Exercise as it relates to Disease/The Effects of Exercise on Smoking Induced COPD

Background - What is COPD?
Chronic Obstructive Pulmonary Disease (COPD) is defined by the Global Obstructive Lung Disease group as a disease state characterized by airflow limitation that is not fully reversible. The air flow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs to harmful particles or gases. COPD usually presents in mid-life (around 40 years and onwards) and currently affects over 2 million Australians.

Causes
The 2 most prevalent causes of COPD are; smoking and environmental exposure to chemicals, dust or coal over many years[1].

Forms of COPD
COPD can generally be classified into one of two groups:
 * 1) Chronic Bronchitis - A recurrent problem, defined as the presence of cough and sputum production for at least 3 months in each of 2 consecutive years[1].
 * 2) Emphysema -  Defined as the abnormal and permanent enlargement of the air sacs of the lungs causing breathlessness and wheezing.

Diagnosis
Indicators of COPD include:
 * Chronic Cough: Present intermittently or every day, throughout the day.
 * Chronic Sputum Production: Any pattern of chronic sputum production may indicate COPD.
 * Acute Bronchitis: Repeated episodes.
 * Dyspnea that is: Progressive, persistent, worse with exercise and respiratory infections.
 * Exposure to Risk Factors: E.g. smoke, tobacco smoke, dusts and chemicals

Recommendations - How to Manage COPD
While there is no cure for COPD and the airway damage cannot be repaired, all the symptoms can be reduced by following certain management strategies. Including: 1. Prevent disease progression; 2. Relieve symptoms; 3. Improve exercise tolerance; 4. Improve health status; 5. Prevent and treat complications; 6. Prevent and treat exacerbations; 7. Reduce mortality, and 8. Prevent or minimize side effects from treatment[3]. In fact, a study conducted by the University of Western Australia in 2008 found that those with COPD who completed an exercise program over 8 weeks had significant improvements in functional exercise capacity and a reduction in hospitalisation due to COPD exacerbations.

The Importance of Exercise for the COPD Patient
Weakness, shortness of breath, and even the fear of breathlessness can cause people with COPD to avoid physical activity. This cycle of weakness, shortness of breath, and inactivity contributes to a progressive decline in muscle strength and inefficient oxygen use, making it difficult for some patients to perform Activities of Daily Living. Exercise Increases: 1. Energy levels; 2. Muscle strength, endurance and efficiency; 3. Cardiopulmonary endurance; 4. Restful sleep; 5. Bone density; 6. Independence; 7. Quality of Life, and; 8. Assist in weight control [4][5] Exercise Decreases: 1. Shortness of breath; 2. Risk factors of heart disease; 3. Blood pressure; 5. Anxiety and depression; 6. Blood sugar levels, and; 7. Desire to smoke[4][5][6]

How Often Should I Exercise?
Those with COPD should aim to exercise for a minimum of 3 sessions per week, for at least 20 to 30 minutes per session. People who have chronic lung conditions and who exercise regularly, such as walking or cycling for more than 2 hours per week can improve their health[4][5]

What Intensity of exercise should I be Doing?
Exercise should be undertaken at 60% of your maximal heart rate or moderate intensity. One way of measuring this is if you have trouble carrying on a converstation during exercise - You DO need to push yourself into minor breathlessness in order to adapt and increase exercise tolerance [4][5]

What Type of Exercise Should I be Doing?
Those with COPD should be looking to undertake aerobic activity to build endurance and resistance training to strengthen muscles. Good aerobic activities include walking, cycling, stair climbing, and aquatic exercises. All forms of aerobic exercise is beneficial, however, a 2009 study conducted by the University of Sydney on aerobic exercise selection found that supervised, progressed walk training resulted in a significantly greater increase in endurance than the equivalent cycling training. Resistance exercise involves the use of free weights, special resistance bands, or resistance machines[5]

Further Reading/Information Sources
For a comprehensive review of COPD and management strategies go to:
 * Better Living with Chronic Obstructive Pulmonary Disease. The Australian Lung Foundation
 * Chronic Obstructive Pulmonary Disease Facts. The Woolcock Institute of Medical Research
 * Chronic Obstructive Pulmonary Disease (COPD). World Health Organization