Lung, and Blood Institute. (2022). What is COPD? Accessed from https://www.nhlbi.nih.gov/health/copd[↩]
2. Global Allergy & Airways Patient Platform. (2023). COPD Exercises. Accessed from https://gaapp.org/diseases/copd/copd-treatment/copd-exercises/[↩]
3. Cleveland Clinic. (2018). COPD: Exercise & Activity Guidelines. Accessed from https://my.clevelandclinic.org/health/articles/9450-copd-exercise--activity-guidelines[↩]
4. Spruit, M. A., Burtin, C., De Boever, P., Langer, D., Vogiatzis, I., Wouters, E. F., & Franssen, F. M. (2016). COPD and exercise: does it make a difference?. Breathe (Sheffield, England), 12(2), e38–e49. https://doi.org/10.1183/20734735.003916[↩]
5. Cleveland Clinic. (2018). COPD: Exercise & Activity Guidelines. Accessed from https://my.clevelandclinic.org/health/articles/9450-copd-exercise--activity-guidelines[↩]
6. McGowan, C. J., Pyne, D. B., Thompson, K. G., & Rattray, B. (2015). Warm-Up Strategies for Sport and Exercise: Mechanisms and Applications. Sports Medicine, 45, 11, pp. 1523–1546). https://doi.org/10.1007/s40279-015-0376-x[↩]
7. Spruit, M. A., Burtin, C., De Boever, P., Langer, D., Vogiatzis, I., Wouters, E. F. M., & Franssen, F. M. E. (2016). COPD and exercise: does it make a difference? Breathe, 12, 2, pp. e38–e49. https://doi.org/10.1183/20734735.003916[↩]
8. American Lung Association. (2023). Physical Activity and COPD. Accessed from https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/living-with-copd/physical-activity[↩]
9. Cleveland Clinic. (2018). COPD: Exercise & Activity Guidelines. Accessed from https://my.clevelandclinic.org/health/articles/9450-copd-exercise--activity-guidelines[↩]
10. Global Allergy & Airways Patient Platform. (2023). COPD Exercises. Accessed from https://gaapp.org/diseases/copd/copd-treatment/copd-exercises/[↩]
11. American Lung Association. (2023). Physical Activity and COPD. Accessed from https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/living-with-copd/physical-activity[↩]
12. National Heart, Lung, and Blood Institute. (2022). What is COPD?. Accessed from https://www.nhlbi.nih.gov/health/copd[↩]
13. Spruit, M. A., Burtin, C., De Boever, P., Langer, D., Vogiatzis, I., Wouters, E. F. M., & Franssen, F. M. E. (2016). COPD and exercise: does it make a difference? Breathe, 12, 2, pp. e38–e49. https://doi.org/10.1183/20734735.003916[↩]

Mikaela Millan

Mikaela is a dentistry clinician at the University of the Philippines.