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Health & Exercise Forum

Lung Disease, Exercise, and Pulmonary Rehabilitation

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May 7, 2009

Dr. Paul MackareyGuest Columnist: Dr. Gregory Cali

In response to an email inquiry about exercise for people with lung disease, I have asked a local pulmonologist (lung doctor), Gregory Cali, DO, to address this topic as a guest columnist.

Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) has become the fourth leading cause of death and is one of the only major chronic diseases which has seen an increase in mortality rates.  COPD includes emphysema, chronic bronchitis and asthma.
Patients with COPD suffer from progressive shortness of breath, cough, wheeze, and sputum production.  Most patients with emphysema have been cigarette smokers.

Patients with emphysema develop obstruction to airflow as a result of narrowing of bronchial tubes due to excess mucous, smooth muscle constriction, and destruction of lung tissue.  Eventually, the lungs become overdistended, which leads to overexpansion of the chest itself.  This process leads to the so-called''barrel chest'' appearance of patients with advanced COPD.

The most common symptom of COPD is shortness of breath.  Initially the patient complains of shortness of breath only with exertion, but symptoms progress over time to include difficulties even at rest.  Eventually the disease worsens to the point that oxygen is required and the patient may become severely disabled.  Treatment of COPD starts with smoking cessation, and, when symptomatic, patients are started on inhaled bronchodilator medications.  Some of these medications include albuterol, ipratropium, titotropium, and inhaled steroids. Long-acting bronchodilators such as formoterol or salmeterol and theophylline
medications may be added.  Oxygen is added when the patient's own oxygen level falls to a certain point.  In fact, oxygen is the only therapy that has been shown to prolong the life of patients with COPD.

Over time, patients with COPD decrease their level of activity due to the sensation of shortness of breath.  This downhill slide eventually leads to a very sedentary existence.  Recent studies have shown that COPD not only affects the lungs, but is a condition which affects the diaphragm and the peripheral muscles. Patients with COPD have been shown to have abnormal limb muscles as a result of deconditioning and systemic inflammation.

Exercise and Lung Disease

Pulmonary rehabilitation has been shown in numerous studies to decrease the shortness of breath associated with COPD.  Exercises to strengthen the arms are helpful to assist  patients in  performing  activities of daily living such as combing hair, cooking, and reaching objects above their heads.  Walking and riding a stationary bike are helpful to exercise the leg muscles, especially the large thigh muscles.

Despite the fact that exercise programs may not improve lung function,  the patients overall level of function is almost always improved. Patients who participate in rehab programs have less shortness of breath, are less likely to be hospitalized, and have improved functional capacity.  These patients have lower rates of healthcare utilization, and improved overall health status and quality of life scores.

The ideal pulmonary rehabilitation program includes smoking cessation training, breathing and relaxation exercises, nutritional information, and training in proper use of medications.  The most important feature of a pulmonary rehab program, however, is aerobic exercise involving the arms and legs.  Pulmonary rehabilitation is an integral part of the treatment of a patient with COPD, and should be considered in any patient who can tolerate exercise.  A cardiac stress test should be done to ensure that there are no occult coronary artery blockages or  cardiac rhythm abnormalities.

In summary, COPD is a growing cause of disability, morbidity, and mortality.  Medications, oxygen, and pulmonary rehabilitation  can help to improve symptoms and quality of life.  The combination of bronchodilator medications with pulmonary rehabilitation is the most effective  approach when treating patients with COPD.  Pulmonary rehab should be offered to every patient with COPD to attempt to improve their functional status.


Some simple suggestions for beginning an exercise program are:

  • Get your physicians approval
  • Consult with a medical professional to set up a program for your individual needs
  • Diaphramatic Deep Breathing – inhale deeply through your nose as much as possible. Place your hands on your belly to feel the air expand your diaphragm and fill your lungs. Hold your breath for 1-2 seconds and slowly exhale through pursed lips over 8-10 seconds.


  • Buy good running sneakers – not walking shoes
  • Long term goal if possible - to exercise 3-5 times per week for 20-30 minutes
  • Walk, Treadmill, Exercise Bike
  • Begin 3-5 minutes and add 1-2 minutes each session
  • Walk in a mall if it is too hot or too cold


  • Use light dumbbells, sandbag weights (1-2 pounds), and resisted bands
  • Begin with 3-5 repetitions and add 1-2 reps each session
  • Alternate weight training days with walking days

Visit your doctor regularly and listen to your body.
Keep moving, eat healthy foods, exercise regularly

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliated faculty member at the University of  Scranton, PT Dept.