Introduction

– Me

Philip Langridge

Aspergillosis Specialist Physiotherapist

– You

A diverse group of people with a variety of abilities

Aims of this afternoon’s talk(My interpretation of what you want as a group)

Introduce exercise and give you some ideas about what you can do

Introduce the Active Cycle of Breathing Technique

Optimising general well being through exercise

Physical Fitness

Health fitness• Body composition• Cardiorespiratory

endurance• Flexibility• Muscular endurance• Muscular strength

Performance/ skill-related fitness• Agility• Balance• Coordination• Power• Reaction Time• Speed

True or False?– The worse my lung function test results are the less I am

able to do– All exercise is good for you– If you have arthritis it is bad for you to exercise– There is a recommendation about how much exercise to

do– If you exercise more you live longer– Those who exercise are healthier– Exercise is necessary for weight loss– The gym is the best place to exercise– You need special equipment to exercise– You must warm up and cool down every time you exercise– The older you are the less fit you become– If you have heart disease it is bad for you to exercise

– (All physios are super fit)

What does research say about the likelihood of cardiac events with exercise?

The relative risk of both exercise-related myocardial infarction and sudden death due to cardiac arrest, is greatest in individuals who are the least physically active and perform unaccustomed vigorous physical activity

I believe

– Exercise can help people cope better with everyday life (physically, mentally and socially)

– Exercise can reduce risk of several problemsEg stroke, deep vein thrombosis, heart

disease, osteoporosis, depression, social isolation

– There are lots of potential difficulties that limit/prevent exercise

– Everyone can do exercise that will benefit them

Potential mechanisms of exercise limitation in lung disease

– Anxiety/tension and depression

– Abnormal perception of breathlessness and ventilatory control

– Alteration in pulmonary mechanics

– Impaired pulmonary gas exchange

– Cardiovascular dysfunction

– Poor nutritional status

– Respiratory muscle fatigue

– Deconditioning due to inactivity

– Decrease in endurance and power of peripheral muscle

Effect of exercise on lung tissue?

Negligible if any!

Why Not Bother Exercising

– Unpleasant– Tiring– Painful– Embarrassing– Dangerous – Fear– Unnecessary– Inconvenient– etc

So what’s the point then?

– Physical benefits• You can improve how you use what

you’ve got and improve existing muscles including your breathing muscles

• You can transport oxygen better around your body and get rid of waste products more effectively

• You can become more flexible and reduce pain• etc

– Non-physical benefits

Improved mood, confidence, perceived breathlessness, social health, sleep, etc

Activity “Dose Response”

HealthHealth Benefit Benefit

FitnessFitness Benefit BenefitMod FreqLow Intensity

High FreqLow-ModIntensity

Mod FreqMod-HighIntensity

High FreqHigh Intensity

Level ofLevel ofBenefitBenefit

Adapted from: U.S. Surgeon Generals Report Adapted from: U.S. Surgeon Generals Report 1996 1996 Pate et al., Pate et al., JAMAJAMA; 273: 402-407, 1995; 273: 402-407, 1995

Volume & Intensity of Activity

Principles of exercise progression

– FITT

Frequency (times per day/week)

Intensity (e.g speed of walking, weight used)

Time (how long spent each session)

Type ( e.g. cycling-walking-running)

Example of intensityintensity progression

– Time how long it takes to dust a room– Try and beat this next time you dust

Example of typetype progression (dancing)

Mechanism of improvement in exercise tolerance

Pulmonary disease: unable to work at sufficient workload to produce normal training effect

– Increased leg and respiratory muscle efficiency

– Increased motivation to exercise– Increase stride length– Desensitisation to breathlessness

How do I know I’m doing enough / too much

– Breathlessness

– Pain

– (Heart Rate)

– Goals

The Borg Scale for breathlessness

SCALESCALE SEVERITYSEVERITY0 No Breathlessness At All

0.5 Very Very Slight (Just Noticeable)

1 Very Slight

2 Slight Breathlessness

3 Moderate

4 Somewhat Severe

5 Severe Breathlessness

6  

7 Very Severe Breathlessness

8  

9 Very Very Severe (Almost Maximum)

10 Maximum

Controlling breathlessness

– Pursed lip breathing

– Pacing

– Prioritising

Goal setting

– Think SMART

Specific

Measurable

Achievable

Realistic

Timed

Goals – some examples

Unrealistic?

– Able to run a marathon

– Lose 4 stone in 2 months

– Never be breathless

– Do what I could 15 years ago

SMART goal examples

– to be able to climb my stairs without stopping half-way within 2 months (currently taking 2 rests)

– Within 4 weeks to feel less breathless having got myself dressed in the morning

– To walk to my friends’ house for drinks on Christmas Eve this year

– To go to my son’s wedding next year and be able to dance at the reception for more than a couple of minutes

Age as a barrier to exercise

Oldest Marathon Runner

– Dimitrion Yordandis, who ran the Athens race aged 98, holds the current record.

Dimitrion expressed some concerns that if he continued running for the next 5 years it might not be that good for his knees

One hundred years– His daily regimen would be the

envy of most men 30 years his junior. Rising around 7 a.m., Gentilhomme typically plays his two hours of tennis in the morning, then takes a brief post-lunch nap before heading to the fitness club for aerobic work and weightlifting. Weekly square-dancing and bowling sessions, piano and card playing, gardening, bike riding, and reading - all help keep his mind and body engaged. After watching the 11 p.m. news, he'll catch up on e-mail before turning in

Training regime

Successful outcome is dependent on:

– Realistic and achievable programme– Individually tailored– Easy to incorporate into Activities of Daily

Living

Phil’s Top Tips for exercise

– Have goals– Monitor your progress– Make it routine not exceptional– Make it enjoyable– Don’t go it alone– Expect effort– Be creative– Give it a fair go/ Be patient!– Recognise your achievements!– Warm up and warm down– Blow as you go! (pursed lip

breathing)– Use it or lose it!

–Be realistic!

The active cycle of breathing technique

– ACBT– LTEE – lower thoracic expansion exercises– BC – breathing control– Diaphragmatic breathing– Low volume forced expiratory technique– High volume forced expiratory technique

Exercises to help clear mucus

COUGH

SHORT FAST

STRONG HUFFS

LONG SLOW

GENTLE HUFFS

DEEP BREATHS

Many thanks for your attention!

Now what do you think you’ll do next………….?

Some examples of simple exercises you can try at home:

images

images

images

images

images

images

Neck exercises

– Stand up tall and look ahead (Sit if your feeling unsteady)

– Place one hand on your chin

– Guide your head straight back (as if you’re trying to get a double chin!)

– Repeat 5 times

– Stand up tall and look ahead (Sit if your feeling unsteady)

– Slowly turn your head as far as you can to the right

– Slowly turn your head as far as you can to the left

– Repeat 5 times to each side

Trunk movements

– Stand up tall and place your hands on your hips

– Do not move your hips– Turn as far as you can to

the right, comfortably– Turn as far as you can to

the left, comfortably– Repeat 5 times to each

side

Ankle Movements

– Sit Down– Point the foot down– Pull the foot back

towards you– Repeat 10 times for

each foot