One of the most common prevailing myths about Chronic Obstructive Pulmonary Disease (COPD) is that exercise could be harmful for those living with the condition. This is not only misleading but can also hinder the overall management and progress in coping with COPD. Understanding the role of physical activity in COPD management is crucial.

Doctors South First spoke to, on account of World COPD Day (15 November), explained that the myth likely stems from the fact that COPD patients often experience shortness of breath, coughing, and fatigue, leading to the belief that physical exertion could exacerbate these symptoms.

“However, avoiding exercise can actually result in a decline in physical fitness and lung function, making daily activities more challenging and potentially worsen COPD symptoms in the long run,” Dr Suma B, a pulmonologist at Excel Care Hospital in Bengaluru, tells South First.

What is COPD?

Healthy vs COPD lungs. (Medical Research Institute of New Zealand)Healthy vs COPD lungs. (Medical Research Institute of New Zealand)
Healthy vs COPD lungs. (Medical Research Institute of New Zealand)

The World Health Organisation defines COPD as a group of progressive lung diseases, most commonly including emphysema and chronic bronchitis. COPD causes obstructed airflow from the lungs. Emphysema involves damage to the air sacs (alveoli) in the lungs.

Over time, the inner walls of the air sacs weaken and rupture, creating larger air spaces instead of many small ones. This reduces the surface area of the lungs and, in turn, the amount of oxygen that reaches your bloodstream.

Another condition that can cause COPD is chronic bronchitis where it involves inflammation and narrowing of the bronchial tubes, which allows mucus to build up. This condition is defined by a long-term cough with mucus.

COPD is most commonly seen in smokers, people with long-term exposure to lung irritants like air pollution, chemical fumes, dust, genetic factors, and even in those with a history of repeated respiratory infections.

Also read: Urgent call for specialised pulmonary care and rehabilitation

‘Exercise can be better than medications’

Dr Suma informs us that the theme for World COPD Day 2023 is “Breathing is Life — Act Earlier”. It aims to highlight the importance of early lung health, early diagnosis, and early interventions.

While taking measures to ensure one does not develop COPD is key, early intervention is also important for those who have already been diagnosed with COPD.

Pulmonary rehabilitation is a comprehensive exercise programme that is taught to patients with chronic lung diseases, especially COPD, to improve their lung capacity, lung efficiency, and also to minimise flare-ups and prevent hospitalisation.

This programme also educates people with COPD and their family about the disease, nutritional aspects, and how to socially integrate with this condition.

Vaayu Chest and Sleep Specialists, clinic which works towards holistic pulmonary rehabilitation. This clinic is set up in Bengaluru.Vaayu Chest and Sleep Specialists, clinic which works towards holistic pulmonary rehabilitation. This clinic is set up in Bengaluru.
Vaayu Chest and Sleep Specialists, clinic which works towards holistic pulmonary rehabilitation. This clinic is set up in Bengaluru. (supplied)

Weighing in, Dr Ravindra Mehta, renowned pulmonologist and founder of Vaayu Pulmonary Wellness and Rehabilitation Centre in Bengaluru, tells South First, “Management of COPD involves a comprehensive, multidisciplinary approach. The GOLD (Global Initiative for Chronic Obstructive Lung Disease) guidelines suggest that individuals with early-stage COPD and limited exercise capacity can benefit from supplementary exercises and pulmonary rehabilitation.”

Explaining further, he says that exercise is absolutely important as it enhances the current lung function, optimises muscle use (which often deteriorates in COPD), improves cardiorespiratory dynamics, and addresses psychological and nutritional aspects.

“Many people think that pulmonary wellness rehabilitation is just yoga or pranayama but it is much more than that and it involves a tailored programme that can span 12-36 sessions, offering significant improvement, often surpassing the effects of medication alone,” Dr Mehta opines.

Also read: Study finds link between low Vitamin K level and poor lung function

The DREAM programme

Dr AJ Rajendran, Senior Consultant and Clinical Lead of the Department of Rehabilitation Medicine at Chennai’s MGM Healthcare, has introduced an innovative programme called DREAM for COPD patients.

The programme’s acronym stands for Diet, Relaxation, Exercise, Attitude, Motivation, each component targeting a critical aspect of COPD management.

Diet: Recognising the increased energy needs of COPD patients, who often breathe at a rate significantly higher than the normal 18 breaths per minute, the programme emphasises a nutritious diet rich in protein and multivitamins to give them energy.

Pursed-lip breathing techniques for COPD patients. (Supplied)Pursed-lip breathing techniques for COPD patients. (Supplied)
Pursed-lip breathing techniques for COPD patients. (Supplied)

Relaxation: To tackle the high stress levels associated with chronic diseases, the programme incorporates strategies from the American Heart Association.

“This includes breathing retraining with prolonged expiration and pursed-lip breathing to improve breathing patterns and reduce carbon dioxide build-up. Additionally, guided meditation sessions lasting 2-3 minutes are offered, aimed at reducing stress chemicals and promoting relaxation,” Dr Rajendran explains to South First.

Exercise: Focused on correct breathing techniques, the programme educates patients on using the diaphragm effectively instead of accessory muscles. Exercise sessions are brief (3-5 minutes) and scheduled throughout the day, with a gap of 55 minutes each to maximise efficacy.

“For instance, a patient is asked to perform these exercises for only five minutes at 9 am, 10 am, and 11 am intervals. Next, at 4 pm, 5 pm, and 6 pm intervals. This would ensure a good 30 minutes of exercise in the day, making the patient feel energised and relaxed the next day,” explains Dr Rajendran.

Attitude: The programme also addresses behavioural aspects, like smoking and alcohol consumption, helping patients identify and modify detrimental habits.

Motivation: Emphasising the interconnectivity of all components, the programme motivates patients to engage in each aspect equally, using a scoring system for progress tracking.

The DREAM programme. The DREAM programme.
The DREAM programme.

The DREAM programme represents a holistic approach to COPD management, promising a better quality of life for patients by addressing both physical and mental health aspects of the condition.

However, doctors warn that it’s crucial for COPD patients to consult with their doctors before starting any exercise regimen. The exercises and rehabilitation programme should be tailored to their individual health status and abilities. Overexertion can be harmful, so it’s important to start slowly and gradually increase the intensity and duration of exercises as tolerated.

Also read: 12 key symptoms commonly associated with long Covid-19

Some exercises patients can do 

  • Walking at home with small steps and for a short duration
  • Strength training using light weights or resistance bands
  • Breathing techniques like pursed-lip breathing and diaphragmatic breathing
  • Gentle stretching exercises
  • Chair exercises that can be done sitting down, like leg lifts and arm raises
  • Meditation

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