Exercise and breathlessness

Progressive breathlessness on exertion is a key feature of COPD. Even every day activities such as washing and dressing can cause disabling breathlessness. Often the response to such experiences is activity avoidance and this can lead to a downward de-conditioning spiral whereby cardiovascular fitness decreases, skeletal muscle mass is lost and patients consequently become more breathless.

The downward spiral of breathlessness in COPD

For people with COPD breathlessness is not harmful although it is unpleasant and can provoke anxiety and panic. Regular exercise improves cardiovascular fitness, maintains function and can reduce the sensation of breathlessness. It is important to encourage COPD patients (except when they have co-morbid cardiovascular disease when specialist advice should be sought) to maintain, and preferably increase their activity levels.

The Medical Research Council Dyspnoea Score allows patients to assess how much their breathlessness interferes with their ability to undertake normal daily activities. The NICE guideline recommends its use during routine reviews.

The MRC Dyspnoea Scale

Grade Degree of breathlessness related to activities

1. Not troubled by breathlessness except on strenuous exercise
2. Short of breath when hurrying on walking up a slight hill
3. Walks slower than contemporaries on the level because of breathlessness, or has to stop for breath when walking at own pace
4. Stops for breath after walking about 100m, or after a few minutes on the level
5. Too breathless to leave the house, or breathless when dressing or undressing

A Borg scale, allows patients to grade the intensity of their breathlessness during activity. It was developed as a tool for athletes and coaches to guide the intensity of sports training, but is equally applicable as a guide to increase exercise tolerance in COPD. The eventual aim should be to experience moderate breathlessness (Borg scale 3-5) for at least 20 minutes, three or four times a week. Exercise needs to be regular and simple exercise regimes that equate with normal daily activity, such as walking, cycling or stair climbing, are most likely to be adhered to.

COPD patients usually use accessory muscles of respiration. These are less efficient and tire easily. Breathing techniques such as abdominal breathing and pursed lip breathing can improve respiratory efficiency and help patients gain a sense of control. Active cycle breathing may help expectoration.

Pulmonary rehabilitation

Pulmonary Rehabilitation is the most cost effective intervention in the management of COPD, other than smoking cessation.

Rehabilitation can

reduce breathlessness
improve both functional and maximal exercise capacity, and
improve quality of life.

The NICE guideline recommends that it is offered to all suitable patients scoring 3 or more on the MRC Dyspnoea Scale.

I thought this might be helpful for some us here,

Love,

Holly