EXERCISE AND COPD

 

COPD reduces exercise tolerance and physical activity levels (Louvaris et al., 2016). Common COPD symptoms exasperated by exercise are dyspnoea, chronic cough, wheezing, and a tight chest (Nese and Samancioglu Baglama, 2022). Peripheral muscle dysfunction is an extra-pulmonary symptom of COPD (Armstrong and Vogiatzis, 2019). Lower levels of physical activity cause muscle atrophy increasing the risk of frailty and functional decline (Guadalupe-Grau et al., 2017).

Nola will undertake the 6-minute walking test (6MWT) as a baseline measure of her aerobic capacity and again on completion of the PR program.

Click here  for a full 6MWT description.

 

High-Intensity Interval Training

HIIT is a time-effective method of improving someone’s health by reducing fat mass, blood pressure, and increasing aerobic capacity (Guadalupe-Grau et al., 2017). Shorter exercise efforts followed by a rest period make HIIT accessible to people with low fitness levels (Guadalupe-Grau et al., 2017), making HIIT a suitable choice for people with COPD. HIIT can improve muscle strength and the bodies efficiency during exercise reducing the effect of muscle atrophy (Wang et al., 2023). HIIT is associated with less undesirable training symptoms including dyspnoea and leg soreness (Ross, Porter and Durstine, 2016).  HIIT is suitable of PR because it can improve pulmonary function, exercise tolerance, and QoL (Wang et al., 2023).

 

Resistance Training 

RT is the practice of training specific muscles or muscle groups by the repetitive lifting or pushing of weights and is important for people with COPD (Armstrong and Vogiatzis, 2019). The European Respiratory Society suggests RT should be performed in the range of 2-4 sets of 6-12 repetitions at 50%-85% of one repetition maximum (Armstrong and Vogiatzis, 2019).  The focus of RT is usually on the lower limbs because these are the muscles often affected by disease-related atrophy (Gloeckl et al., 2018). Improvements due to RT are often translated into benefits seen in everyday activities such as standing up out of a chain and arm elevation activities (Gloeckl, Marinov and Pitta, 2013), therefore QoL for someone with COPD.

 

Nutrition and Exercise

For Nola to gain the highest benefits from participating in the PR program she needs to achieve both energy and protein balance if not she will risk further muscle mass and weight loss (Beck et al., 2023). However, Nola is trying to gain weight, therefore, is it important she understands how to effectively fuel herself with both pre and post-exercise meals.

 

Pre-exercise

(Tesco, 2024a)
(Tesco, 2024a)

The consumption of carbohydrates 30 minutes before pre-exercise is often recommended as a strategy to improve exercise capacity (Kerksick et al., 2017). However, people with COPD should avoid a high-carbohydrate diet as it can reduce pulmonary function, increase respiratory rate, and dyspnoea (Tramontano and Palange, 2023). Dyspnoea can be induced by eating a meal which may affect Nola’s ability to exercise (Holst et al., 2019).

 

(Tesco, 2024b).
(Tesco, 2024b).

Nola should eat light snacks pre-exercise, so she is adequately fuelled but does not risk inducing dyspnoea. Suitable snacks that have been suggested as part of Nola’s meal plan are mixed nuts which can increase satiety (Baer et al., 2023) to allow Nola to feel full but without eating ameal and a slice of watermelon as it contains >90% water it will allow for hydration (Popkin, D’Anci and Rosenberg, 2010).

 

 

 

Post-exercise meal

 

Soon after completing her exercise session (within 30 minutes) Nola should try and consume a meal that contains both protein and carbohydrates to aid recovery and has been shown to provide beneficial improvements in maximal strength (Huhn, Flenker and Diel,2022). Although carbohydrates should be avoided pre-exercise due to dyspnoea post-exercise, theyare needed to replace used muscle glycogen (Kerkstick et al., 2008). A suitable post-exercise meal from Nola’s meal plan would be chicken, broccoli, and sesame noodles.

References 

Armstrong, M. and Vogiatzis, I. (2019) ‘Personalized exercise training in chronic lung diseases’, Respirology, 24(9), pp. 854-862. Available at: https://doi.org/10.1111/resp.13639

Baer, D. J., Dalton, M., Blundell, J., Finlayson, G and Hu, F. B. (2023) ‘Nut, Energy Balance and Body Weight’, Nutrients, 15(5). Available at: https://doi.org/10.3390/nu15051162

Beck, A. M., Geisler, L., Mikkelsen, S. L., Rasmussen, H. H., Jorgensen, B. G., Bach-Dal, C. and Holst, M. (2023) ‘Optimizing individual benefits of pulmonary rehabilitation including a multifaceted dietary intervention – A single-arm feasibility study’, Clinical Nutriton Open Science, 52, pp. 96-109. Available at: https://doi.org/10.1016/j.nutos.2023.10.006

