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Exercise and COPD:

help patients break a cycle of inactivity

Q: Why is exercise an important part of a COPD treatment regimen?

 

Dr. Lee-Chiong: In general, exercise is an important component of pulmonary rehabilitation. Increasing the duration or intensity of exercise could have a positive effect on the benefits of a rehabilitation program and improve the quality of life for COPD patients. Long-term physical activity has been shown to reduce the frequency of hospitalizations1 and exacerbations2. COPD symptoms, such as breathlessness and exercise intolerance, make participating in everyday activities such as climbing a flight of stairs and even showering difficult for patients. These symptoms progress as the disease advances, leading to inactivity and muscle deconditioning. This can continue in a cycle leading to further inactivity, social isolation, and fear of undertaking any activities that could result in dyspnea.3 Improvements in exercise tolerance have been found to be linked with physiological changes such as improved muscle function, altered breathing pattern (higher tidal volume), and lower breathing frequency that leads to a reduced dead space to tidal volume ratio and thus to a lower ventilatory requirement for exercise.4, 5 With increased exercise tolerance patients have a better chance of being able to complete and enjoy daily activities.

"At Philips, we realize that encouraging healthy habits is as important as treating unhealthy disorders. Encouraging patients with COPD to remain physically fit and active not only improves their overall health, it allows them to live their lives to the fullest they want to be. We understand the importance of enhancing self-empowerment and self-management in health by innovations in the sciences. We are committed to creating technology and services that are effective."

-Dr. Teofilo Lee-Chiong, pulmonologist and Chief Medical Liaison, Philips

Q: How can COPD patients improve their exercise tolerance?

 

Dr. Lee-Chiong: Exercise training helps COPD patients gain the muscle mass and strength they need to improve peripheral muscle function and is considered essential for patients to achieve a physiological training effect.4, 5

Q: What is the main challenge patients face in adhering to their exercise training programs?

 

Dr. Lee-Chiong: For patients to be able to stick to and enhance their exercise training programs, they must feel relief from their dyspnea. Exertional dyspnea is breathlessness or labored breathing brought on by exercise. It’s both a common symptom of COPD and a key challenge to building exercise tolerance in COPD patients.6

Q: What contributes to exertional dyspnea?

 

Dr. Lee-Chiong: There are variety of known pathophysiological factors that contribute to exertional dyspnea in COPD patients—inspiratory muscle weakness, increased ventilatory demand relative to capacity and dynamic airway compression are a few. In addition to lung function, peripheral muscle strength is an important determinant of exercise capacity.7, 8

Q: How can patients gain relief from dyspnea?

 

Dr. Lee-Chiong: Interventions such as pursed lip breathing9,10, use of anti-inflammatory drugs11, helium-oxygen mixtures12, 13 and surgical procedures—lung-volume reduction14, 15 or placement of endobronchial valves16, 17—can reduce airflow obstruction or dynamic hyperinflation and, in turn, provide dyspnea relief. For stable COPD patients who have increased respiratory muscle effort associated with high ventilatory demand relative to respiratory muscle capacity that contributes to dyspnea, CPAP or pressure support ventilation by NIV devices can alleviate symptoms and improve exercise tolerance.18

Q: What are the advantages and disadvantages of using NIV to treat dyspnea?

 

Dr. Lee-Chiong: Studies have shown that the administration of NIV during exercise training may reduce exertional dyspnea and improve exercise performance and endurance. 19, 20, 21 However, during the studies NIV was typically applied using a facemask and required a power source, both of which can limit portability and possibly compliance.20

Q: What new areas are being explored in the use of NIV to improve exercise tolerance in COPD patients?

 

Dr. Lee-Chiong: At Philips we are excited about the opportunity to make NIV administration easier and more convenient for patients because we do know the role NIV can play in improving their quality of life. We recently completed a pilot study to examine the relationship between the use of intermittent noninvasive positive pressure therapy (NIPPV) during exercise and the time it takes patients to recover from shortness of breath to evaluate the impact of NIPPV on exercise capacity. The results were extremely promising, which was tremendous for us to see, but made even better knowing that they were achieved using a portable positive pressure device. Bringing a battery-operated, non-pharmacological tool for this application has potential to really impact the lives of COPD patients and that’s exciting and motivating for us as a company.

Dr. Teofilo Lee-Chiong
Dr Teofilo Lee-Chiong

For COPD patients, staying active and improving exercise tolerance are important to reducing symptoms and risks such as disease progression and exacerbation events.

 

However, the symptoms of COPD, such as breathlessness often make it difficult to exercise.

