Pulmonary Rehabilitation : Aerobic Exercise

This post is only educational,kindly refer to your physician and physio for personalised advice.

Aerobic exercise is a form of cardio-respiratory training that helps one improve his

cardiovascular system allowing it to be maintained in as much as possible an optimal levels. It is well documented that with such training breathlessness and the heart rate decrease ,whilst exercise tolerance is also seen to improve. Aerobic exercise means any form of exercise generally without weights that increases the load on the heart and breathing , this form of strain conditions these systems to work better and be more efficient. The following are some techniques, tips and monitoring scales for aerobic exercise.

Types of Aerobic Exercise There are various ways one may exercise his body by increasing the heart rate and breathing , such as walking, running, swimming, cycling, dancing and more. Even daily tasks can incorporate an amount of aerobic exercises for example doing chores at home like cleaning or doing the laundry . The American Heart Association suggests of doing 30minutes of light strenuous exercise such as walking to reap the benefits of exercise (1). This time interval can be split into 2 , 15minute sessions or 3,10minute sessions. There are also scales one can refer to on to help him quantify how he is feeling and if exercise is helping or not.

BORG Modified Rate of Perceived Exertion (RPE)

The Borg scale is commonly used to rate the amount of effort someone has to put in to complete their exercise. The Borg scale will have been explained during your assessment/pulmonary rehabilitation sessions. By varying the level of intensity during exercise it allows you to incorporate a warm up and cool down during your exercise session. By practicing this and doing a little more each time you exercise, you will continue to progress your fitness.

• Use this scale below to help achieve the right exercise intensity.

• Whilst completing your warm up/cool down try to aim to exercise at level 1-2. • When completing your main exercise programme try to aim to exercise at level 3-4 and sustain this level for as long as you can.

• Once you reach above level 4 or feel too breathless to continue with your exercise rest or reduce the pace/intensity.

It is really important to try and work at a level 3-4 in order to improve your cardio-vascular fitness. If you continue to work at level 2, your fitness will not improve. Try to incorporate a warm up and cool down within your walking (using the BORG scale). For example, if you are going out for a twenty-minute walk, spend five minutes warming up and walking at a level 1-2 on the BORG scale; then increase the intensity and spend ten minutes working at a level 3-4; and then cool down by walking for five minutes at a level 1-2. This is just an example, if you cannot manage twenty minutes of walking then just adapt this to your own pace and time. Try to complete a walking diary to identify what progress you are making. Once ready from an exercise rate how you felt on a diary on a particular exercise, note if any differences arises after a week of training. e.g of BORG scale

0 :Nothing at all. 1: Easy, effortless. Your breathing feels quite comfortable. 2 :Very light – mild effort. 3: Moderate – you are feeling warm and breathing a bit more deeply. 4: Somewhat strong – your breathing is heavier, becoming a little sweaty, can feel your heart beating and muscles are working. But you can still hold a conversation .5Strong – your breathing is becoming too heavy, getting breathless and talking is difficult. 6-9:Very strong. 10 :Very, very strong; almost maximal effort.

Using technology In this day and age technology can also provide us with data to monitor our daily steps and exercises . Smart watches can provide data on heart rate and oxygen levels , giving an idea how ones body is reacting ; though these may not be 100% accurate, results may still encourage the wearer to walk more and reach daily targets of activity. If one doesn't want to buy a smartwatch , various apps on the mobile can monitor and track walking distances and also act as a step counter .

The heart rate can also be an indicator that one is straining too hard on a particular exercise , meaning that he should slow down and catch his breath before continuing .One can also feel his pulse , through the carotid artery in the neck and sense if it is fast or slow.Deep slow and diaphragmatic breathing may help slow it down. These tips should be used to encourage one to push himself to the limit on a daily basis. Which in turn will aid him maintain a better health condition and also independence.

How to do Aerobic Exercise? Continuous movement using large muscle groups like walking, cycling or treadmill.

• Increasing your heart and respiratory rate during aerobic activity

improves conditioning.

• You need organized aerobic exercise to improve fitness. Walking from your bedroom to the living room is not enough.

Warm Up:

It is important to warm up 5 minutes before all exercises to:

• Warm up muscles and body temperature

• Increase heart rate and breathing rate slowly

• Lower the risk of injury

• Slowly increase your speed on the exercise equipment or when you are walking to ease into it

Cool Down:

It is important to cool down for 5 minutes before stopping.

Cooling down:

• prevents dizziness, sore muscles and blood pooling

• helps you regain control of your breathing and heart rate

• slowly decrease your intensity on exercise equipment before coming to a complete stop

Warm Up and Cool Down:

Breathing exercises and slow-paced walking are ways to warm-up and cool down.

Muscles to engage Front Muscles

-Neck Muscles:

• Help with breathing.

• Need to stretch and relax.

-Chest Muscles:

• Help with breathing, moving shoulders ,opening and closing arms.

• Need to stretch.

-Abdominal Muscles:

•Help with breathing, coughing and posture.

-Shin Muscles:

• Need to be strong for walking.

-Facial Muscles:

• Use for pursed lip breathing and emotion.

-Shoulder Muscles:

• Move upper arms.

• Need to be strong.

-Bicep Muscles:

• Bend elbows for lifting and overhead tasks.

-Hip Muscles:

• Need to be strong for walking and moving.

-Thigh Muscles:

• Need to be strong for walking and stair

climbing.

Muscles in the back:

-Back Muscles

• Help with posture.

-Inner Thigh Muscles: • Help with walking. • Need to be strong.

-Calf Muscles:

•Bend the ankles for walking.

-Shoulder and Neck Muscles: • Help with breathing.

• Need to stretch and relax.

-Shoulder Muscles:

• Move upper arms.

• Need to be strong.

-Tricep Muscles:

• Straighten elbows.

• Used for overhead motions.

• Need to be strong.

-Hip Muscles:

• Help for walking, climbing stairs, and getting up from chair.

-Back Thigh Muscles:

• Bend knees.

• Help with climbing stairs. • Need to be strong.

-Achilles Tendons:

• Help with walking and going up on toes.

• Need to stretch and strengthen Home Exercise Tips :It is important to maintain your exercise and activity levels. Your Physiotherapist will give you a home exercise program and schedule to follow.

• Make exercise a regular part of your day.

• Set up an exercise space in your home with your equipment.

• Try to follow your schedule to keep on track.

• Give yourself time. It takes a few weeks to get into a routine.

• Avoid feeling discouraged. Remember, practice makes perfect.

• Balance rest with activity.

Your activity program may include:

• Daily breathing exercises

• Walking

• Going up and down stairs

• Riding a stationary bicycle

• Using a treadmill

• Doing arm and leg strengthening exercises

Other places to do your exercise routine:

• Community Centre or Senior Centre

• Fitness or Wellness Centre

• YMCA or YWCA

• Shopping Mall walking