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Part II of II

November is National Chronic Obstructive Pulmonary Disease (COPD) month. COPD is the fourth leading cause of death in the United States, according to the Centers for Disease Control and Prevention. This problem refers to a group of lung diseases that causes damage to the airways and air sacs in the lungs.  People with COPD suffer from diminished airflow and difficulty breathing. Emphysema and chronic bronchitis are two of the most common types of COPD. The damage can't be reversed, so treatment includes medications and lifestyle changes designed to control symptoms and minimize further damage, according to the Mayo Clinic.

Exercise is an important part of life for those with COPD because it improves the overall strength and endurance of respiratory muscles. When you exercise, muscles adapt and use oxygen more efficiently so your lungs don't have to work so hard. Also, in addition to improvement in breathing, exercise boosts mental health, helps maintain a healthy weight and blood pressure, and improves circulation. Most importantly, exercise will improve your quality of life with COPD. Before you begin an exercise program, see your family physician or pulmonologist for approval. Then, see a physical therapist to design a program specific to you needs. Always begin slowly and rest if you get short of breath, have chest pain, feel dizzy or sick to your stomach.


1. Endurance Exercises

While not all of these endurance exercises may be appropriate for you, one or two of these may offer a good starting point.

Walk Around the House – Start walking around the house for 1-2 minutes nonstop. Every 1-2 hours. Then, add 1-2 minutes every week.

Static Marching – hold onto the countertop or back of chair and march in place for 30 seconds. Rest 1-2 minutes and repeat. Do 5 cycles. Add 5-10 seconds every week.

Climb the Steps – If you can do so safely, use the steps for exercise 1-2 times per day. Then, add 1-2 times per day.

Walk the Mall/Treadmill – If you are able to get out of the house and can tolerate more extensive endurance exercises, get out and walk the malls or use a treadmill.

Recumbent Bike – If balance is a problem, but you can tolerate more extensive. Endurance exercise, use a recumbent bike (a bike with a backrest)

Walking is free exercise and can be done in some form by almost everyone…even with an assistive device such as a cane or walker. For those with COPD who are active and fit – walk 4-5 days per week for 30 to 45 minutes. Less fit individuals can walk for 15 to 20 minutes. For those with COPD who are in poor condition and have significant SOB – walk for 2-3 minutes (to the bathroom or around the house) every 30 to 45 minutes. Try not to sit for 60 minutes without getting up and walking around.

2. Posture Exercises

Posture exercises are designed to keep your body more upright and prevent rounded shoulders and forward head/neck. More erect posture promotes better breathing. Perform 5 repetitions each 3 -5 times per day

Row-The-Boat - Pinch shoulder blades together as if you are rowing a boat.

I-Don’t-Know – Shrug shoulders up toward the ears as you do when you say “I don’t know.”

Chin Tucks – Bring your head back over your shoulders and tuck your chin in

3. Arm Exercises

Bicep Curls – sit in chair and bend your elbows up and down with a can of peas in your hands

Wrist Curls – as above but bend your wrists up and down

Chair Push-ups – Push up with your arms to get out of a chair

Saw Wood – pull a light resistance band (yellow) back from a door knob as if you were sawing wood.

4. Leg Exercises

Hip Hikes – Sit in chair and march by hiking your hip and lifting up your heel 4-6 inches off the floor

Leg Kicks – Sit in chair and kick your knee out straight – then bend it down to the floor

Hips Out and In – Sit in chair and bring your knees in and out against a resistance band

Toe Raise/Heel Raise – Sit in chair and raise your toes up – then raise your heels up

5. Breathing Exercises

Diaphragmatic Breathing - The diaphragm muscle is essential for breathing. While sitting or lying down, put one hand on your abdomen and the other on your chest. Slowly inhale through your nose and try to separate the hand your stomach from the hand on your chest. Then, slowly exhale through pursed lips.

Pursed Lipped Breathing - breathe in through your nose slowly for 3- 5 seconds. Then, purse your lips as though you're going to whistle. Lastly, exhale slowing through the pursed lips over 5 to 10 seconds.

More Info

“Better Breathers Club,” in conjunction with the American Lung Association, offers a free local support group to help patients and their families suffering from COPD and chronic lung disease. For more information contact the American Lung Association at

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 in downtown Scranton, PA and is an associate professor of clinical medicine at GCSOM.

Part I of II

World COPD Day 2022 is Wednesday November 16th! The purpose of this two part series on lung disease is to raise the level of awareness for the prevention and treatment of this disease.

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 over distended, 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 difficulty breathing, 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 are 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.  Next week, in Lung Disease - Part II, learn more about pulmonary rehab for patients with COPD to improve their functional status.  

Guest Columnist: Dr. Gregory Cali, DO – is a pulmonologist (lung doctor) in Dunmore, PA.

Visit your doctor regularly and listen to your body.     

Keep moving, eat healthy foods, and exercise regularly

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

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 in downtown Scranton, PA and is an associate professor of clinical medicine at GCSOM.

See all of Dr. Mackarey's articles at