AM I TOO SICK TO
EXERCISE?
Nola Cecins & Dr Sue Jenkins
Senior Physiotherapists (Pulmonary Rehabilitation) Sir Charles Gairdner Hospital
Outline
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Benefits of physical activity
Exercise and physical activity
Recommendations
Exercise and lung disease
Lung flare-ups
Exercise and depression
Take home messages
Benefits of physical activity
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Regular physical activity reduces risk of:
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‘All cause’ mortality or DEATH!
Heart disease and stroke
Colon and breast cancer
Dementia
Helps to prevent and control diabetes (type 2)
 symptoms of osteoarthritis (hip and knee)
Any other benefits?
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 bone density
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 risk of falls and fractures
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 anxiety and depression
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Boosts immune system
Better than any pill!
What’s the difference?
Exercise
Physical Activity
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Any body movement in daily life
that contracts muscles to burn
calories
• Housework
• Shopping and carrying
groceries
• Walking to and from shop
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Physical activity that is planned,
structured, repetitive and
purposeful
• Exercise program at gym
• Walking for 30 min
• Pulmonary rehabilitation
classes
Beware of the active
‘couch potato’
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Sedentary behaviour
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Australians spend 7 to10 hours sitting per day
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Time spent sitting or lying down (not asleep)
2 to 3 hours watching TV
Despite being active - increased sitting time is related
to poor health
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eg. diabetes and heart disease
Recommended guidelines
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Some physical activity is better than none
150 to 300 min of moderate intensity physical activity per
week
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Be active most days of the week
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Do muscle strengthening exercises 2 days each week
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Minimise the amount of time spent sitting or lying down
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Break up long periods of sitting as often as possible
Department of Health, Australia’s Physical Activity and Sedentary Behaviour Guidelines
for Adults 2014
What is moderate intensity activity?
Light
Moderate
Vigorous
Walking slowly
Brisk walking
Walking briskly uphill
Light housework
Housework
(sweeping)
Vacuuming, moving heavy
furniture
Watering garden
Gardening
Heavy gardening (digging
/ mowing lawn)
Chair aerobics
Pulmonary rehab
classes
Reducing sedentary time
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Reduce sitting time
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Have breaks every 30 min or break up the time
Do ‘light physical activity’ or stand to do tasks
Suggestions
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TV viewing
Reading
Domestic tasks
Shopping
Increasing physical activity reduces
mortality – or death!
What limits being active if you have lung
disease?
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Breathlessness
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Energy levels – fatigue
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Cough
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Tired legs
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Fear of losing breath – panic
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Losing bladder control
Breathlessness: Spiral of inactivity
Breathless on
activity
Further inactivity &
deconditioning
More breathless on
less activity
Uncomfortable
 less activity
Muscle
deconditioning
Is it safe for people with lung disease to
exercise?
YES Exercise is safe
Benefits of exercise
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Improves fitness
Reduces breathlessness
Improves quality of life and energy levels
Improves strength and joint mobility
Moves secretions from the lungs
May reduce the need for hospital admissions
BUT it doesn’t change your lung function
Break – stand up !
But…. are there precautions you should
take during exercise?
If the following persist during exercise  see GP
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Excessive shortness of breath or tiredness – much worse than
normal for you
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New chest, neck or arm pain  STOP IMMEDIATELY
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FAST (stroke)
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‘New’ irregular heart beats
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Dizziness or nausea
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Sudden muscle pain or tearing  STOP IMMEDIATELY
When shouldn’t you exercise?
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Within 1-2 hr of a meal
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Extreme weather conditions
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If unwell / sick
What do we mean by ‘sick’?
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Diarrhoea and vomiting
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Severe headache
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Flu-like symptoms
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Fever (>38o)
Body aches and pains
Excessive tiredness
What exercise can you do if you have mild
lung disease?
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150 to 300 min moderate intensity activity per week
Walking
• 30 – 60 minutes brisk walking on 5 days each week
• Can incorporate a small incline
Strength training on 2 days each week
• Gardening (digging or lifting pots)
• Steps, squats, lunges, hand weights
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Swimming or walking in water
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Living longer living stronger program
AND reduce the time you spend being sedentary!
What exercise can you do if you have more
severe lung disease?
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Pulmonary rehabilitation
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Exercise and education program (group)
Individually prescribed, supervised and monitored by a
physio
8 weeks – 2x/week + home exercise program
Walking (set intensity), cycling, arm and leg exercises
Some people need oxygen when exercising
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Your physio or doctor will decide this
Some people need regular rests when exercising
(interval training)
Lung flare-ups - recommendations
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Exacerbation or flare-up
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Home
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Worsening of symptoms
On average 2 to 3 times per year
Action plan
Reduce (but don’t stop) activity level
Fever, aches etc – NO exercise
Hospital - severe ‘flare-up’
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Mobilise as soon as possible (usually seen by PT)
‘Stable’ (not getting worse)
 Remember – it can be normal to have day to day ups and
downs in your lung symptoms
Should I exercise – YES or NO?
Humid day and more breathless than usual
 YES – you will often feel better
Fever and chills
X NO – do not exercise and if these persist for > 24 hrs go to
doctor
Busy weekend and very tired
 YES – just do a bit less
Visitors
 YES and NO – enjoy your visitors but try to keep your
routines (you wouldn’t not take your medication)
Should I exercise – YES or NO?
New dull chest pain – not going away
X NO – go to doctor
Aching back
 YES - try paracetamol and do any exercise that does not
make it worse
Severe pain in achilles tendon
X NO – get checked by doctor or physio
What if I am low and don’t feel like
exercising….
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Depression affects up to 40% of people with lung disease
Regular moderate intensity exercise can be as good as
medication in mild to moderate depression
Regular aerobic exercise (walking, cycling) and strengthening
exercises all help
Pulmonary rehabilitation has been shown to improve mood
How does exercise help?
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Exercise increases endorphin levels – chemicals in brain that
affect mood
Other benefits of exercise that help mood
• Provides a distraction from ‘worries’
• Can be a social activity
• Increases energy levels
• Improves sleep
• Improves own sense of control
Take home message
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Being active has many health
benefits
Exercise or being physically
active is OK if you have lung
disease
Sit less!
Physical activity is the best
medicine
Thank you – questions / comments?