This page is intended for educational purposes only and should not be used as a substitute for consulting with a Medical Professional of your choice.  Most of the contributors are not health care professionals; this page in part is a collection of personal experiences, suggestions, and practical information mainly from myself and other COPD patients.  Please remember when reading this that every Person with COPD responds differently;  What is true for one COPD patient may or may not be true for you.  Although every effort is made to keep this information accurate, this should NOT be used as an authoritative reference.  I will not be responsible in any way for your use of this material. Assume all responsibilities and liabilities for yourself if you use material on these pages.  Otherwise  don't use it.


Dr. Mirkin's E-Zine
October 28, 2001

How Exercise Affects Cholesterol

A recent study from the University of Alabama in Birmingham showed that exercising longer has a greater beneficial effect on cholesterol than exercising harder (American Journal of Cardiology, Volume 87, 2001). Exercising intensely causes sore muscles on the next days and therefore limits the amount of exercise you can do.  When you exercise longer, you burn more calories and therefore you lower cholesterol.  If you have high blood levels of cholesterol, any combination of diet and exercise that reduces calories will help lower cholesterol.  Saturated fats in meat and whole milk diary products are broken down into acetone units that your liver uses to make cholesterol. When you burn more calories than you take in, the acetone units are burned for energy and therefore cannot be used to make cholesterol.

Pursed-lip breathing

1. Inhale slowly through your nose until your lungs fill up with air.
2. Purse your lips as if you were going to whistle or kiss someone.
3. Breathe out slowly while keeping your lips pursed.
4. Take twice as long to breathe out as you do to breathe in.
5. Do not force your lungs to empty.
Pursed-lip breathing will help you control your breathing rate and shortness of breath. It helps more air get into your lungs and reduces the energy required to breathe. It will also help you feel more in control and make it easier for you to do things.
Holding your breath
1. Breathe in.
2. Try to hold your breath for three seconds.
3. Breathe out.
Holding your breath extends the time for your lungs to exchange oxygen for carbon dioxide. This helps your blood to take in
more oxygen.

Breathing from your diaphragm

Your diaphragm is a thick, flat muscle just below your rib cage and above your abdomen (your belly). By using your diaphragm
when you breathe in, you help your lungs expand so that they take in more air.
1. Relax your shoulders.
2. Put one hand on your abdomen.
3. Make your abdomen push out while you breathe in through your nose.
4. Suck in your abdominal muscles.
5. Breathe out using the pursed-lip technique. You should feel your abdomen go down.
6. Repeat three times and rest for two minutes.
7. Repeat this exercise many times a day.

Rib-cage breathing

1. Repeat the steps used in diaphragm breathing, but place your hands on your ribs instead of your abdomen, and don't pull in your abdominal muscles.
2. Feel your chest expand and fall back as you breathe.
These methods will make breathing less work, control your breathing when it's hard to breathe, and help more air get to your lungs and the air sacs where oxygen reaches your bloodstream.

 Exercise May Boost Immunity

                       Source: Tufts University

                       Exercise gives health a boost

                       Regular exercise provides a number of well-documented benefits, including stronger hearts, bones,
                       and muscles. According to research published in Medicine & Science in Sports & Exercise,
                       another item may be added to this list:strengthening the immune systems of older adults.

                       The aging immune system

                       Aging is often accompanied by a decrease in the effectiveness of the immune system. A weaker immune
                       system can, in turn, make older adults increasingly vulnerable to infections and illnesses such as the
                       flu or pneumonia.

                       Researchers have speculated that some of the decline in the immune system can be attributed to dietary
                       deficiencies and/or a decrease in physical activity. To  investigate this link, a group of Dutch  scientists
                       worked with 112 frail men and women for 17 weeks. The volunteers, whose average age was 79, all
                       lived independently but required some outside assistance such as home care or home delivered meals.

                       The participants were divided into four groups. One group engaged in a moderately intensive, 45-minute
                       exercise program twice a week; a second group consumed daily portions of food enriched with vitamins
                       and minerals that are frequently under-represented in the diets of older adults; a third both exercised and
                       ate enriched food; and a fourth did neither.

                       Study results

                       A skin test (designed to gauge participants' reaction to irritants) was used to measure the strength of the
                       participants' immune system at the beginning and end of the 17-week study period.  The researchers
                       found that those individuals who participated in the exercise program showed a small, but meaningful
                       increase in their immune response. While the group eating enriched foods experienced a beneficial
                       increase in their blood levels of vitamins and minerals, there was no observed change in their immune

                       According to the authors, the body of research that focuses on exercise and immune function in older adults
                        is small and inconsistent, and this study is the first to concentrate on a frail population. While additional
                       research is needed, these results indicate that moderate exercise might help older adults, particularly frail
                       older adults, fend off age-related declines in the immune system.

