By Mary Burns, RN, BS
PERF Executive Vice President
Hearing the suggestion, or advice, to start exercising is enough to make anyone groan with dread. When, in addition, you have trouble breathing it may seem like an impossibility. We know how difficult exercising is for you, but everyone should exercise. If you have respiratory disease, you must exercise. More about that later. Let’s take first things first and get you started.
Number one on your to-do list is making an appointment with your doctor to discuss your wish to start a low-level exercise program, and to make sure it is safe. Ideally, your physician will refer you to a pulmonary rehabilitation program. It is much easier to get started on your new exercise regime with professional help and support. Suppose you live in an area without any pulmonary rehab. Does that mean all is lost? No! It’s harder but you can do it on your own. We will now take you down that road to success, step by step.
It would be best to have an exercise test, such as a simple 6-minute walk or even a cardiopulmonary exercise test, done by your physician, before starting to exercise. It is important to be sure that your oxygen level with exercise is adequate, meaning that it is over 88% saturation. Low oxygen levels put a strain on the heart and decrease your energy level. You also need to make sure that there are no heart problems that you need to consider.
Before we start on the physical side of exercising, let’s work a little on the mental side. Occasionally someone may start pulmonary rehab with deconditioning and lung disease so severe they arrive in in a wheelchair, unable to walk across the room. Can you believe that 6 weeks later that wheelchair is in the closet and they are able to walk an hour at a time? Magic? Some people think so, but it really isn’t. You too have that same capacity, though we have to admit that without professional help and encouragment it is more difficult and probably will take longer to achieve. Your muscles (principally the ones in your legs), not only your lungs, are the problem. We’ll discuss that in detail another time but briefly, we now know that respiratory disease affects the muscles as well as the lungs. We may not be able to make major changes in your lungs but we CAN do a great deal to improve your muscles and your ability to exercise! HAVE FAITH!
The most difficult thing you will need to learn is to slow down and pace yourself. You also need to learn to breathe properly as you exercise. For that reason, and because most folks are so badly deconditioned, start very slowly. HAVE PATIENCE! Here is the formula for success.
Start by walking only one minute, 5 times a day, so that you can concentrate on your breathing and your pacing. Now, you can walk more often than 5 times if you wish, but start out with an easy program so that you will see early progress and won’t get discouraged.
You don’t have a rehab program to demonstrate how to start exercising? Let me help you. Work slowly at first!
Sit in a chair. As you get out of the chair, move slowly and breath out, using pursed lip breathing (PLB) with the effort. If necessary, do it in two steps. Exhale continuously with PLB as you move to the front of the chair. Rest a few seconds, breathe in and then again slowly, exhaling continuously with PLB, blow yourself up and out of the chair. Rest again. Don’t try to run across the room before you get short of breath! Move slowly, using good breathing techniques. The goal is to walk one minute without being more than moderately short of breath (SOB). If you can’t manage one minute, walk only 30 seconds at first. Concentrate on walking slowly. We know that this goes against the grain for all of you but you can do it! Concentrate on your breathing techniques. These basics are essential in order to achieve that goal of walking an hour without difficulty. Have patience with yourself! An hour a day may seem like an impossible achievement but actually, it’s the first 15 or 20 minutes that are the hardest. Once you have achieved that level of exercise, the rest will be much easier to achieve.
Do you notice that we haven’t said anything about a target heart rate? Shortness of breath limits the exercise of patients with respiratory disease, not their heart rates. Use your SOB as a guideline to increasing exercise. A little shortness of breath will not hurt you. But, until you learn better control of your breathing, keep that level of SOB down to what you would rate as moderate. That way you won’t cause yourself to develop respiratory panic.
Keep a diary so that you can look back and see how much you have improved a month from now. Gradually increase your exercise, only one minute at a time to begin with, as your shortness of breath gets under control. We know most of you can walk a lot longer than that but you need to concentrate on proper breathing before you push youself to doing more exercise.
However, you must continue to walk at least 5 times a day when you are only walking a few minutes at each session. If you have severe SOB, do not increase the number of minutes you are walking. Slow down! Always remember that endurance, not speed, is what you are aiming for at this time. Walk as slowly as is necessary to keep that shortness of breath under control. Once you are able to walk about 20 minutes, you may start increasing your speed and will be able to do so.
