November 2015 Issue

Focus on Fitness: COPD and Exercise
By Jennifer Van Pelt, MA
Today's Dietitian
Vol. 17 No. 11 P. 54

Knowing clients' symptoms can help dietitians prescribe healthful activity.

Imagine having to think about every breath you take, feeling like you're breathing through a straw, or struggling to breathe like a fish out of water. These are just a few of the descriptions given by individuals living with chronic obstructive pulmonary disease (COPD) who answered a question on the COPD Foundation's website (

COPD is the general, inclusive term to describe a group of progressive lung diseases that includes chronic bronchitis, emphysema, refractory asthma, and some types of bronchiectasis. Symptoms include increased breathlessness, frequent coughing, wheezing, and tightness in the chest. COPD is characterized by periodic exacerbations—flare-ups or episodes in which breathing is more difficult than usual—and other symptoms, such as fever, confusion, and more rapid breathing and wheezing than normal. Exacerbations are typically the result of an infection, and may be serious enough to require a doctor's visit or trip to the hospital emergency department. Because frequent exacerbations can cause COPD to progress more rapidly, prevention is important for disease management. Physical inactivity has been linked to higher rates of exacerbations and breathlessness in COPD patients,1 so maintaining a regular exercise program will help clients with COPD.

Occurrence of COPD
According to the COPD Foundation, the disease affects approximately 24 million Americans. When breathing while just sitting or making a meal is hard, summoning the effort to exercise can be a substantial challenge. The COPD Foundation website states, "Almost all individuals with COPD have dyspnea [shortness of breath], and because of it, they tend to do less and less. The less they do, the less they're able to do, and eventually they become too weak to do much at all. This is called progressive deconditioning. Deconditioning is losing fitness from lack of exercise." Although exercise cannot reverse COPD, it can help improve quality of life for your clients by boosting their fitness levels and breathing capabilities.

The American College of Sports Medicine (ACSM) notes that, for most COPD patients, 15 minutes of moderate physical activity, three days per week is the minimum amount required for benefit. Ideally, light to moderate physical activity for 30 minutes daily, on most if not all days of the week, is recommended to improve quality of life. Regular daily exercise will increase physical capacity, decrease anxiety about COPD symptoms, allow greater independence in recreational and vocational activities, and reduce fatigue. According to the ACSM, the benefits of regular exercise occur despite continued decreased lung function that persists after exercise.1

Clients who have been lifelong exercisers or very physically active before their COPD diagnosis may not need as much assistance with exercise program maintenance and motivation. But they may require guidance regarding appropriate exercise types, and how to manage their symptoms during exercise. For example, swimming may no longer be a comfortable activity for COPD patients due to the strain on the lungs. But water aerobics or deep water running, with the head above the water, will allow clients to still enjoy water exercise with easier breathing. Clients who've been physically inactive or who have more severe symptoms will require more guidance and encouragement to exercise regularly.

Regardless of their fitness level or exercise experience, all clients with COPD will benefit from attending a pulmonary rehabilitation program. Usually affiliated with a hospital or pulmonary medicine clinical practice, pulmonary rehabilitation combines supervised exercise, education, and support with the goal of helping patients with COPD function at the highest level possible. Pulmonary specialists teach clients about proper breathing techniques, medications, and supplemental oxygen, as well as how to cope with daily living activities, travel, and employment. Because COPD is a chronic disease and breathing problems can induce panic, specialists will also help clients with managing anxiety, stress, and depression. Pulmonary rehabilitation will provide information for clients on appropriate exercises for their COPD symptoms that can be continued outside the supervised rehabilitation setting.

Suggested Exercises
Walking is the most frequently prescribed activity for COPD, but many clients will need variety in their exercise program to avoid boredom and remain motivated. Recently published studies have shown other exercises, including resistance training, yoga, tai chi, and qigong, to be beneficial for COPD patients, and found the following:

• Two 2015 systematic reviews of resistance training vs endurance training (walking) in patients with COPD found that resistance training had the same benefits as endurance training in improving quality of life, shortness of breath, muscle strength, and activities of daily living with no adverse events.2,3

• A 2014 systematic review and meta-analysis found that yoga improved lung function and exercise capacity in people with COPD.4

• A 2014 systematic review and meta-analysis of tai chi and qigong improved lung function, shortness of breath, and quality of life in COPD patients.5

The positive effects of resistance training alone are important because some COPD patients may have trouble walking. Using resistance bands, light handheld weights, or weight machines may be a more stationary exercise alternative for COPD patients to begin an exercise program and build leg strength for walking. Or, resistance training can be added to complement a walking or other endurance exercise to maintain interest as well as increase muscular strength.

The physiological benefits of yoga, tai chi, and qigong for COPD patients are likely due to the coordinated combination of movement with breath and the focus on deep breathing in mind-body exercise. Though the studies focused on the physiological benefits of yoga, tai chi, and qigong, these mind-body modalities can also reduce stress and anxiety for COPD patients.

While clients with COPD can be encouraged to try resistance training and mind-body activities, any exercise guidance given should be in accordance with their medically supervised exercise program. 

— Jennifer Van Pelt, MA, is a certified group fitness instructor and health care researcher in the Reading, Pennsylvania, area.

1. Exercise for persons with chronic obstructive pulmonary disease. American College of Sports Medicine website.  

2. Iepsen UW, Jørgensen KJ, Ringbaek T, Hansen H, Skrubbeltrang C, Lange P. A systematic review of resistance training versus endurance training in COPD. J Cardiopulm Rehabil Prev. 2015;35(3):163-172.

3. Liao WH, Chen JW, Chen X, et al. Impact of resistance training in subjects with COPD: a systematic review and meta-analysis. Respir Care. 2015;60(8):1130-1145.

4. Liu XC, Pan L, Hu Q, Dong WP, Yan JH, Dong L. Effects of yoga training in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. J Thorac Dis. 2014;6(6):795-802.

5. Ding M, Zhang W, Li K, Chen X. Effectiveness of t'ai chi and qigong on chronic obstructive pulmonary disease: a systematic review and meta-analysis. J Altern Complement Med. 2014;20(2):79-86.