                       Benefits of exercise begin at any age
                       The participants in this study who exercised did not lift 50-pound weights, log miles on a treadmill, or
                       engage in other rigorous activities to obtain favorable changes.  Rather, they used equipment described
                       as "inexpensive," in a program designed to maintain or improve mobility. And, none of the relatively
                       aged volunteers were regularly active when they enrolled in the study, reinforcing the notion that it is
                        never too late to start reaping the benefits of exercise and that modest efforts go a long way.

                       Immunity in frail elderly: a randomized control trial of exercise and enriched foods.  A. Chin, M. Paw,
                       N. De Jong, E. Pallast,  et al., Medicine & Science in Sports &
                       Exercise, 2000, vol. 32, pp. 2005--2011

COLUMBUS, Ohio -- People suffering from diseases such as chronic bronchitis and emphysema can benefit from
high-intensity exercise of their chest muscles and diaphragm, according to a recent study.

In fact, the sickest patients are the ones who appear to benefit most from high-intensity respiratory muscle exercise.

Researchers at the Ohio State University College of Nursing looked at the effect of this specialized exercise on 22
patients with chronic obstructive pulmonary diseases (COPD). These diseases, which include chronic bronchitis and
emphysema, are the fourth leading cause of death in the United States.

The scientists found that COPD patients who exercised their respiratory muscles three times a week for three months
-- both those who trained at a high-intensity level and those who trained at a lower level -- showed significant
improvement in respiratory muscle endurance, combined strength and endurance, and walking speed.

Further, they found that these improvements were greatest among those patients with poor lung function who participated in high-intensity training.

"With high-intensity training, there was some concern about injury, a concern that you could overtrain and perhaps cause a patient to have more problems," said Thomas Clanton, associate professor of physiology, internal medicine and allied medical professions at Ohio State and one of the authors of the study. "These results show that patients can tolerate it well and that even low-intensity training can have beneficial effects."

The study, which appeared in a recent issue of the journal Chest, is among the first to demonstrate the benefits of
high-intensity respiratory muscle training for COPD patients. Respiratory muscle training itself -- during which patients must generate enough inhaling power to pop open a pressure-loaded valve, yet maintain a regular breathing pattern -- is fairly controversial, Clanton said.

"Probably only about 50 percent of people involved in pulmonary rehabilitation believe that it's a great part of a
comprehensive rehabilitation program," he said. "The other half think it's not of as much value as other components."

Despite the controversy, study results suggest that high-intensity respiratory muscle training could become a way for the most seriously ill COPD patients to improve their quality of life, Clanton said.

"There are not a lot of treatments available for people who've lost lung tissue to these diseases," he said. "The idea behind respiratory muscle training is that if we can exercise these muscles and make them less susceptible to fatigue, patients will be able to exercise more and may have the 'reserves' necessary to stave off respiratory failure and stay out of the hospital."

Clanton conducted the study with former nursing doctoral student Barbara Preusser and former Ohio State professor of nursing Maryl L. Winningham.

For their study, the scientists measured the lung function, respiratory muscle strength, endurance, combined strength and endurance, and walking speed of the COPD patients. They then assigned the patients to either a high-intensity or
low-intensity respiratory exercise group and had them exercise three times a week for three months using a threshold trainer -- a respiratory testing device that measures patients' ability to generate inhaling power and pop open a pressure-loaded valve. Patients in the high-intensity group had a higher pressure load to inhale against.

During the study, the researchers increased the size of the load, the length of the training session and the work-to-rest ratio. In the first week, the training session took five minutes; in the last, 18 minutes. At the end of the study, the scientists measured each patient's respiratory muscle strength, endurance, combined strength and endurance, and walking speed.

The results:
Respiratory muscle endurance, combined strength and endurance and walking speed improved for both the high-intensity and low-intensity groups over the course of the study, indicating no significant difference between the two training regimens. "This suggests that both high- and low-intensity training are effective in conditioning the respiratory muscles," Clanton said.

However, respiratory muscle strength, endurance, combined strength and endurance, and walking speed improved most among very ill patients who participated in high-intensity training and least among very ill patients who participated in low-intensity training.

"Patients who have the most severe lung disease are constantly 'training' just through their everyday living. Because of this, they probably need a higher load in order to show a training effect," Clanton said.

Respiratory muscle strength, endurance, combined strength and endurance, and walking speed did not significantly improve during the third month of the study in either group.

"This suggests that the optimal length for this particular training regimen is two months," Clanton said. Currently, however, some third-party health insurance providers won't even pay for that many weeks, he said.

Clanton said he hopes this training regimen will eventually be evaluated in a multi-center trial with a larger group of patients.

Also, he hopes researchers will address the question of whether respiratory muscle training reduces health care costs -- over and above regular pulmonary rehabilitation.

"If you add respiratory muscle training to the overall pulmonary rehabilitation program, are patients less likely to end up in the hospital? Will spending a little extra on this element ultimately lower patient costs? That's a question we need to answer in a statistically defendable way."

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Contact: Thomas Clanton, (614) 293-4936
Written by Kelly Kershner, (614) 292-8308

Study: Old Exercisers Have Potential
WASHINGTON (AP) - Older exercisers have youthful potential to gain strength, if they work hard at it, researchers find. Leg muscle strength increased up to 84 percent over 16 weeks among men ages 60-75 who did weight-training-type exercises at an intensity that matches gym rats in their 20s, the researchers found. And the older exercisers' increases in muscle fiber size were proportionate to the gains showed by younger exercisers.

``Elderly men cannot only tolerate these very high workloads, but will exhibit muscular changes similar to their younger counterparts,'' said one of two studies on the men, both published in the Journal of Gerontology.

Ohio University scientists looked at healthy men who kept active but did no regular weight training. Nine were put on a training program that had them doing leg extensions. The men first did 10 repetitions at 50 percent of the maximum they could lift at one time. They then did three sets of 6-8 repetitions at 80-85 percent of their one-time maximums. The men did this twice a week.  The other nine did no weight training and served as a comparison group.

Although both groups were similar at the start, the exercisers had pulled well ahead at the end of the 16 weeks. They averaged 50 percent better on the extension, 72 percent better on the press and 84 percent better on the half squat, the study said.

 The scientists also found the exercisers gained endurance - the men's hearts had to work less hard at a given intensity in a treadmill test. There was no such improvement in the nonexercising comparison group.

The researchers also took raisin-sized samples of muscle tissue by biopsy. They found the exercisers had fewer Type IIB muscle fibers, a type associated with inactivity, and more Type IIA, a trained-muscle form that increases with exercise, said researcher Robert S. Staron. The workout regimen apparently triggered a transformation in fiber type similar to that seen in athletes, he said.

The exercise paid off in lifestyle improvements, Staron said. ``All of them indicated they felt better,'' he said.  ``They were doing more things. They felt much more comfortable and much more strong in their daily activities.''

The companion report in the journal took a closer look at changes in the size of the cells. The cells in the exercisers grew by 30 percent, the study said. That's similar to what's found in men in their 20s who weight train, said researcher Robert S. Hikida.

The research is in line with other studies on resistance exercise, even at high intensities, said researcher William J. Evans of the University of Arkansas for Medical Sciences, who was not part of the studies. And the gains can be dramatic among people who have done no previous exercise, he said.

The idea that older people must resign themselves to inactivity and frailty is old-fashioned, said Dr. Walter R. Frontera, a researcher at Harvard-affiliated Spaulding Rehabilitation Hospital, Boston.

Although age does mandate limits on how much strength an exerciser can gain, researchers increasingly are unsure what the limit might be, Frontera said. ``It is not easy to identify a plateau in their strength gains,'' he said.

For sedentary older folks, the gains can be dramatic, and even in veteran masters athletes, some gains may be possible, Frontera said. ``They will reach a limit,'' he said.   ``I don't think we know what the limit is, which is the interesting question.''

Besides the fact that doing regular exercise can improve the quality of your sex life, the National Institutes of Health calls exercise "the most effective anti-aging pill ever discovered." And did you know that exercise always lifts your mood by releasing feel-good endorphins, the body's natural painkillers?  Now that your interest in feeling fit has been stoked, take this quiz and learn the how-to's about warming up, working out, staying motivated, and cooling down with various types of exercise. The more you know, the more you'll glow with fitness.
Take the Quiz

National Institute on Aging Exercise Video for $7.00

When Should Medicare Ccoverage beAvailable for Outpatient Physical Therapy? 
Deskercise of the Day
Exercise boosts clot-dissolving protein
Pulmonary rehabilitation for COPD
Optimal Breathing - Diaphragm Development
Oxygen Desaturation During Submaximal Exercise
Sarcoidosis* The Value of Exercise Testing
Regular Exercise Helps Patients With COPD
Exercise and COPD: Modest Gains Pay Big Dividends
Your Exercise Treatment for Lung Disease

First you start out slow because most of us have had to do just that,,Myself included. When I was first diagnoised and told I needed a transplant my  FEV1 was 23% and I had difficulity walking 100 feet without stopping to rest and I was on  4lpm of oxygen. I keep working for the next year in this same condition and did a lot of walking to my job sites where I worked on computers in hospitals. I finally had to quit the job by request of my doctor as my sats were dropping into the 70's on a regular basis and he was concerned about the damage I could be doing to my heart and putting my transplant chances in jeopardy. Well,,I asked if I could go to pulmonary rehab and he agreed that would be a good thing to do. My first 6 minute walk test was only 680 or so feet and I had to stop 4 times because my saturation would drop below 88. When I was finished with the 12 weeks of rehab,,,my 6 minute walk test was 1300 feet and I did not have to stop once and my sats stayed above 90 the whole time and while I was in rehab my FEV1 was down to 12%. EXERCISE makes a trememdous difference. It helps your body stay in some sort of condition and keeps the organs working as well as they are capable depending on your condition. The morning before I went in for transplant I walked a mile on my treadmill at home and sats stayed above 93% and I was walking at 1.5mph and this was with a FEV1 of 9%. So as my lung function kept on getting lower and lower I was still able to remain active because of exercise and a little attitude.. I believe if I had not been in the condition I was in when I went in for transplant, I would not have survived the recovery due to  the complications I had after the tx.  I am a real believer in exercise. It does make a difference.  How long the improvement last is a variable for each one of us. I believe the
longer you can exercise the longer the improvement will stay with you. You are definitely not going to stay in the same condtion just because of  nature and the ageing process but you can stay alive and mobile a lot longer if you do exercise. You can do the things some of us can do. Its a matter of getting started with a exercise program that fits you. Even with severe emphysema, which I most definitely had, you can be active and with exercise maybe even surprise yourself just how much you can do. keep on keepin' on
Tony in Dallas <THamel5038@AOL.COM>

Re-tx an emphysemiac view
Well, I haven't gotten into this discussion much but wanted to say this. Exercise makes a world of difference but it will only take you so far when you have damaged lungs.  You CANNOT repair the damage all you can do is teach your body to use 02 more efficiently which in turn makes things easier.  I have worked out at my club for more than 8 years.

I began early on when I was 16% lung function and basically in a wheel chair. I can pump iron with the best of em. BUT,  I am still limited.  Now if you are a person who doesn't want to run or play tug of war with a dog who can
rip your arm right out of the socket then I guess that is fine for you. Everyone has their own goals.

One thing to keep in mind though (for anyone pre-transplant and deciding whether to do it or not)  It's quite easy to lose lung function.  One good infection with already compromised lungs can do the trick.  I hardly get sick because I take care in that.  But the few times I have both pre and post I lost lung function that DID NOT come back.  Once you have changed your life style to a slower pace things will be easier but try to keep up with the rest of the world and you have a problem.

Mind you that is not what I want I think most of the people today haven't got a clue.  But I do want to play with my dogs do agility with them. And do other aerobic type activities that I cannot do.  Believe me I am in great shape as well.  Pumping iron for 8 years gets ya that way.  I believe in myself without one bit of doubt and that makes it easy for me to make decisions like this.  If anyone would be turned off by lung transplants I guess that would be me seeing as what happened in the first one.  But I don't operate that way and for me I think God loves that in me.

Karen Fitchett <KDFitchett@AOL.COM>

 Re: [COPD] Treadmill conditioning for us'ns with Emphysema
When we write of "conditioning" our muscles through exercise, it isn't just to strengthen our legs, or abs, etc., it is to work toward a number of goals, including the release of endorphins and improving flexibility.

We get a boost to our morale as we do a little more this week than last. We may lose a little weight.

The primary goal, however, is to tone your muscles; to improve your general conditioning so your motor muscles are more efficient and use a bit less O2.  The improvement is going to be subtle and gradual, but it will occur.

You may still have bouts of sob, and it will still be an effort to walk through the supermarket, but your episodes will probably be a bit milder and your recovery periods a bit shorter.

Bill Horden <SOBnSA@AOL.COM>

Walk Away Stress (Healthy Alternatives)
Does sitting in one spot for half an hour to meditate strike you as a bore? Then what about meditating as you walk? The activity of walking can actually be an aid to reaching the awareness that is the goal of meditation. Read up on how to turn your walks into a source of emotional and spiritual renewal.

Re:  chest pains etc.....(right-heart, etc)

My right-sided heart condition was, at different times, and by different doctors, called either tachycardia or fibrillation,

both of which were described as a result of COPD-induced stress.

It is my opinion that multidisciplinary pulmonary rehabilitation programs will be beneficial for all but a few COPD
patients (those who are, in fact,on their last legs).

Please note my use of the word "multidisciplinary" in this declaration. I use it to distinguish proper rehabilitation from that performed by "personal trainers" or "aerobics instructors." In a qualified rehab program the doctor, nurses, and therapists evaluate the condition of each patient and determine an appropriate course of treatment, setting goals and limits. The patient's condition and progress are regularly monitored and reported; if troubledevelops or goals are not being met, a reassessment is in order.

I'm going into this detail because most folk know me as a long-term champion of pulmonary rehab and I find, too often, recently, that members of the Mailing List give blanket endorsement to one or another "new" exercise book.  I'm genuinely concerned that some readers will overdo some exercises or, being unaware of realistic goals, become quickly discouragedwhen "exercise" fails to meet their expectations.

Each newcomer to this list should be reminded often that the first two exercises the patient must learn are PLB
(pursed-lip breathing) and diaphragmatic breathing. Without the confidence and comfort of these weapons,
no other exercises can be effective. With them, the patient can regain control of a large part of his life.

Bill Horden <SOBnSA@AOL.COM>

My nebulizer has a relatively long Tygon tubing, sufficiently long so that when using the nebulizer I can (1) ride my
stationary bike (2) look at the golf channel on television and (3) use my treadmill.  Most of the time I just do the
stationary bike and nebulizing but sometimes the treadmill too.  The only thing one should do is to make certain the
seat of high enough so that the diaphragm (and/or lower gut is fat like I am) doesn't interfere with the breathing process. When using the nebulizer and treadmill I go slow enough so that I can do my normal breathing.  Being able to combine these together while watching television helps me a great deal.  These are the different ways that I combine enjoyment with my daily breathing routines..... Gaylon Ross <logross@sccoast.net>

Q:What else can I do to improve my lung function? Peter Browne Terry, M.D., is professor of medicine in the division of pulmonary and critical care medicine at the Johns Hopkins Center for Asthma and Allergy. His research interests include emphysema, pulmonary blood vessel diseases, pulmonary education and bioethical issues.
A:Congratulations on quitting smoking! You have done the most important thing you can do to protect your lung function. Concerning exercises to increase your lung capacity, the most important thing to know is that your lungs do not have muscles in them, except in the breathing tubes. The lungs are moved passively by contracting your diaphragm and the muscles between your ribs.  You can strengthen the diaphragm and muscles between the ribs by doing any form of exercise that requires breathing greater than you would normally do during routine daily activities. So jogging, running, swimming, skipping rope or even walking distances will increase the stamina of these muscles. Other things you can do to maintain your lung function are to avoid pollution, avoid getting infections and get a flu shot in the fall if you are someone who haves frequent contact with others during the flu season.

Got Oxygen? Deep Breath
Did you know that one out of every three Americans now gets some form of cancer? This rate is similar in many countries. It's a scary statistic.  But another, more optimistic statistic is this: athletes have a different ratio of contracting cancer-one out of every seven. Why? Studies have shown that one of the reasons why athletes stay healthier is because they give their bloodstream more of its most vital element-oxygen-on an ongoing basis. They are stimulating their immune system by stimulating the movement of the lymph fluid, which acts as an internal vacuum cleaner. More oxygen in the cells means less irritants in the system.
Athletes get more oxygen because they don't just breathe, they breathe deeply. When you breathe deeply you can actually feel the benefit of receiving more oxygen. Try this and see: Inhale for one count (but don't just take a breath; take a quick, deep breath). Hold the breath for four counts. Then exhale for two counts. Repeat five times.  If you are not an athlete, or you do not get any regular aerobic exercise, here's a good breathing exercise that you can incorporate into your life:  Starting from your abdomen, take a deep breathe in through your nose and count to seven as you inhale. Now hold your breath for twenty-one counts (or as long as you can hold it). And then exhale slowly through your mouth for a count of fourteen. Don't strain.  If the counts are too big, then start smaller and gradually work up to this level. Do this ten times, three times a day, and just see what will happen to your energy level. It will explode! And your overall health is likely to improve, as well.
Medical Reference - Exercise to Stay Healthy
Subject: Re: COPD and SOB
Date: Wed, 19 Jan 2000 11:49:47 -0800
From: Paul Marks <pmarks@SPEAKEASY.ORG>

While exercising can be physically difficult it is the second most important thing that we can do for ourselves - the first being quitting smoking.  I would like to tell you about my personal experience with this to show what is possible.

Several years ago I agreed to participate in a lung association bicycle trek   The route would start at Pt Reyes northwest of San Francisco and proceed over the coast range into the city, a distance of 45 miles.  With a lung function of 37% my hope was to ride 5 or 6  miles of flat terrain.  About 6 weeks before the event I decided that I'd better get in shape for the ride.  I got on my old bike and started off.  I was totally out of breath after just 100 feet or so.  Pretty discouraging.  Being a bull-headed individual I refused to quit and started riding a bit each day.  Soon I was able to ride around the block, then
a mile, then five miles.  Finally on the weekend before the event I rode 13 miles on the flat.  For the event I was then able to ride 37 of the 45 miles and managed to even ride (very, very slowly) into the finish area.  Dead last.  Exhausted. But grinning.  The big revelation came after the event.  Every day events were now easier.  I could do stairs without "losing it".  I was darn near normal again.

The point here is that we can do more than we give ourselves credit for.  Because we all find it difficult to get around we tend to get less and less exercise.  It is a natural thing for us to do, but it is wrong.  The good news, as my experience demonstrates, is that we can recondition our muscles and that once this occurs we can lead pretty normal lives.  We may move a little slower and we may huff and puff but we can still keep on keepin' on.

Start with what you can do... and do a bit more of it.  Soon you'll be able to do something else that is a bit more challenging.  Do that and keep pushing the envelope a little bit at a time.  Don't overdo.   Just do.



Pulmonary Rehab -----------------------The trick is to do these exercises without your o2 SAT levels dropping below 90.  I started the program 6 mo. ago when I also began supplemental o2.  In 6 mo. I have gained 30 much needed pounds and have greatly increased my endurance. My first session began with my only being able to treadmill 6 min. at 1.5 mph. Now I go 40 min. at 3.3 mph.  I also ride the bike, and workout on nautilus equip.  The instructors initially show you how to operate the equip. and check your o2 sats periodically.  I go 3 times a week for 1 1/2 hrs.  My insurance pays for it.  At this point what I do is called Pulmonary Exercise (not therapy) and costs about $15. monthly.  I personally know that I couldn't do this without the use of my inhalers, or nebulizer and my oxygen.  They and (very important.) Most COPD patients need pursed- lip breathing techniques to effectively exercise.  If you have to exercise yourself remember to always do warm-up and cool-down excercises.  I wish you luck in finding a facility to help you.  The social interaction does take your mind off of yourself and makes the time go faster.
1)  Stand tall with your feet about 10-12 inches apart.  Raise your arms as straight up into the air as high as you can and hold it.  Then stretch just a little more..  Hold for 10 seconds then lower arms to floor (or as close as you can).    Keep legs relaxed yet straight and feet flat on floor during this.  Repeat 12 times.

2)  Stand in same position, body straight, feet flat.  Lift shoulders straight up toward ceiling, hold for 3 seconds, then roll shoulders backward and hold 3 seconds.  Lower shoulders to normal position.  Repeat 12 times.  On last one connect fingers of each hand behind your back.  Straighten elbows as much as possible and hold for 10 seconds, creating arched back and good stretch.

This is what I know about the pursed-lip breathing and I will share it with you.
1. Relax your neck and shoulder.  Breathe in slowly through your nose for 2 counts
2. Pucker your lips as if you were going to blow out a candle

Breathe out slowly and gently through your lips for 4 counts Remember, Always breathe out for longer than you breathe inNever hold your breath between breathing in and breathing out.  I feel pursed lip breathing will help one relax, I feel it's a better way to beathe.  The technique is simple, but it must be practiced so that it becomes a part of you.  This method of breathing forces you to slow down when you have a tendency to panic and breathe fast. OK practice it now. Relax, Breathe in through your nose. Not a deep breath, just a normal breath  Pucker up and slowly let the air fall out through your pursed lips. When blowing out, do not force your air out, just let it relax out slowly.  This kind of breathing helps you slow down so that you are able to remove the air that becoes trapped when you breathe to fast. Remember, keep your body relaxed.  Don't force your air out through your lips, just let it fall out slowly.  Slow, easy, and relaxed in and out  Take a slow breath through your nose.  Then pucker your lips like you are going to whistle,  and let the air fall out slowly through your pursed lips.  I use my pursed- lip breathing whenever I am active I breathe in first then I breathe out as I move. I also use my pursed- lip breathing when I am having an anxiety attack. I feel one of the most important things that I have learned with this disease is the purse-lipped breathing.
    Glenda Jones