So where can you walk when you only have a range of a few minutes? Why, in your living room, of course, during a TV commercial. Are you too weak to walk one minute? Then just stand up for a few seconds, sit down, and then repeat that several times. Or you can also do a few leg lifts every half-hour. What are leg lifts? Sit in your chair and lift you feet off the floor, one at a time, as if you were walking. This will help to strengthen your leg muscles a bit so that you will be able to eventually walk. Remember that deconditioned leg muscles cause this weakness, NOT your lungs. You CAN improve!
Do you have such bad arthritis that it pains you to walk? If so, this type of exercise regime is exactly what you need to help your arthritis, also. Walk only until you have pain, or marked discomfort, even if it is only 30 seconds. Stop until the pain is gone, and then start again. A bike is helpful for very heavy people, or those with a lot of pain when they exercise. Set the bike at zero tension until you are able to ride for 30 minutes. Start out by riding only 5 minutes at a time, or less, but do it 5 times a day, gradually increasing the time as you get stronger or have less discomfort.
As you find that your shortness of breath and fatigue lessen, you will find you are able to walk 5 or 6 or 7 minutes at a time. Keep doing it slowly. You aren’t trying out for the Olympics! When you are able to walk 6 or 7 minutes at a time you can cut back to 4 times a day. Once you achieve 10 minutes at each session without more than mild shortness of breath you can drop down to 3 times a day if you wish. Do you realize that you are now walking one half hour a day? Once you can walk 20 minutes at a time you’ll have it made and then increasing your time will become much easier.
When you are able to walk 20 minutes you can graduate to 30 minutes, twice a day. You’ll find it quite easy now to gradually increase your time several minutes longer each session. Soon you will be walking one hour at a time and that is when you can try to gradually increase your speed.
You can’t find anyplace in your neighborhood to walk? The weather is too bad? Try walking in the local malls. If you get a treadmill, make sure you can slow it down to a pace that is easy for you to maintain but without elevation. Remember that your goal at first is to be able to exercise with no more than moderate shortness of breath.
Don’t increase the speed on your treadmill until you are able to walk 30 minutes. Remember that your goal is endurance and no more than moderate shortness of breath. Once you can walk an hour, you will be able to handle anything, even Disneyland!
If you have restrictive lung disease, such as pulmonary fibrosis, you need to be especially careful to move very slowly when you start to exercise. You probably have a tendency to drop your oxygen level very quickly if you move too fast.
Another warning, for all of you: If your doctor prescribed oxygen with exercise, use it! Keep your oxygen saturation above 88%, preferably over 90%, when exercising. Ask his recomendation. Your doctor may wish you to keep your oxygen saturation at 93% or even higher. It will help your endurance and prevent a strain on your heart.
Do you have congestive heart failure? With the permission of your physician, and only with that permission, the above exercise prescription for walking very slowly may help you, also. Discuss these guidelines with your physician.
Starting an exercise program can be very difficult – so why bother? Is it really worth it? You bet, it is! We could list a whole page of benefits, but the biggest benefit is the freedom you will again have. Being limited to an area only as large as that which you can cover in a few minutes of walking is worse than being in jail! No wonder people with respiratory disease often are depressed or irritable. Who wouldn’t be? And that is another benefit of exercise. Your sense of well-being will increase and life will feel worth living again. You’ll sleep better at night. Your arthritis usually improves and is better than it has been in years. Bronchial secretions at first seem to increase, as you may start to cough them up after walking. However, a regular exercise program is the best thing you can do to decrease your sputum or get rid of it entirely. What happens then? You aren’t as susceptible to infections and you feel better!
This is an example of one of the diaries used during rehab, to document improvement in exercise. The BORG scale is a way you can monitor your shortness of breath and exertion on a scale of 1-10. Remember, at first aim for a 3, which is “moderate,” for SOB or exertion. Later, when you gain control over your breathing, you can push yourself harder. Good luck! We’ll be waiting to hear how this plan works for you.
Click on either image below to download and print out your own copy of a BORG scale and walking diary: