Resistance Training for COPD: Strategies and Benefits

1. Chapter 13 Resistance-Training Strategies for Individuals with Chronic Obstructive Pulmonary Disease

2. COPD • Main term for group of respiratory diseases, including: • Asthma • Emphysema • Chronic bronchitis • Progressive diseases

3. COPD • Impairment quantified by measuring forced expiratory volume in one second (FEV1) • Refer to Table 13.1

4. COPD Characteristics • Gradual loss of lung function • Airflow obstruction • Dyspnea with exertion • Weight loss associated with muscle wasting • Recurrent bronchial infections

5. COPD Characteristics • Chronic disability • Reduced quality of life • Downward spiral of inactivity, social isolation, and disability

6. Greater Risk for Comorbidities • Congestive heart failure • Osteoporosis • Diabetes • Depression and anxiety

7. Prevalence of COPD • Almost 10 million adults have emphysema and/or chronic bronchitis • 3 million men • 6 million women • People over age 50 likely to be disabled • Younger individuals still significantly contribute to economic impact of COPD

8. Prevalence of Asthma • 11 million adults • 9 million children • More than 8 million males • More than 11 million females

9. Economic Impact of COPD • Third major cause of lost work days • Fourth most common noncommunicable cause of disability • More than 32 billion dollars spent on associated medical costs • Costs likely higher due to under-diagnosis

10. Etiology of Asthma • Airway hypersensitivity to allergens (triggers) • Causes airway inflammation, asthmatic episode (bronchospasm), and mucosal edema

11. Etiology of Asthma • Leads to decreased ventilation, lung perfusion, and respiratory failure • Lung obstruction usually reduced by pharmacological management

12. Signs of Asthma • Coughing • Includes frequent throat clearing • Wheezing • Hoarse whistling sound on exhalation • Shortness of breath • Chest tightness

13. Etiology of Emphysema • Destruction of alveolar walls and permanent enlargement of airspaces distal to terminal bronchioles, resulting in: • Airflow limitations • Impaired gas exchange efficiency • Loss of lung elastic recoil • Intraluminal pressure • Loss of small airway patency

14. Etiology of Emphysema • Caused by smoking, occupational exposures, or air pollution • In early stages, dyspnea during activity • As disease progresses, dyspnea at rest • Hypoxia can ultimately cause respiratory failure

15. Etiology of Bronchitis • Hypersecretion of mucus and chronic productive cough • Continues for at least three months per year for two consecutive years • Exacerbated by pollution and cigarette smoke

16. Etiology of Bronchitis • Results in: • Decreased exercise tolerance • Wheezing • Shortness of breath • Frequent, productive cough • Frequent respiratory infections • Hypoventilation • Right-sided heart failure

17. Benefits of Resistance Training • Increased muscular strength • Trabecular bone content • Glucose tolerance and lean body tissue • Decreased falls

18. Benefits of Resistance Training • Enhanced ability to handle orthostatic challenges • Improvements in performing activities of daily living

19. Research Supports Resistance Training • Major theme: • Resistance training is safe, effective modality to increase strength and improve quality of life • Individuals can tolerate maximal testing and high-intensity resistance training

20. Research Supports Resistance Training • Safety depends on proper exercise selection, training volumes, and intensities • Refer to Table 13.2

21. Program Design Considerations • Obtain physician clearance • Review medical history and medications • Perform physical assessment with baseline physiological measures: • Heart rate • Blood pressure • Body composition • Oxygen saturation

22. Program Design Considerations • May require supplemental oxygen, oxygen delivery devices, or pulse oximeter • Record heart rate, blood pressure, and oxygen saturation at rest/during exercise for clients with moderate to severe COPD • Document goals for rehabilitation and participation

23. Exercise Testing Considerations • 1 RM assessment safe to use • Even on severely deconditioned clients • Cardiopulmonary responses during 1 RM testing significantly lower than during aerobic exercise at sub-maximal level

24. Program Components • Goal: • Achieve maximal physiologic training effects • May require modification due to disease severity, limitations, comorbidities, or motivation level • Include 2 to 4 sets of 6 to 12 repetitions

25. Program Components • Intensities range from 50 to 85 percent of 1 RM • Exercises should mimic actual movements • Interval training an appropriate exercise modality • See sample 24-Week Program

26. Increased Risk for Anxiety and Depression • Include screening as part of initial assessment • Requires beginning exercise at lower intensity/duration than individual can tolerate

27. Increased Risk for Anxiety and Depression • Mild to moderate levels may improve with pulmonary rehabilitation • Individuals with significant psychiatric disease require appropriate professional care