People who suffer from COPD can have mild, moderate or severe limitations, when it comes to physical activity.Why? Breathing, which we normally do without even thinking about it, requires increased effort when you have COPD.
Part of engaging with physical training is to learn how to incorporate the increased breathing necessary for various degrees of exertion. Individuals with COPD already have to make an increased effort to breathe while at rest. So learning how to deal with any level of exertion is beneficial, since even activities-of-daily-life can sometimes require exertion. That can feel unpleasant or scary to the COPD patient.
For this reason, COPD patients tend to mostly avoid exercise programs. That avoidance is often not because of laziness, but rather because individuals with COPD use a lot of energy while they are simply at rest. Most patients with COPD are not overweight. In fact, the classic emphysematous patient tends to be thin, looks undernourished, and presents with a “barrel chest” - a prominent rib cage.
Nevertheless, exercise programs are crucial for overall health and to maintain and build muscle mass. More importantly, the regularity of exercise, even just minutes a day, allows the coordination of the muscular, respiratory and cardiovascular systems and helps to mobilize more efficient production of the energy required for increased activity.
Pulmonary Rehabilitation teaches this process to the patient with COPD. It is largely an educational program designed to teach more efficient ways of doing activities that require more energy.
In an attempt to overcome the fear of engaging with physical activity, there’s been some investigation of the use of yoga in COPD patients. The rationale is that in yoga, the increase in physical activity comes in the forms of postures known as asanas and breathing techniques known as** pranayamas**. The idea is to improve performance by training individuals in a range of movements that involve motion, balance, and flexibility.
The fact that yoga integrates proper breathing techniques directly within the execution of movements and poses really hits the nail on the head for the typical COPD patient. This challenge of breathing goes to the essence of the limitations in COPD. There is potentially less fear in the COPD patient of becoming or remaining breathless while engaging with this exercise program, because of the forgiving nature of yoga and its inclusion of breathing techniques. After all, this is what the average COPD patients has had to endure, on a daily basis, when just engaged with simple activities of daily living. Yoga modalities also typically progress slowly when adding additional difficulty or advancing levels.
Building an ongoing relationship with yoga
A recent study done in Montreal looked at how yoga might be an effective exercise approach to the COPD patient. Patients were randomly assigned to a 12 week program of yoga that included physical postures, breathing techniques, meditation and relaxation techniques, and compared to another group who engaged in a traditional pulmonary rehabilitation program with supervised exercises. The end points that were compared included subjective feelings as measured by Borg Scale, which measures the individual perception of shortness of breath, and objective measures like the distance one was able to walk in six minutes (the six minute walk test), and a blood measure of inflammatory markers which include C-reactive protein and Interleukin-5.
Although there was an improvement in all measures in both groups,** there was a significantly better improvement in the subjective measures in the yoga group.** Overall, taking into account all the measures, there was no statistically significant difference between both groups. ** Yoga practice by COPD patients was found to be just as effective as** ** traditional pulmonary rehabilitation**.
Perhaps the most significant finding was something that was not measured. One feature of both programs was that after the study was completed, both groups received counseling to continue the exercise on their own. Researchers discovered that the yoga group continued with the exercise and breathing habits on their own, using what they had learned during the study. This exercise commitment has not been observed in the past, in COPD patients who participate in standard pulmonary rehabilitation programs. There appear to be some unique qualities to yoga that increase the feeling of well-being which then motivates these individuals to continue with the practice on their own.
It is important to note that neither of these programs results in a cure of the disease.
There has been no proof to date, that pulmonary rehabilitation decreases mortality and it is even unclear whether it reduces hospitalizations. What pulmonary rehabilitation does accomplish is an improved sense of well-being and confidence, so the patient realizes that more can be done with their limited respiratory system.
Yoga, with its added mind-body-spirit balance, may take this well-being state to the next level, reducing the stress and anxiety normally associated with increased physicality in the COPD patient, and allaying fears that engaging with exercise may be harmful or dangerous.
This is a truly novel approach to a chronic disease that current traditional medicine, til now, has considered as having no hope for a cure.
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Eli Hendel, M.D., is a board-certified internist/pulmonary specialist with board certification in Sleep Medicine. An Assistant Clinical Professor of Medicine at Keck-University of Southern California School of Medicine, and Qualified Medical Examiner for the State of California Department of Industrial Relations, his areas include asthma, COPD, sleep disorders, obstructive sleep apnea, and occupational lung diseases. Favorite hobby? Playing jazz music. Find him on Twitter @Lung_doctor.