 

Dr. Teofilo Lee-Chiong, pulmonologist and Chief Medical Liaison, Philips, shares insight on how to help your patients fight dyspnea and stay active.

Useful Links

Learn more about the use of Portable Positive Pressure Devices to relieve dyspnea after exercise:

 

 

1 Garcia-Aymerich J, Lange P, Benet M, Schnohr P, Anto JM. Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study. Thorax. 2006;61(9):772-778.

2 Garcia-Aymerich J, Farrero E, Felez MA, et al. Risk factors of readmission to hospital for a COPD exacerbation: a prospective study. Thorax. 2003;58(2):100-105.

3Hardy, William, Jasko, Jeff. Philips Respironics. Evaluation of a portable positive pressure device to relieve dyspnea during exercise in COPD patients. Murrysville, PA: 2015, online.

4Casaburi R., Porszasz J. Burns MR, Carithers ER, Chang RSY, Cooper CB. Physiological benefits of exercise training in rehabilitation of severe COPD patients. Am J Respir Crit Care Med 1997; 155: 1541-1551.

5Casaburi R. Mechanisms of reduced ventilatory requirement as a result of exercise training. Eur Respir Rev 1995; 5: 15, 42-46.

6Hardy, William, Jasko, Jeff. Philips Respironics. Evaluation of a portable positive pressure device to relieve dyspnea during exercise in COPD patients. Murrysville, PA: 2015, online.7Rossi A, Polese G, Brandi G, Conti G. Intrinsic positive end-expiratory pressure (PEEPi). Intensive Care Med 1995; 21: 522-536.

8 O’Donnell DE. Exertional breathlessness in chronic respiratory disease. In; DA Mahler, ed. Dyspnea. New York, Dekker, 1998; pp. 97-147.

9Gosselink R. Breathing Techniques in patients with chronic obstructive pulmonary disease (COPD). Chron Respir Dis. 2004; 1:163-172.

10 Sahijua J, de Marchie M, Grassino A. Effects of imposed pursed-lips breathing on respiratory mechanics and dyspnea at rest and during exercise in COPD. Ches 2005; 128:640-650.

11 Grimes GC, Manning JL, Patel P, et al. Medications for COPD: a review of effectiveness. Am Fam Physician. 2007; 76:1141-1148.

12 Eves ND, Pertersen SR, Haykowsky MJ, et al. Helium-Hyperoxia, exercise, and respiratory mechanics in chronic obstructive pulmonary disease. A randomized crossover trial. Am J Respir Crit Care Med. 2006; 173:865-870.

13 Rice KL, Kunisaki KM, Niewoehner DE. Role of tiotropium in the treatment of COPD. Int J Chron Obstruct Pulmon Dis. 2007;2:95-105.

14Bendit JO, Wood DE, McCool FD, et al. Changes in breathing and ventilator muscle recruitment patterns induced by lung volume reduction surgery. Am J Respir Crit Care Med. 1997; 155:279-284.

15Lederer DJ, Thomashow BM, Ginsburg ME, et al. Lung volume reduction surgery for pulmonary emphysema: Improvement in body mass index, airflow obstruction, dyspnea, and exercise capacity index after 1 year. J Thorac CArdiovasc Surg. 2007; 133:1434-1438.16 Hopkinson NS, Toma TP, Hansell DM, et al. Effect of bronchoscopic lung volume reduction on dynamic hyperinflation and exercise in emphysema. Am J Respir Crit Care Med. 2005; 171-:453-460.

17 Wan IY, Toma TP, Geddes DM, et al. Bronchoscopic lung volume reduction for end-stage emphysema: report on the first 98 patients. Chest. 2006; 129:518-526.

18Johnson et al. Effects of Training with Heliox and Noninvasive Positive Pressure Ventilation on Exercise Ability in Patients with Severe COPD, Chest 2002; 122:464-472

19 ZuWallack, R. The Roles of Bronchodilators, Supplemental Oxygen and Ventilatory Assistance in the Pulmonary Rehabilitation of Patients with Chronic Obstructive Pulmonary Disease. Resp Care 2008; 53(9): 1190-1195.

20 Van’t Hul A, Gosselink R, Hollander P, et al. Training with inspiratory pressure support in patients with severe COPD. Eur Respir J 2006; 27:65-72.

21 Van’t Hul A, A. Kawakkel G. Gosslink R. J. The acute effects of noninvasive ventilatory support during exercise on exercise endurance and dyspnea in patients with chronic obstructive pulmonary disease: a systematic review. Cardiopulm Rehabil 2002; 22(4): 290-7