By Jonathon Stavres MS, ACSM-EP-C
Chronic Obstructive Pulmonary Disease (COPD) is a disease that, by definition, reduces expiratory volume, expiratory rate, and total minute ventilation. Stated more simply, COPD obstruct a person’s ability to breathe, resulting in low blood oxygen saturation and poor delivery of oxygen to active tissues. According to the Centers for Disease Control and Prevention, from the years 2007-2009, 11.9 million Americans (5.1% of the U.S. adult population) had been diagnosed with COPD. This prevalence of COPD in the US has remained consistent since 1998 (1).
The nature of COPD presents a paradox for rehabilitation.
Patients with COPD generally find it very difficult to exercise for any extended period of time or with any added resistance, because blood oxygen saturation tends to fall relatively quick. However, in order for a person to improve daily function their muscles need to experience peripheral adaptations. Peripheral adaptations are elicited by moderate to high intensity muscular work. Therefore, patients with COPD need to perform moderate to high intensity exercise to experience peripheral muscular benefits, but their physical ability is limited by an inefficient oxygen transport system.
Recent research has addressed this issue by examining the effects of upper body resistance training on pulmonary function. Resistance training is an interesting method of therapy and exercise for COPD patients, because it is an anaerobic exercise. This means that traditional resistance training requires very little oxygen to be performed. Even with a reduced demand for oxygen, resistance training is a great method for increasing muscular strength, muscular power, and even muscular endurance. More specifically, upper body resistance training may elicit all of these adaptations in the muscles that aid breathing.
A research study, led by Singh examined how upper body resistance training over four weeks (three times per week) effected symptoms of COPD. The exercises used in this study (seated chest press, front lat-pull, lat-row, shoulder press, and shrugs; each for three sets of ten repetitions) were focused on major muscle groups and multi-joint movements. All of these exercises were performed in a seated position, which would reduce the oxygen requirement of each exercise by eliminating the lower body component.
Researchers found that pulmonary function improved following four weeks of upper body resistance exercise. Specifically, there were observed improvement in the amount of air that could be forcefully expired (forced vital capacity; FVC) and the amount of air that could be forcefully expired in 1 second (FEV1). Also, the percentage of the FVC that could be expired in 1 second (FEV1/FVC) improved.
Results from this study mention above, as well as other studies, suggests that upper body resistance training may be very beneficial for individuals with COPD.
Before beginning exercise there are some things to consider.
- First, exercises should to be performed correctly- This may require consulting a professional in the field of exercise science for an introduction to resistance training.
- Second, the correct workload needs to be identified– This can either require performing a 1 repetition maximum assessment for each exercise, or (and preferred in this scenario) identify a workload for each exercise that elicits a 12-15 rating on the 6-20 Borg RPE scale and a score of 3 or less on a 1-4 Dyspnea Scale (both indications of moderate intensity work, and both scales that are commonly used in rehabilitation settings).
- Finally, exercise should be safe-It is recommended to either use resistance bands or guided-machine weights, primarily to avoid lifting weights overhead. Most importantly, individuals with COPD should practice pursed lip breathing while during repetitions. Holding breath while exercising is contraindicated in this population, and presents a safety risk. Practicing proper breathing mechanics is crucial.
With the previous stated considerations, upper body resistance training may be very beneficial in improving pulmonary function of COPD patients.
*For more examples of other variations/exercises look under Multimedia-VDF Exercise Tips
**Consult with a physician and/or medical healthcare provider before starting any exercise regimen
Article’s Resources
Akinbami, L. J. & Liu, X. (2011). Chronic obstructive pulmonary disease among adults aged 19 and over in the United States, 1998-2009. NCHS Data Brief, 63. 1-8
Singh, V. P., Jani, H., John, V., Singh, J. P., & Joseley, T. (2011).Effects of upper body resistance training on pulmonary functions in sedentary male smokers. Lung India, 28(3). 169-173. doi: 10.4103/0970-2113.83971