Starting an exercise program can be very difficult. So why bother? Is it really worth it? You bet it is! Hearing the suggestion, or the 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. And, if you have a respiratory disease, you must exercise: exercise really is the best medicine.
Before you start on the physical side of exercising, work a little on the mental side. We could list a whole page of benefits, but the biggest benefit for you will be the freedom you will regain. Being limited to only an area you can cover in a few minutes of walking is worse than being in jail! No wonder people with a respiratory disease often are irritable or depressed. 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. Excess sputum production decreases. Recent research shows that memory and arthritis usually improve too! More about all that later.
Number one on your to-do list is making an appointment with your doctor to discuss your wish to start an exercise program. This is to make sure it is safe for you to start exercising. If you have fatigue, maybe some coughing, and shortness of breath even during low-intensity exercise, ideally, you should see a pulmonologist and get referred to a pulmonary rehabilitation program. It is much easier to get started on your new exercise regime with the professional help and support that a pulmonary rehabilitation program can offer. Suppose you live in an area without any pulmonary rehabilitation. Does that mean all is lost? No! It’s harder, but you can do it on your own. There are many resources on our website to help you find a program near you and ideas on how to do more exercise on your own. We will now take you down that road to success, step by step.
If you have not exercised for a long time, chances are that you are deconditioned, so it would be a good idea to have an exercise test to measure how your body responds to exercise. These are tests called a cardiopulmonary exercise test or a cardiac stress test done by your physician. This is especially important since you already are having problems breathing, so this test will identify what needs to be done to help you overcome them and help the exercise specialist make your training prescription. It is important to be sure that your oxygen level with exercise is adequate, meaning that it is over 88% blood oxygen saturation, preferably 93% or more. Low oxygen saturation puts an extra strain on the heart and decreases your energy level. You also need to make sure that there are no heart or other problems you need to consider.
Your muscles (principally your leg muscles), and not only your lungs, are often the problem! We’ll discuss that in detail another time, but briefly, exercise with unfit muscles makes you breath harder than you exercise with trained muscles. We know that respiratory disease reduces muscle strength and endurance. Performing exercise training to recover the muscle fitness that you have lost over the years will dramatically ease your breathing when you need to be active. We may not be able to make major changes in your lungs, but we can do a great deal to improve the fitness of 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, especially when you first start your exercise program. You need to learn to breathe properly before you can increase your exercise tolerance. Breathing properly will help prevent shortness of breath and increase your ability to exercise. See our articles in this series on Why Learn New Breathing Techniques? And How to Reduce Shortness of Breath for more information. So start very slowly. Go for endurance, not speed. No one wants to do that, so HAVE PATIENCE! That is the formula for success.
Occasionally someone may start pulmonary rehabilitation with such severe deconditioning and lung disease that they arrive in their wheelchair, unable to walk across the room. Can you believe that six weeks later, that wheelchair is in the closet, and they are able to walk an hour at a time? Slowly, to be sure, but they can do it. Is it magic? Some people think so, but it really isn’t. You, too, have that same capacity to get these results. If you are as limited as this wheelchair-bound patient, then you should certainly seek professional help and encouragement. The more deconditioned you are, the more difficult it is, and it will take longer to achieve results, but you can do it! Now let’s get you started.
If you are so limited you can hardly walk across the room, start your exercise session sitting in a chair. Move forward slowly, breathing out through pursed lips (see our article on Why Learn New Breathing Techniques?) as you scoot to the front edge of the chair. Take a breath or two, and then stand up, “blowing yourself” out of the chair using pursed lip breathing (see our video here). You did it, and probably are not even winded!
Start by walking only one minute, five times a day. Concentrate on your breathing techniques and your pacing. That is what is most important, and that is what you need to learn. I’m sure you believe you can walk much longer than that, maybe even as long as 15 minutes, but the purpose of these short walks is to help you become used to pacing and breathing correctly, not just to improve exercise stamina. You can walk more often than five times a day if you wish, but when you start with a very easy program, you will see the early progress and not get discouraged.
When you walk across the room, are you tempted to rush across it before you get short of breath? Don’t. Remember to move slowly, using good breathing techniques. The goal is to walk one minute without being 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.
At first, it may seem that exercise makes you cough more and bring up more mucus. Maybe you are. But this probably is because you are breathing deeper when exercise, and clearing out your lungs of phlegm. Don’t be surprised if you start coughing up secretions after walking. This is better than having secretions pool in the bottom of your lungs and potentially cause pneumonia or another infection. A regular exercise program is the best thing you can do to eventually decrease your mucus or even get rid of it entirely. Why is that good? With fewer secretions in your lungs, you won’t be as susceptible to infections, your breathing will feel easier, and your oxygen levels will stay higher!
