EMPHYSEMA CAN BE HELPED
by Ron Peterson
I have emphysema. These words are being written because I have not been able to find a "self-help book" written by a non-medical person who has been diagnosed with this disease. I hope the things I've learned will help others in similar situations.
A diagnosis of emphysema is no longer the end of the line for those who are willing to walk to continue to live.
I was first diagnosed with emphysema eight years ago. I have learned how to libe better as a result of my diagnosis. I have begun to feel better by stopping smiking and walking frequently.
Some pulmonary rehabilitation centers in the United States have used exercise to help those with emphysema. The exercise has given significant improvement to the emphysema patients. The improbvement is attributed to the "training effect" of the muscles. A trained muscle uses less oxygen to do the same amount of work as an untrained muscle so the muscle has become more efficient.
I recently spoke with a graduate from a pulmonary rehabilitation program who was very pleased with her improvement. She has emphysema. Before the program, she smoked, was required to use supplementary oxygen 24 hours a day and became short of breath after two minures of slow walking. She was able to discontinue the use of both tobacco and oxygen after an exercise program and now walks a three and one-half mile course with three steep hills every day. She does the course in less than an hour and reports, "the harder I work during my walk, the better I feel for the rest of the day."
I stopped smoking the ninth of January of 1996 and started walking. I've recorded below the number of minutes of walking a week that I've done since that time.
This is a record of the numer of minutes of walking I have done each week so far:
during week number 1, I walked a total of 0 minutes
during week number 2, I walked a total of 7 minutes
week 3: 18 minutes
4: 49
5: 76
6: 62
7: 160
8: 44
9: 122
10: 118
11:174
12: 113
13: 98
14 232
15 304
16: 266
17 303
18: 405
19: 423
20: 245
21: 636
22: 558
23: 554
24: 520
25: 519
26: 520
27: 289
28: 423
29: 420
30: 341
31 :531
32 :209
Every time I start brisk walking, I feel short of breath at first. I've discovered, however, that the sensation of being short of breath usually goes away as I continue to walk. Every day, my body adjusts to the increased oxygen demands of my muscles and I am able to eventually breathe quite comfortably while continuing to walk.
I was recently told by a senior pulmonary physician at the Mayo Clinic (after he examined me, subjected me to a battery of two days of tests and reviewed the test results) that, "you are doing better with emphysema than anyone else I have ever seen". I believe he formed that opinion as a result of the following walking program I've come up with.
Even if you currently suffer from emphysema and have not been able to quit smoking, this program may be what it takes to put you back on the road to better health.
Exercise instructions for those without lung disease dictate less vigoorous effort when you cannot easily carry on a conversation while walking. This method of determining exertion level while exercising is not adequate for those wihh emphysema. Our needs are different in two vital areas.
The first area where we have a different need than those without lung disease is the necessity to incorporate pursed lip breathing while exercising. It is not possible to talk while using pursed lip breathing. Thus the exercvise instruction to, "slow down if you can't easily carry on a conversation" doesn't apply to those with lung disease.
The second area where our exercise needs differ from those without lung disease is the need to routinely exercise thru the sensation of shortness of breath. We need to teach our bodies that our performance capability is greater than when we sense we initiallly become short of breath. The sensation of being short of breath (as all those with emphysema know) is very frightening but, with experience, we can learn to overcome this fear and begin the recovery of our health.
We can safely exercise through shortness of breath by using a heart rate monitor to control how hard we exercise. Whenever our heart rate goes higher than a "target rate", we need to slow down.
Actual heart rate can be continuously displayed on a wrist band readout. Monitors sense heart rate with a sleeve that goes over the finger or a belt that goes around the chest. They are available at some pharmacies (without prescription) and many sporting goods stores. Manually sensing of heart rate is not adequate for this program. (can be ordered at 800-959-4089)
Initially, I exercised so that I did not become short of breath while slowly walking for two minutes. I added one beat per minute to my actual heart rate at the end of the two minute period and that was my target heart rate for the following day.
