As a L4 Exercise Specialist, I work with clients on the Active for Health Exercise Referral Scheme in Rotherham, South Yorkshire. I am also having my work validated in a research project with Sheffield Hallam University. One of the pathways being studied is COPD and Asthma. Here I share some stats, signs, symptoms, pathophysiology, medications, and exercise benefits and guidelines for both of these diseases.
If you are a L2 Fitness Instructor or L3 Personal Trainer, I encourage you to gain the L3 Exercise Referral qualification (Envisage offer a great course – and the tutor’s not bad either!!) – the qualification will allow you to work with this group of amazing clients and to safely help them improve their fitness levels and overall quality of life.
Respiratory Conditions – these include Asthma and COPD (Chronic Obstructive Pulmonary Disease) which both affect the lungs and air passages.
The respiratory system is fully developed in an adult by the age of 25, but does not reach full maturity until the adult is in their early 40s. This is due to the continual increases in power, posture of the thorax, respiratory muscles and stature.
Asthma – affects 1:12 adults (more common in women than men) and 1:11 children in the UK. It is disabling and disrupts work and leisure pursuits as well as normal everyday life. If left untreated, asthma can go on to cause chronic lung damage.
The symptoms of asthma vary considerably from one person to another; they can also vary on a day-to-day basis in each individual. People can also react very differently, both physiologically and psychologically to an attack and the subsequent recovery. Wheezing, coughing, breathlessness and tightness in the chest are all signs and symptoms of asthma.
Mild asthma may only be symptomatic when provoked by stimuli: smoking, dust mites, stress, animals, chemicals, genetics or a viral / bacterial infection. Severe asthma causes mainly irreversible obstruction of airways despite good medication correctly administered.
Exercise Induced Asthma (EIA) is, as the name suggests, brought on by exercise rather than an allergen. This can bring about a real fear of exercise, making it something to be avoided. However, EIA is usually only triggered when working at or above 75% of MHR (maximum heart rate). Even then, with good use of medication, it needn’t cause a major disruption in fitness training. Training between 60-75% of MHR is still effective for improving overall fitness. Even if you are only able to train at 60% MHR or less due to breathlessness, you can still build up your endurance levels.
The benefits of exercise for asthmatics are many: it re-establishes correct breathing technique, improved cardiovascular function, improved balance, improved coordination (making everyday movement more efficient), improved muscle strength (especially in the upper back and chest area), improved flexibility, improved mental health (especially if Tai Chi is a part of the exercise program) as anxiety and depression are common comorbidities with asthma.
When working with clients who have asthma, it is important to ensure they take their beta-selective sympathomimetic agonist inhaler 10 minutes before exercising. This will help to minimise symptoms during exercise.
You also need to ensure an extended warm up of at least 10 minutes is undertaken. This allows the CV system to adjust to the increased demands placed on it. If you introduce your client to the Borg scale of intensity for breathlessness, it will increase their self-efficacy and confidence in managing their symptoms. Not being able to breathe properly is very frightening. By helping the client to self-monitor, it reduces the accompanying fear and anxiety, which in turn will help with exercise performance.
Circuit training in a group setting is an excellent exercise type with this client group for several reasons. It allows specific muscle groups to be worked on, while also building up cardiovascular fitness. The group setting encourages some healthy competition, which along with good motivation from the exercise professional, should make the session both fun and beneficial, both physically and psychologically.
COPD – is an irreversible condition, which is a combination of bronchitis (inflammation of the bronchi, which increase mucus production, which in turn produces phlegm, which then results in a cough) and emphysema (where the air sacs in the lungs lose their elasticity, causing the airways to narrow, resulting in shortness of breath).
There are six main body systems affected by COPD:
1) Ventilation – there is increased airway resistance. The airways tend to become smaller as lung volume decreases on exhalation. Breathing itself becomes harder due to neuromuscular weakness or hyperinflation. The effort of exhaling can put the inhalatory muscles at a mechanical disadvantage. Breathing becomes inefficient due to ‘dead space’ in the lungs.
2) Gas exchange – as the alveolar-capillary membrane is destroyed (usually in late-stage COPD), carbon dioxide can build up (hypercarbia) and oxygen saturation levels can drop (hypoxemia). This may necessitate the use of a mobile oxygen cylinder during exercise. I work with clients who use oxygen – they either put the cylinder in a small rucksack on their back or pull it around in a ‘shopping trolley on wheels’ – a bright pink flowery one in the case of one of my female clients!
3) Cardiovascular impairments – an inevitable side effect of COPD is a deconditioning of the CV system. This in turn may result in the build-up of lactic acid within the muscles, even at low work rates. In severe cases, the right ventricle of the heart becomes unable to respond adequately to the increased demand put on it during exercise.
4) Muscular impairment – reduced activity due to uncontrolled breathlessness can lead to muscle weakness and wastage. People also lose muscle mass as part of the aging process (sarcopenia).
5) Symptomatic – breathlessness (dyspnea) is very frightening. Neurological messages from the lungs (pulmonary receptors), from the balance of blood gases (chemoreceptors), and from the physical movement of the chest wall (mechanoreceptors) can all flood the brain with information. This can create anxiety, which can cause a disproportionate amount of breathlessness in relation to ventilatory limitations.
6) Psychological – as I’ve already mentioned, anxiety can run alongside COPD. Depression is also very common with this group of people – due to a limited ability to perform activities of daily living (ADLs), the resulting social isolation, and feelings of helplessness and despair.
However, there are many benefits to exercise for COPD clients. As well as those listed for asthma, we can include decreased breathlessness, improved gaseous exchange efficiency, and increased muscular strength in the chest. A good exercise programme will include the practice of correct breathing (using pursed lips and breathing from the diaphragm). It may also include cognitive behavioural therapy (CBT) from a qualified practitioner to help alleviate anxiety and depression. Exercising in short intervals several times a day works best, as it allows the same volume of work to take place without causing the session to be cut short due to a high level of breathlessness.
Finally, Tai Chi has also been shown to work very well with clients who have COPD, as it aids relaxation of body and mind as well as improving coordination. It can also create a great end-of-session belly-laugh if you have clients who get the giggles whenever the music and finger-cymbals start up!!
Please note that I am an Exercise Specialist and NOT a medical doctor. Before starting on any new activity or exercise, please consult with a qualified medical practitioner.
For further information on these conditions, I recommend the following: