STARTING AN EXERCISE PROGRAM
by Mary Burns, R.N.; B.S.

Hearing the suggestion, or advice, to start exercising is enough to make anyone groan with dread. When, in addition, you have trouble breathing it may seem like an impossibility. We know how difficult exercising is for you, but everyone should exercise. If you have respiratory disease you MUST exercise. More about that later. Let's take first things first and get you started.

Number one on you to-do list is making an appointment with your doctor to discuss with him your wish to start a low-level exercise program and to make sure it is safe. Ideally, your physician will refer you to a pulmonary rehabilitation program. It is much easier to get started on your new exercise regime with professional help and support. But suppose you live in an area without any pulmonary rehab. Does that mean all is lost? No! You can do it on your own and we will now take you down the road to success step by step.

You need to have an exercise test, such as a 6-minute walk or a cardiopulmonary exercise test, done by your physician, before starting to exercise. It is very important to be sure that your oxygen level with exercise is adequate, meaning that it is OVER 88% saturation. Low oxygen
levels put a strain on the heart and decrease your energy level. You also need to make sure that there are no heart problems that make exercise inadvisable.

Before we start on the physical side of exercising lets work a little on the mental. Someone with lung disease may start rehab in a wheel chair, unable to walk across the room, but usually, 6 weeks later is able to walk an hour a day. Magic? Some people think so, but it really isn't. You too have that same capacity, though without professional help it is
more difficult and may take longer to acheive. It is your muscles, not your lungs that are the problem. Wee'll discuss that in detail another month but briefly, we now know that respiratory disease affects the muscles as well as the lungs. We may not be able to make major changes
in your lungs but we CAN do a great deal to improve your muscles and your ability to exercise! HAVE FAITH!

The most difficult thing you will need to learn is to slow down and pace yourself. You also need to learn to breathe properly as you exercise. For that reason, and because most folks are so badly deconditioned, start very slowly. HAVE PATEINCE! Here is the formula for success.

Start by walking only one minute, 5 times a day. Now, you can walk more often than that if you wish, but most people find it difficult.

You don't have a rehab program to demonstrate how to start? Let me help you. Work slowly at first! Sit in a chair. As you get out of the chair, move slowly and exhale, using pursed lip breathing (PLB) with effort. If necessary, do it in two steps. Exhale continuously with PLB as you move to the front of the chair. Rest a few seconds and then exhaling continuously with PLB, blow yourself up and out of the chair. Rest again.

Don't try to run across the room before you get short of breath!Move slowly, using good breathing techniques. The goal is to walk one minute without being more than moderately short of breath (SOB). If you can't manage that, walk only 30 seconds at first. Concentrate on walking slowly. We know that this goes against the grain for all of you but you can do it! Concentrate on your breathing techniques. These basics are essential in order to achieve that goal of walking an hour without difficulty. Have patience with yourself! An hour a day may seem like an impossible acheivement but actually it's the first 15 or 20 minutes that are the hardest. Once you have achieved that level of exercise the rest will be much easier to achieve.

Did you notice that we haven't said anything about a target heart rate? Shortness of breath limits the exercise of patients with respiratory disease, not their heart rates. Use your SOB as a guideline to increasing exercise. A little shortness of breath will not hurt you. But until you learn better control of your breathing, keep that level of SOB down to what you would rate as moderate. That way you won't cause yourself to develop respiratory panic.

Keep a diary so that you can look back and see how much you have improved a month from now. Gradually increase your exercise, only one minute at a time to begin with, as your shortness of breath gets under control. However, you must continue to walk at least 5 times a day if you are only walking a few minutes at each session. If you have severe
SOB, do not increase the number of minutes you are walking. Always remember that endurance, not speed, is what you are aiming for at this time. Walk as slowly as is necessary to keep that SOB under control. Once you are able to walk an hour, you may start increasing your speed and will be able to do so.

So, where can you walk when you only have a range of one minute? Why, in your living room, of course, during a TV commercial. Are you too weak to walk one minute? Then just stand up for a few seconds or do a few leg lifts every half-hour. What are leg lifts? Sit in your chair and lift your legs, one at a time, as if you were walking. This will help to strengthen your leg muscles so that you will be able to eventually walk. Remember, that decinditioned muscles cause this weakness, not by your lungs. You CAN improve!

Do you have such bad arthritis that it pains you to walk? If so, this type of exercise regime is exactly what you need to help your afrthritis, also. Walk only until you have pain, or marked discomfort, given if it is only 30 seconds. Stop until the pain is gone, and then start again. A bike is very helpful for very heavy people or those with a lot of pain when they exercise. Set the bike at zero tension until you are able to ride for 30 minutes or an hour. Start out by riding only 5 minutes at a time, or less, but do it 5 times a day, gradually increasing the time as you get stronger or have less discomfort.

As you find that your shortness of breath and fatigue lessen, and you are able to walk 5 or 6 or 7 minutes at a time, you can start walking 4 times a day.

When you get up to 10 minutes at each session you can drop down to 3 times a day if you wish. Do you realize that you are now walking one half hour a day! Once you can walk 20 minutes you'll have it made and after this it will be easy.

Advance to 30 minutes twice a day. You'll find it quite easy now to gradually increase your time as much as 5 or even 10 minutes a session. Soon you will be walking one hour at a time and now is when you can try to gradually increase your speed.

You can't find anyplace in your neighborhood to walk? The weather is too bad? Try walking in the local malls. If you get a treadmill, buy one that goes as slowly as 1/2 mile an hour if you are very limited. If necessary, start your walking at that rate, just a few minutes at a
time, with no elevation. Remember that your goal is to be able to exercise with no more than moderate SOB.

You can gradually increase the speed on the treadmill to 1 mile an hour but don't go higher than that until you are able to walk one hour at a time. Remember that your goal is endurance and no more than moderate shortness of breath. Once you can walk an hour you will be able to
handle anything, even Disneyland!

If you have restrictive lung disease, such as pulmonary fibrosis, you need to be especially careful to move very slowly when you start to exercise. You may have a tendency to drop your oxygen level very quickly if you move too fast.

Another warning, for all of you: if your doctor prescribed oxygen with exercise, use it! Keep your oxygen saturation above 88%, preferably over 90% when exercising. Your doctor may wish you to keep it at 93%. It will help your endurance and prevent a straing on your heart.

Do you have congestive heart failure? With the permission of your physician, the above exercise prescription may help you, also. Discuss this with your physician.

Starting an exercise program can be very difficult - so why bother? Is it really worth it? You bet, it is! We could list a whole page of benefits, but the biggest benefit is the freedom you will again have.

Being limited to an area only as large as that which you can covber in a few minutes of walking is worse than being in jail! No wonder people with respiratory disease often are depressed or irritable. Who wouldn't be! And that is another benefit of exercise. Your sense of well being will increase and life will feel worth living again. You'll sleep better at night. Your arthritus usually improves and is better than it has been in years. Bronchial secretions at first seem to increase, as you cough them up after walking. But a regular exercise program is the best thing you can do to decrease your sputum or get rid of it entirely. So then what happens? You aren't as susceptible to infections and you feel better!

Mary Burns has been giving pulmonary rehabilitation classes for over 20years. Think of that. She was way ahead of the world. Mary is a registered nurse and has lectured extensively internationally.

This article first appeared in the October 1998 Second Wind Newsletter (subscriptions available by request to perf@pacbell.net).

The article is an expansion of a talk Mary gave to the Puff-ins support group of Providence Hospital in Acchorage, Alaska and is dedicated to Dorie.

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