COPD and Exercise Rehabilitation

Morgan Walker          October 13, 2016

Chronic obstructive pulmonary disease (COPD) is a general term for the presence of chronic bronchitis, emphysema, and a full range of chronic obstructive lung diseases.1  Approximately 12 million adults in the U.S. are diagnosed with COPD, and 120,000 die each year.1  While nicotine addicts make up the majority of this diagnosed population, it is now recognized that 10-20% of them have never smoked.1  It is possible that a smoker never develops the disease.  This suggests that both genetic and environmental factors could influence the risk of COPD.  Major risk factors for the development of COPD include cigarette smoking, exposure to passive smoke, and air pollution, as well as several rare genetic syndromes and occupational exposure.

Management of COPD has many forms. Medicines such as bronchodilators, anti-inflammatories, anti-asthmatics, and those used to decrease mucus production may all be effective in managing symptoms of COPD.  Surgical procedures such as a transplant may be necessary in severe cases where other treatments are ineffective.2 Exercise programs supervised by qualified personnel have been established in conjunction with other treatment methods to improve/manage COPD.1

Clinical exercise physiologists (CEP) will use a combination of light to moderate cardiovascular exercises such as NuStep, SciFit, treadmill, and/or bike; and musculoskeletal exercises such as resistance training to train muscle and tissues (Table 17.5).3  Physiological responses to exercise include cardiovascular reconditioning, desensitization to dyspnea, and improved ventilator efficiency. It is common for COPD clients to become short of breath.  In these situations, it is important to allow them time to recover and always monitor blood oxygen saturation.  Use supplemental oxygen if saturation drops below 88% at any point.

The FITT principle for an exercise prescription for a client with COPD may be as follows (Table 17.5)3:

Type	Cardiovascular	Resistance
Frequency	2-3 sessions/week	2-3 sessions/week
Intensity	RPE 4-6 on 10 pt scale	Low resistance, high repetition (fatigue by 8-15 reps)
Time	30 minutes	Not specified

Due to the number of comorbidities that accompany it, management of COPD takes a team of professionals.  It is the duty of the CEP to initiate and mediate conversation between the client and his/her physicians.  An observant and knowledgeable CEP can make the difference in quality of care and quality of life for the COPD patient.  

REFERENCES
1National Institutes of Health. March 2013. Chronic Obstructive Pulmonary Disease

(COPD).Retrieved from http://report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=77.

2National Heart, Lung and Blood Institute. What Is a Lung Transplant?.  Retrieved from

http://www.nhlbi.nih.gov/health/health-topics/topics/lungtxp. October 3, 2016.
3 Ehrman J., Gordon P., Visich P. & Keteyian S. Clinical Exercise Physiology-3rd edition. 2013.