In June of 1997, medical researchers reported that the effects of emphysema had been reversed for the first time (Nature Medicine, Volume 3, Number 5, June 1997, pages 675-7). Even though this medical miracle is so far only effective for laboratory rats, some humans who have been battling this killer for years have been given new hope.
With the medical miracle of human lung regeneration from emphysema on the horizon for humans, exercise techniques to prevent continuing lung deterioration for those with emphysema have become of paramount importance. Some with lung disease who exercise regularly believe they have halted lung deterioration and would like to share the information with others in the same boat.
I have included information from others in this paper where clearly indicated. The remainder of the views expressed herein come from my experience and beliefs.
Frequent exercise appears to prevent the disabling lung infections that I have had so often in the past.
I believe a healthy exercise lifestyle will prevent lung infections, halt the deterioration of lungs and maintain my health until medical research brings lung damage reversal from laboratory rats to humans and emphysema can be cured.
I have summarized my experiences with exercise in combating emphysema in the following information. I have also presented the experiences of some others. I hope the information will be sufficient to give other emphysema patients hope and motivate them to exercise daily to save their lives.
I am in touch with each of these people and will forward your questions to them if you contact me. My contact information is: Ron Peterson 5353 Walsh #1B St Louis MO 63109 email address: [email protected]
TN is a 55 year old woman with emphysema who has been able to discontinue using oxygen as a result of the increased efficiency of her body after extensive exercising.
MH also has emphysema and believes we must exercise if we want to continue to live. She knows others who did not exercise after a diagnosis of emphysema who have passed away.
FE combats his emphysema by doing several short periods of treadmill walking every day. He has seen his peak flow meter readings increase even more dramatically than mine.
BS has the inherited form of emphysema and has increased his FEV1 readings from 26% to 41% through a program of 2 hours per day of exercise and daily prolastin infusions. He has also discontinued using oxygen as he walks on a very hilly golf course.
BB has battled emphysema with exercise for 17 years. He had lung reduction surgery in 1994 and is currently considering (at age 68) turning down lung transplant surgery.
JW enjoyed good health before a lung transplant by exercising for 5 years. She was out of bed walking on the second day after her transplant.
PL has increased her FEV1 readings five percentage points from pulmonary rehabilitation and an aggressive post rehab exercise program.
SP has decreased his supplementary oxygen need while exercising from 3 to 2 liters per minute by exercising about 2 hours a day, 7 days a week.
BD has increased her FEV1 level 10 percentage points in ten months by exercising 250-400 minutes a week.
I am 53 years old and was diagnosed with the non hereditary form of emphysema in October of 1987. I am not a physician. Daily exercise has been an important part of my life for many years and I believe it has helped me to stay healthy in many ways.
It has now been over 23 months since I have had a lung infection (as I write this in October of 1997). Sometimes in the morning, before exercising, I can "feel" a lung infection starting. After exercise, I can feel that the start of the infection has been eliminated in my lungs. I think this self healing of an impending lung infection comes about because when I exercise, I breath deeply and use all of the remaining sections of my lungs.
Please remember to talk your exercise program over with your pulmonologist before you start. Get the medical profession involved and they will help you in many ways.
Exercise also helped me quit smoking in January of 1996. I had been trying to quit smoking for many years. Exercise was "the straw that broke the camel's back" for me.
Staying off the smokes has also been easier when exercising. Smoking, exercise and emphysema do not mix well. If you have emphysema and still smoke, start exercising and you may finally be able to leave the smokes behind you for good. Exercise definitely helped me!
The most important aspect of exercise for me is to do it daily for an extended period of time. I have slowly worked my way up to an hour a day. I believe a long period of exercise is important for those with emphysema because it takes a long time for our respiratory system to begin working at maximum efficiency.
I also believe daily exercise is very important to prevent lung infections and very seldom miss even one day.
I started using supplemental oxygen while exercising in November of 1996. I went to my pulmonary physician and he determined the oxygen was necessary by having me walk around his office for 5 minutes and then checking the amount of oxygen in my blood with an oximeter. After doing this test, he wrote me a prescription for the oxygen and Medicare paid for 80% of the cost. Since then I have purchased supplementary Medicare insurance which pays for the remaining 20%.