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 the lowest intensity possible, until you are able to ride for 30 minutes. Start by riding only 5 minutes at a time, or even less, but do it five times a day, gradually increasing the time as you get stronger or have less discomfort.
If you have restrictive lung disease, such as pulmonary fibrosis, you will need to be especially careful to move very slowly when you start to exercise. Be very sure to get the guidance of your physician on this. You may find that you drop your oxygen saturation very quickly if you move too fast. An oximeter to monitor your oxygen saturation levels can be very helpful for everyone, but especially for you (see our article on Pulse Oximetry and Oxygen Saturation).
Do you have a form of heart failure? With the permission of your physician, and only with that permission, the above exercise prescription for walking very slowly may also help you. Discuss these guidelines with your physician. Where can you walk when you only have a range of a few minutes? Why in your living room, of course! Perhaps 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 until you are able to walk. Or you can also do a few leg lifts every half-hour. What are leg lifts? Sit in your chair and lift your 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 walk eventually. Remember that unfit leg muscles cause this weakness; it is not lungs that are doing it. You can improve!
Are you a type A personality trapped in an unresponsive body? Have patience with yourself. Always start by concentrating on good breathing techniques and by always pacing yourself. I have often been told that was the hardest thing to learn in a pulmonary rehabilitation program. However, patience and pacing during exercise are how to avoid respiratory panic. These basics are essential in order to help you achieve that eventual goal of walking an hour without difficulty. An hour a day may seem like an impossible achievement at the moment, but actually, it’s the first 5 to 20 minutes that are the hardest. Once you have achieved that level of endurance, the rest will be much easier to achieve.
Do you notice that we haven’t said anything about a target heart rate? That is because in patients with lung disease, it the shortness of breath and muscle fatigue that limits exercise endurance, not heart rate. The exception is if you have a heart rate that is already over 100 even at rest. In that case, you should consult with your doctor before you start to make sure there is nothing else going on with your health. With a high resting heart rate, you will have to be sure that you walk slowly enough at the beginning of your exercise program so that your heart rate does not shoot through the roof. Rate your shortness of breath (out of a score of 10; 10 being the worst you have experienced) as a guide to increasing your exercise intensity. A little shortness of breath will not hurt you! 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.
Another warning for all of you: If your doctor prescribed oxygen with exercise, use it! Keep your oxygen saturation above 88%, preferably around 93% when exercising. Ask your physician for his or her recommendation. Your doctor may even wish you to keep your oxygen saturation at 94% or 95% to help your endurance and prevent a strain on your heart. Studies have shown that lung disease patients who exercise with oxygen get greater results than those who do not.
Keep a diary so that you can look back a couple of weeks from now and see how much you have improved. Start slowly! Gradually increase your exercise, only one minute at a time to begin with, to get your shortness of breath under control. We know you can walk a lot longer than that, but you need to concentrate on proper breathing and pacing before you push yourself to do more exercise.
Remember, you must continue to walk at least five times a day when you are only walking those few minutes at each session. However, if you have severe shortness of breath, do not increase the number of minutes you are walking. Slow down or even stop more often instead! Always remember that endurance, not speed, is what you are aiming for at this time. Be the tortoise, not the hare! Walk as slowly as is necessary to keep your shortness of breath under control. Once you are able to walk about 20 minutes, you may start increasing your speed, and you will be able to safely and comfortably do so.
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 increasing your time slowly, a few more minutes every few days. Remember, you aren’t trying out for the Olympics! When you are able to comfortably walk 6 or 7 minutes at a time you can cut back the number of sessions to 4 times per day. Once you achieve 10 minutes at each session, without more than moderate 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. Increasing your time now 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 any place in your neighborhood to walk? The weather is too bad? Go to the grocery store and support yourself on the shopping basket. Graduate to walking in the local mall. If you want to get your own treadmill, make sure that it has a slow enough setting for your pace; one that it is easy for you to maintain 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. Once you can walk an hour, you will be able to handle anything, even Disneyland!
You can use the rating of breathlessness scale (also called the Borg Scale) and walking diary to document your improvement in an exercise program. This information also will be helpful for your physician. Don’t worry about your heart rate if you haven’t figured out how to take it as yet. Put it on your to-do list and remember, if the scouts can learn this, so can you! 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 or 4 for your shortness of breath, which is “moderate.” A little shortness of breath won’t hurt you! Later, when you gain control over your breathing, you can push yourself harder if you wish.
Good luck! And enjoy the new freedom you will soon enjoy with your increased ability to walk and exercise!
Mary Burns, RN, BS
PERF Executive Vice President