Exercise is important for increasing lung capacity and oxygen usage by the body. This statement is true for both people who suffer from pulmonary disease and those that are healthy. Lung function is measured by VO2 max, which is the maximum rate your body consumes oxygen when performing activity. VO2 max shows how the heart, lungs, blood vessels, muscles and nervous system are all working together. Although measuring VO2 max directly involves a controlled test on a treadmill while wearing an oxygen mask, it can just be estimated by the degree of breathlessness felt during exercise. You have reached your VO2 max when you are breathing as hard as you can.
Improving your VO2 max can lead to many benefits. These include:
- Feeling better and less stressed
- The ability to breeze through daily challenges
- Improved sports performance
- Lower rates of stroke, heart disease, colon cancer and type 2 diabetes
- Increased quality of life
- Better sleep quality
- Decreased risk of dementia and Alzheimer's
- Slowed rate of aging as measured by increased bone strength and decreased muscle loss
The American College of Sports Medicine shows that a 10% increase in VO2 max is associated with a 15% decrease in deaths from any causes. The American Lung Association also recognizes the importance of increasing VO2 max for overall health. By improving the amount of oxygen the body uses, we improve blood flow to the lungs and increase blood flow to the heart, leading to better metabolic health. Cardiovascular exercise increases the ability to pull oxygen from the lungs and into the blood. Unfortunately only 22-25% of adults exercise enough to improve VO2 max and gain better health.
Exercise can be an important adjunct in the treatment of obstructive lung diseases such as asthma, chronic bronchitis, COPD and emphysema. In 2011, a study was published in the European Respiratory Journal that showed exercise can have a significant positive treatment effect on asthma control. They conducted a 12-week supervised trial of asthma patients and there was a significant improvement in aerobic fitness as well as improvement on the Asthma Control Questionnaire. Healthcare use was higher in the physically inactive group also, as measured by decreased scores on lung function tests, lower quality of life, increased breathlessness during activity and increased inhaler usage.
When someone who suffers from an obstructive lung disease begins an exercise program, there are several factors that must be considered. Firstly, many of these patients have other diseases that need to be taken into account. Monitoring oxygen saturation via a pulse ox meter is recommended because they will likely experience oxygen desaturation and breathlessness at low workloads. Many will also experience chronic deconditioning, low aerobic fitness and decreased muscle performance. Exercise intensity should be guided by shortness of breath, working at levels of 40-60% of maximum effort for 20-45 minutes with rest as needed. Upper extremity exercises will be more fatiguing so following a Peripheral Heart Action training circuit is recommended, which involves 4-6 exercises in a row alternating between upper and lower body exercises to evenly distribute blood flow. Each exercise should be repeated for 8-20 reps with 30-45 seconds of rest before moving on to the next set of exercises. Emphasis should be placed on duration of exercise and the intensity should be guided by breathing control.
What implications could all of this have for patients with COVID-19? Studies have shown that in lung cancer patients who are undergoing surgery, a higher VO2 max is the strongest predictor of a positive outcome and lower risk of surgical complications. Could a higher VO2 max be used as a triage tool when deciding to hospitalize COVID-19 patients? Studies are now underway to see if there is a correlation between higher VO2 max and lower severity of symptoms. For now the Centre for Peri-Operative Care advocates brisk exercise, smoking cessation, alcohol free days and good nutrition as important in the prevention of COVID-19. In my opinion, improving lung function by getting a least 30 minutes of cardiovascular exercise 3 to 5 times a week is very important in avoiding serious complications from COVID-19. This could prove to be particularly important for people who suffer from lung diseases like asthma and COPD. If you aren’t sure where to start when beginning an exercise program or are afraid to exercise without supervision, consulting a trainer such as myself who is experienced in dealing with medically complicated clients would be a good place to start. The positive changes from exercise can help you live a longer, healthier life!