It is important to your health to be evaluated for the need for supplemental oxygen when you exercise. There are two reasons that I know of why this is important.
The first reason is that the muscles of the body, for example the heart muscle, function more efficiently when they have an adequate oxygen supply.
The second reason why it is important to maintain adequate oxygen levels in the body when exercising is so the exercising muscles can become "trained". Training does not occur as quickly at low blood oxygen levels.
There seems to be wide agreement of medical personnel that the minimum safe level of oxygen while exercising is 90% of the maximum (saturated) oxygen possible in the blood.
To give some perspective of the significance of 90% of saturation, it is generally accepted that the blood oxygen level of normal people (without lung disease) is 95% of saturation or above while at rest.
I use a Nonin oximeter when I exercise (can be purchased without a prescription for about $400 from Aeromedix.com at 888-362-7123).
I obtained a Pulse Dose oxygen dispensing unit (sometimes called a conserver) from my oxygen supplier. It only dispenses oxygen when I inhale and only which weighs about 8 lbs, fits in a backpack and supplies close to two hours worth of supplemental oxygen at a "rate" of 3 liters per minute. The maximum rate of the unit is 6 liters per minute. When I walk inside on a treadmill, I am supplied oxygen from a conventional "concentrator" unit.
I consider exercise for emphysema patients to be any activity that causes us to breath deeper. Whenever we breathe deeper than at rest, we are exercising our breathing muscles and helping clear out our lungs..
One of the ways that I motivate myself to exercise is to compare my activity levels and duration to myself in the past. If I note increases, I am spurred to try even harder. I never compare myself to others however, because I feel I would either become discouraged if I couldn't do as much as another or complacent if I could do more.
My last pulmonary function test showed my FEV1 level (amount of air you can blow out in one second) to be 21% of normal. A reading 8 months earlier was 18% of normal. Even with this much lung damage, I have the breathing capacity to exercise at a heart rate as high as normal people if I start very slowly and gradually increase my exercise intensity.
I have purchased a heart rate monitor that I use when I exercise. A strap around my chest senses my heart rate and transmits the information to a digital readout on my wrist. Heart rate information helps me know when I should speed up or slow down my activity level. I purchased my unit from Sensor Dynamics, Inc. at 800-959-4089. It's a cardiochamp model that costs about eighty dollars.
It has become my routine to exercise about 2 hours after I get up in the morning. The only food I have before exercising is 8 ounces of hot water mixed with 3 teaspoons of vinegar and 3 teaspoons of honey, vitamins and an apple. I believe the reason my body feels better with this light food intake before exercising is that oxygen is not being used to digest food at the same time as the muscles I am exercising are also calling for oxygen so they can work.
These descriptions of what works best for me when I exercise are not necessarily what will also work best for you. Each of us is a different person with different amounts of disability and each body reacts slightly differently to exercise. I suggest that you use my descriptions as a guide to your exercise program but let how your body feels be the final judge in how you exercise.
Warming up before exercising and cooling down after exercising are important to prevent sore muscles. It is very hard to exercise with sore muscles. I do a set of stretching exercises to start my warm-up and finish the warm-up with a five minute period of slow walking. After my 60 minutes of exercising, I cool down by doing another 5 minutes of slow walking and finish up the cool down period with a repeat of the stretching exercises. Any book on exercise will describe an adequate set of stretching exercises. I will send you stretching exercises if you request (please include a self addressed, stamped envelope with your request).
I believe proper breathing while exercising is the most important thing I have learned so far. I've broken breathing techniques into four parts; inhaling through the nose, inhaling while expanding the stomach, exhaling through "pursed" lips and attempting to breath as slow as possible.
Inhaling through the nose is important to warm and filter the air before it gets to the lungs.
"Pursed" or "puckered" lip exhaling naturally slows down exhalation but its also helpful to learn to inhale as slow as is comfortable to you. This helps make your respiration system more efficient.