"The Pulmonary Education and Research Foundation (PERF) id offering 'Essentials of Pulmonary Rehabilitate - A Do It Yourself Program,' consisting of two videos and an accompanying booklet for $15.99. Call 1-800-539-8390 for further information."
As with us all, exercise is your choice "to do or to die" and that my dear is the real truth in my advertisement.  If today you can do only 5 minutes at .7 on the treadmill then you have established your start point.  Every day this week get your butt on that treadmill and do 5 minutes at .7.  Next week do 5 minutes at .8 every day for a week.  When you have gone as many weeks as it takes to do 5 minutes at 1.2 then start moving up each week by two minutes a week. I have not asked you to do a great amount of exercise here.  I have only asked you to be consistant.  Steadily, slowly increasing your program.  You should stay on this program until you are up to 30 min a day at 1.5.  I started at .7 for 4 minutes.  I do 40 minutes on the treadmill every other day now.  On alternate days I am trying to build my tummy, back of my legs and arms.  How you ask?  By the killer rowing machine. I am up to 6 minutes on it and believe you me it is a killer for me.  You have to look at the thing as I will do it reguardless, even if I have to add my time, 30 seconds a week. It doesn't matter that I am moving forward at such a slow pace.  It only matters that I am moving forward.  Remember folks.
Exercise is the best salvation a lung patient has for survival.
(Next to stopping smoking, that is.)
NO ONE is so bad that exercise will not help them.  Ask yourself this, about an exercise program what can I do now?
1.  Can I walk from here to the bathroom?  Let me do it twice before I allow myself to use it. In otherwise go to bathroom turn around and go back  to where you were and then make the trip to the bathroom again.  This time you can use it.
2.  Sit in your chair with a 16 oz. can of anything in your hand and do handlifts.  Strengthening those arm muscles.
3.   Practice Diaphramic breathing.  In through the nose to a count of 2, 3 0r 4, expanding the stomach.  Out through pursed lips.
(like you were whistling) to the count of 4, 5 or 6 (twice the intake count) and the stomach goes in as the air goes out.  This
strengthens the diaphram which is our source of life.  Move it in and out with the above exercise as many times a day as you
think of it. Every time you get short of breath would be good.  These are things you can do now.
And a very important exercise almost all of us should practice is to exercise our mind to look at exercise as
"What can I do to get this accomplished?"
Instead of "This is too hard" or "I can't do this when I am so short of breath."  You have to push yourself, every day."
If  today you can only do 3 minutes on the treadmill or 10 steps.  Do that then.  Do what you can do now.  Just do!!!!
After about 5 days in a row of 10 steps. The sixth day do 12 steps.  Every 5 or so days add a couple of more steps.  Pretty soon you will be able to do a mile. One step at a time.
Just do the thing in your mind first.  You have to see yourself being able to do it, before you actually will achieve it.
Just remember you can do it!!!  I know this for a fact because I know where I was.  And I know where I am now.

Slow Speed Ahead
Want to improve your strength more quickly? Then slow down the pace at which you lift weights.

In a recent study, participants who completed weightlifting sets at a speed of 14 seconds per lift increased their strength almost 50% more than did those participants who did each repetition in 7 seconds. When you lift a weight more slowly, you're relying less on momentum, and more on sheer strength. The muscle simply has to work harder.

The message? Slow and steady may result in superior strength.

RealAge Benefit: Lifting weights for 10 minutes 3 times per week can make your RealAge as much as 1.7 years younger.

Benefits of Exercise
"Mini" Relaxation Exercises
Breathing Exercises
Proper stretching for Walkers
Regular Exercise Helps Patients With COPD
Walking Away Depression
Breathing Retraining
Pulmonary Rehabilitation Plus
Pumping Iron Increases Independence In Frail Elderly
Pulmonary Rehab Program Videos
Diaphragmatic Breathing
Exercise and Chronic Obstructive Pulmonary Disease
Home exercises for Pulmonary Rehab
Exercise Physiology
Upper Body Strengthening Program Exercise
Exercise - Why you need it
Results of Home Training Program for Patients With COPD
Fitness online
The Importance of Proper Breathing Techniques


by Mary Burns, R.N.; B.S. who has been teaching pulmonary rehabilitation to patients for over 20 years in California

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 you to-do list is making an appointment with your doctor to discuss with him 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. But suppose you live in an area without any pulmonary rehab. Does that mean all is lost? No! You can do it on your own and we will now take you down the road to success step by step.

You need to have an exercise test, such as a 6-minute walk or a cardiopulmonary exercise test, done by your physician, before starting to exercise. It is very 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 make exercise inadvisable.

Before we start on the physical side of exercising lets work a little on the mental. Someone with lung disease may start rehab in a wheel chair, unable to walk across the room, but usually, 6 weeks later is able to walk an hour a day. Magic? Some people think so, but it really isn't. You too have that same capacity, though without professional help it is more difficult and may take longer to acheive. It is your muscles, not your lungs that are the problem. We'll discuss that in detail another month 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 PATEINCE! Here is the formula for success.

Start by walking only one minute, 5 times a day. Now, you can walk more often than that if you wish, but most people find it difficult.

You don't have a rehab program to demonstrate how to start? Let me help you. Work slowly at first! Sit in a chair. As you get out of the chair, move slowly and exhale, using pursed lip breathing (PLB) with 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 and then 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 that, 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 acheivement 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.