I added one beat per minute to my target heart rate for the next day whenever I was able to attain an actual heart rate equal to my target heart rate. I also added time to my exercise period for the next day. If I did not have sufficient breathing capacity to reach my target heart rate after trying for 30 minutes, I used the same target heart rate (but add a minute to my planned exercise time) the next day until I reached the target heart rate.
If you become short of breath or tired while slowly walking for 2 minutes, I'd suggest carrying a light lawn chair with you and sitting down as necessary to rest or catch your breath. If you are currently using supplemental oxygen, it;s very important to comtinue to use it while exercising until your physician feels you've improved enough to discontinue its use, Going off your oxygen too soon will stop your progress and is dangerous.
EXERCISE IN SIX PARTS
A daily exercise regimen is made up of six parts. Each of these parts is necessary to achieve improvement without injuring yourself.
My exercise activity is walking. Walking is thought by many to be the best form of exercise. Whatever form of ecercise you prefer may be substituted for walking, however, without loss of the basic benefits of this program.
The first part of a daily exercise regimen is the warm up. This is simply a period of time of relaxed activity (I use 10 minutes of slow walking) to acclimate you body to exertion.
Stretching exercises follow the warm up, This actibity is described in many exercise books and is needed to prevent pulled muscles during your exercise program. I feel that the "slow walking" gives me all the stretching needed, but in other forms of exercise you would be wise to do some stretching before betginning.
The third part of your daily exercise regimen is to elevate your actual heart rate to your target heart rate. This is accomplished by "brisk activity" (I use fast wlaking) as you raise your actual heart rate displayed on the wrist monitor to the target heart rate that you are "shooting at" for that day. It is surprising how easy it happens. >p> For those with lung disease, a sensation of shortness of breath surfaces during this part of the program. The sensation is temporary and represents our body trying to heal itself. I try to continue walking briskly as my actual heart rate elevates to my target heart rate. If you become more uncomfortable that you want to tolerate, decrease your exertion level very slightly, but keep trying. In almost all cases, your actual heart rate will eventually reach your target heart rate. I discontinue my attempt for the day if 30 minutes of brisk walking does not elevate my heart rate to my target level. If it doesn't elevate all the way today, it most surely will tomorrow.
The fourth stage is to simply maintain your heart rate at your target level. As your body adjusts to this level of exertion, your breathing rate slows down and the sensation of shortness of breath goes away. This pleasant state continues for the remainder of your period of brisk actibity and is bery helpful to your entire body.
The last two steps of your daily exercise program are to "cool down" by exercising very slowly for a while (I use 10 minutes of slow walking) and finally, repeat the stretching exercises.
When you exercise, the more oxygen you can get to your muscles, the better you will be able to perform and the faster you can improbve the quality of your life. You get more oxygen to your muscles by breathing more efficiently.
The most important breathing technique you can use to breathe more efficiently is called pursed lip breathing. This simply means exhaling thru lips that are pushed together like you're going to blow into a trumpet. Your body will intuitively understand how helpful pursed lip breathing is and automatically incorporate this invaluable breathing technique wheneber you experience shortness of breath.
Diaphragmatic breathing can improve your breathing efficiency nearly as much as pursed lip breathing but it does not come naturally, you must learn and practice the technique before it feels comfortable.
Diaphagmatic breathing is sometimes called "breathing from the stomach" because the stomach pushes outward as air is inhaled. Exhaling (thru pursed lips of course) air from the lungs is done by "sucking the gut in". It is difficult to use diaphragmatic breathing while exercising so don't allow yourself to become discouraged and give up on this very helpful technique.
Listen to your body. It's important to slowly build up your exercise times. I believe it's best to exercise every day but we must constantly "listen to our body" to make sure we don't increase our exercise times too fast. It took me six non-smoking months (and years of exercising as a smoker) to work up to my present level of 500 minutes of exercise a week level. I believe increasing exercise times too fast will lead to pulled muscles or "burnout".
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