Inhaling by expanding the stomach is not easy. All our lives, we have been inhaling by expanding our chest. I'd suggest learning how to inhale by expanding the stomach by lying on your back and putting a small book on your stomach. Now try to raise the book as you inhale. When you can easily raise the book by inhaling while lying on your back, teach yourself how to extend your stomach while standing up straight by putting your hand on your stomach. When you can easily move your hand forward when standing still when you inhale, it will not be too hard to learn to breathe from the stomach while you are exercising. Lots of practice will make this important technique automatic.
Some mornings (for any one of many reasons), I do not feel like exercising. I believe that these are the times when exercising is most important. I think of exercising as my job on these bad days and force myself to exercise. I ALWAYS feel better after exercising on these bad days.
Most of the time, I look forward to my daily workout and feel better when I am done.
If you (or someone you know who has emphysema) would like to share your experiences of exercising with emphysema, I would welcome hearing from you. I will include your experiences in future publications.
Many exercise experts claim walking is the best possible exercise. Others recommend swimming because it works every muscle in the body. For those with severe emphysema, however, these forms of exercise may be too vigorous because many muscles are used simultaneously. If that is your situation, several good chair exercise tapes are available (for example, Level I of the "Swing Into Shape" series from Lutheran Hospital in La Crosse, Wisconsin at 800-362-9567 extension 5513) that only work one muscle group at a time.
I am currently getting my exercise by walking on a treadmill. I find the treadmill best because I am not dependent on the weather to cooperate to exercise. A few suggestions I have if you decide to purchase a treadmill are: 1. Be certain it is possible to use the treadmill in a position so that the walking surface is level; even a little uphill slope is very difficult to walk up continuously if you have emphysema. 2. Make certain that the treadmill motor is at least 2 horsepower and is warranted for three or more years. 3. Make certain that the treadmill will operate with you walking on it as slow as 0.3 miles per hour.
Walking outside is my preferred method of exercising. I like the changing scenery.
It is not true that supplemental oxygen is addictive. I know some who have been able to discontinue using oxygen as a result of exercise and they report no withdrawal symptoms. Most have so far not been able to discontinue using oxygen because they waited too long to begin using it; those that start early when they only need it when they exercise are most likely to be able to stop using it.
A device called a peak flow meter is available by request from your pulmonary doctor or without perscription from Wal Mart Pharmacies. It measures how fast and hard you can blow air out of your lungs in a manner similar to the pulmonary function tests most of us have had done. Since I stopped smoking and started getting serious about exercise, both my peak flow meter readings and my FEV1 readings (determined from a pulmonary function test which is usually done by medical personnel but now can be done by the patient at home) have increased.
These long term increases are very unusual for an emphysema patient.
I have recently come to the conclusion that the most significant measure of the health of our respiratory systems is not how much oxygen we need but how high the carbon dioxide levels have risen in our blood. I know of only two ways to decrease the CO2 levels:
1. Use a BiPAP unit-this is a device which lowers CO2 levels for some- this must be determined (and prescribed by) a physician. 2. Exercise sometimes lowers CO2 levels because the exercising muscles become more efficient as they are used . It is also important to remember that it is generally accepted that the feeling of shortness of breath is from too much CO2 and not too little oxygen.
Health improvements to those with emphysema happen very rapidly after starting to exercise-in as short a time as six weeks. I have described some of these relatively short term benefits I felt in a previous article in The Health Keepers Journal.
The information contained herein describes health improvements I have experienced after 21 months of an extensive exercise program of 300-500 minutes a week.
The best way to initiate an exercise program if you have emphysema is to attend a pulmonary rehabilitation class. You must generally be referred to the class by your doctor by prescription. If for some reason this is impossible for you and you elect to initiate your own exercise program, it is very important that you start slow and increase the amount of exercise you do by no more than 5% per week. I have recently learned (from a ten year veteran with an oxygen supply company) that the age of their new customers is decreasing-presumably because those with lung disease are being diagnosed earlier. Perhaps these younger patients with better overall health will be more motivated to exercise by learning how exercise has helped others in similar situations to theirs.
About 25% of the adults in the United states still smoke cigarettes. It is not surprising, then, to learn that a recent report estimated that between 30 and 40 million Americans now have COPD (an "umbrella disease" that includes emphysema, chronic bronchitis and asthma). Fortunately, the disease in these people is mostly in such an early stage that no shortness of breath symptoms are yet felt. These people can help themselves very much by adopting an extensive exercise program.