Gloeckl, R., Marinov, B. and Pitta, F. (2013) ‘Practical recommendations for exercise training in patients with COPD’, Eur Respir Rev, 22(128), pp.178-86. Available at: https://doi.org/10.1183/09059180.00000513

Gloeckl, R., Schneeberger, T., Jarosch, I. and Kenn, K. (2018) ‘Pulmonary Rehabilitation and Exercise Training In Chronic Obstructive Pulmonary Disease’, Dtsch Arztebl Int, 115(8), pp.117-123. Available at: https://doi.org/10.3238/arztebl.2018.0117

Guadalupe-Grau, A., Aznar-Laín, S., Mañas, A., Castellanos, J., Alcázar, J., Ara, I., Mata, E., Daimiel, R. and García-García, F. J. (2017) ‘Shirt- and long-term effects of concurrent strength and HIIT training in octogenarians with COPD’, Journal od aging and physical activity, 25(1), pp. 105-115. Available at: http://dx.doi.org/10.1123/japa.2015-0307

Holst, M., Beck, A. M., Rasmussen, H. H. and Lange, P. (2019) ‘Insufficient intake of energy and protein is related to physical functional capacity among COPD patients referred to municipality based pulmonary rehabilitation’, Clinical nutrition ESPEN, 30, pp. 35-41. Available at: https://doi.org/10.1016/j.clnesp.2019.02.009

Huhn, A., Flenker, U. and Diel, P. (2022) ‘Effects of Carbohydrates and Protein Administration by Food Items on Strength ROsponse after Training in Stable COPD’, Nutritents, 14(17). Available at:  https://doi.org/10.3390/nu14173565

Kerksick, C., Harvey, T., Stout, J., Campbell, B., Wilborn, C., Kreider, R., Kalman, D., Ziegenfuss. T., Lopez, H., Landis, J. L. and Antonio, J. (2008) ‘International Society of Sports and Nutrition position stand nutrient timing’, J Int Sic Sports Nutr, 5, pp. 17. Available at: https://doi:10.1186/1550-2783-5-17

Kerksick, C. M., Arent, S., Schoenfeld, B. J., Stout, J. R., Campbell, B., Wilborn, C. D., Taylor, L., Kalman, D., Smith-Ryan, A. E., Kreider, R. B., Willoughby, D., Arciero, P. J., VanDusseldorp, T. A., Ormsbee, M. J., Wildman, R., Greenwood, M., Ziegenfuss, T. N., Aragon, A. A. and Antonio, J. (2017) ‘International Society of Sports Nutrition position stand: Nutrient timing’ Journal of the International Society of Sports and Nutrition, 14(1), pp. 33-33. Available at: https://doi.org/10.1186/s12970-017-0189-4

Louvaris, Z., Spetsioti, S., Kortianou, E, A., Vasilopoulou, M., Nasis, I., Kaltsakas, G., Koulouris, N. G. and Vogiatzis, I. (2016) ‘Interval training induces clinically meaningful effects in daily activity level in COPD’, The European respiratory journal, 48(2), pp. 567-570. Available at: https://doi.org/10.1183/13993003.00679-2016

Nese, A. and Samancioglu Baglama, S. (2022) ‘The Effects of Proressive Muscle Relaxation and Deep Breathing Exercises on Dyspnea and Fatigue Symptoms of COPD Patients: A Ranomized Controlled Study’, Holistic nursing practice, 36(4), pp. E18-E26. Available at: http://doi.org/10.1097/HNP.0000000000000531

Popkin, B. M., D’Anci, K. E. and Rosenberg, I. H. (2010) ‘Water, hydration and health’, Nurition Reviews, 68(8), pp. 439-458. Available at: https://doi.org/10.1111/j.1753-4887.2010.00304.x

Ross, L. M., Porter, R. R. and Durstine, J. L. (2016) ‘High-intensity interval training (HIIT) for patients with chromic diseases’, Journal of Sports and Health Science, 5(2), pp. 139-144. Available at: https://doi.org/10.1016/j.jshs.2016.04.005

Tramontano, A. and Palange, P. (2023) ‘Nutritional State and COPD: Effects of Dypnoea and Exercise Tolerance’, Nutrients, 15(7), pp. 1786. Available at: https://doi.org/10.3390/nu15071786

Tesco (2024a) Tesco Watermelon wedges 550g. Available at: https://www.tesco.com/groceries/en-GB/products/287594559 (Accessed: 4th May 2024).

Tesco (2024b) Tesco Unsalted Mixed Nut Snacks 200g. Available at: https://www.tesco.com/groceries/en-GB/products/268419141 (Accessed: 4th May 2024).

Wang, H., Liu, Q., Liu, L., Cao, J., Liang, Q. and Zhang, X. (2023) ‘High-intensity interval training improves the outcomes of patients with chronic obstructive pulmonary disease: A meta-analysis of randomized controlled trials’, Respiratory medicine, 208. Pp. 107128-107128. Available at: https://doi.org/10.1016/j.rmed.2023.107128