Did 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. However, you must continue to walk at least 5 times a day if 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. Always remember that endurance, not speed, is what you are aiming for at this time. Walk as slowly as is necessary to keep that SOB under control. Once you are able to walk an hour, 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 one minute? 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 or do a few leg lifts every half-hour. What are leg lifts? Sit in your chair and lift your legs, one at a time, as if you were walking. This will help to strengthen your leg muscles so that you will be able to eventually walk. Remember, that decinditioned muscles cause this weakness, not by 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 afrthritis, also. Walk only until you have pain, or marked discomfort, iven if it is only 30 seconds. Stop until the pain is gone, and then start again. A bike is very 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 or an hour. 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, and you are able to walk 5 or 6 or 7 minutes at a time, you can start walking 4 times a day.

When you get up to 10 minutes at each session 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 you'll have it made and after this it will be easy.

Advance to 30 minutes twice a day. You'll find it quite easy now to gradually increase your time as much as 5 or even 10 minutes a session. Soon you will be walking one hour at a time and now 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, buy one that goes as slowly as 1/2 mile an hour if you are very limited. If necessary, start your walking at that rate, just a few minutes at a time, with no elevation. Remember that your goal is to be able to exercise with no more than moderate SOB. You can gradually increase the speed on the treadmill to 1 mile an hour but don't go higher than that until you are able to walk one hour at a time. 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 may 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. Your doctor may wish you to keep it at 93%. It will help your endurance and prevent a straing on your heart.

Do you have congestive heart failure? With the permission of your physician, the above exercise prescription may help you, also. Discuss this 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 covber in a few minutes of walking is worsethan 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 arthritus usually improves and is better than it has been in years. Bronchial secretions at first seem to increase, as you cough them up after walking. But a regular exercise program is the best thing you can do to decrease your sputum or get rid of it entirely. So then what happens? You aren't as susceptible to infections and you feel better!

With the permission of your doctor, you can start rehabilitiation by yourself.  Start learning pursed lips breathing - inhale through your nose and exhale very slowly through pursed lips (inhale for a count of one, exhale for a count of three and breathe out like you you're saying the word prune).  This kind of breathing helps reduce SOB, and you don't need to use your shoulders.
Start walking - even if you have to begin with 2 minutes at a time - increase the time every day.  You don't have to walk fast, just a constant pace.  Remember to do pursed lips breathing while you're walking.  I coordinate my steps with my breathing.  I also need to increase my oxygen when I'm walking.  A treadmill is best, because weather doesn't matter, but any level place will do.
If you have 1 lb. weights you can start arm curls and some other simple upper body exercises.  If you don't have weights, you can use two soup cans.  Remember to breathe while lifting.
You will begin to feel much better very quickly - within a week or two.  As your strenghth and stamina increase, your will be able to do more and more things.
Be aware of your posture.  Whether sitting or standing, if you allow yourself to get into a 'slouched' position, you are working against your optimum breathing rhythm and movement.  While walking, try to keep your shoulders up and
slightly back, thus extending the sternum and rib cage area.  The next time you get into your favorite 'easy chair' to watch TV or read, pause a moment to examine how you are sitting.  Are you sitting down low and curved back into chair?
Same thing, if you are, you're working against yourself.  I have gone to using a glider rocker; it's soft, but the straight
back promotes better breathing posture.  Also, the chair arms help keep your shoulders up.  If you've been sitting in a 'slouched' position for an extended time, you've probably noticed that it's been really difficult to go the short distance to the bathroom without becoming very SOB.  Try to look at all aspects of your daily activities, with respect to the physical mechanics, and see if you can change to a more beneficial approach. Simple little things can add up to make a big difference.

WebMD HEALTH - Test Name -- Pulmonary Exercise Testing
There is a really GREAT book, free of charge, from the National Institute on Aging.  It is called
"Exercise" A Guide from the National Institute on Aging". It's a large book, 100 pages long, and covers
exercise AND nutrition for flexibility, for strength, and for endurance.  Lots of clear discussions, lots of
sketches, ways to measure progress, etcetera.  Just the thing for people like us -- especially those who
may think they can't even start, or who have no rehab center nearby, or whose insurance won't pay. 
You can get a copy, free of charge, in any of several ways. 

Write: NIA Information Center.........................Phone:1-800-222-2225 
PO Box 8057............................................FAX:    301-589-3014 
Gaithersburg, MD 20898-8057..........................E-mail: niainfo@lkacc.com 

(When you receive your copy, you will also receive an order form with which you can choose any of a
number of other free publications.)  Finally, you can also look at an online version, which even includes
some animated examples of the exercises at: http://weboflife.arc.nasa.gov/exerciseandaging/. 







Email Web Mistress: Olivija

last edited on 3-14-2002