I am noticing that my heart rate does not increase much while walking outside on level ground yet it goes up about 20 beats per minute during the hour I walk on the treadmill. The only reason I can think of for the heart rate increase is the slight uphill incline of the treadmill.
Another change while walking outside I have noticed is that my sinuses empty as I walk. I have no explanation for this other than that I inhale through the nose as I walk.
When I am having a bad day health wise (ie: my lungs are ineffective so my oxygen level is lower than usual), I ALWAYS have higher oxygen levels after walking than before. I believe this is a vivid, immediate indication of my lungs opening up and healing myself from exercising.
An understanding of what happens in the human body when exercisers feel their "second wind" has been helpful to me in making exercise easier. After we exercise for several minutes, a message is received by the brain which sends a signal to the blood vessels to dilate (get bigger around) and more blood goes to the muscles being used. More blood allows more carbon dioxide to be carried to the lungs where it is exhausted when we exhale. Getting rid of the carbon dioxide lessons the feeling of shortness of breath and makes it easier psychologically for those with emphysema to continue exercising. I use the "second wind" concept to make exercising easier by starting to walk very slowly and increasing my walking speed (and amount of arm swinging exertion) not sooner than every ten minutes as I walk. I also slow down a bit during the last 10 minutes of my walk.
Resources that I regularly receive or take part in and find helpful are as follows:
1. 2nd Wind Internet Support Group; you may become a member of this group by requesting an application from Dick Wyatt at the following address: Dick Wyatt 1917 Beechwood Street Little Rock AR 72207-2003 email address: [email protected]
2. The Second Wind Newsletter (not associated with the above support group) which is available by request by writing: Pulmonary Education and Research Foundation PO Box 1133 Lomita CA 90717-5133
3. The Pulmonary Paper which is available by subscription by writing: The Pulmonary Paper PO Box 877 Ormond Beach FL 32175
4. Respiratory News and Views which is available by subscription by writing: Respiratory News and Views PO Box 20321 Tompkins Square Station New York, N.Y. 10009
5. COPD internet support group; You may become a member of this group by requesting an application from Bill Powell at the following address:
Bill Powell 742 45th Avenue NE St Petersburg FL 33703 [email protected]
The training effect is very important to those with emphysema. We need to understand that when a muscle experiences training, it needs less oxygen and gives off less waste carbon dioxide to do the same task as the muscle used before it was trained. Thus when we get all our exercise from walking, training does not occur in the arms. Our arms then use relatively large amounts of oxygen (and give off large amounts of carbon dioxide making us feel short of breath) when they must be used in our daily life.
I now swing my arms when I walk and lift light (2 pound) barbells to also train my arms. Others use soup cans as barbells. Severly disabled individuals move their arms through weight lifting motions with no weight.
Swimming is sometimes mentioned as the best exercise because every muscle in the body is used. For those with lung disease, it is very attractive to train every muscle so that when a muscle is needed, it will be trained and a minimal amount of oxygen will be required. Unfortunately, swimming requires large amounts of oxygen and the use of supplemental oxygen while swimming isn't (to my knowledge) practical.
Any or all of this material may be used without permission in any manner, whether edited or not, you deem appropriate. This information is not protected by copyright and is intended to be freely copied and distributed without restriction as desired.
I hope all who read this information will consider it worthwhile to be copied and passed on to someone they know with lung disease.
Lots of people have helped me in many ways to allow me to generate and provide this information to the community of people with lung disease and I would like to thank them here. I could not possibly thank them all individually. It is my hope that all who read this information will find something here that helps them in some way.
I am personally aware of two that were diagnosed with emphysema and had heart disorders. Both became frequent exercisers (with supplemental oxygen) and were found years later with heart cauterization tests to have hearts without abnormalities of any kind.
Moving air from a table fan blowing on me while I walk on the treadmill helps me to keep cool and enhances breathing capacity. The more comfortable I am, the easier it is to continue walking and the moving air from a fan makes me more comfortable.
In August of 1997, I first spotted another person walking in a mall with supplemental oxygen in Kansas City, Missouri. I hope that was the first of many.
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