Practical Help

Exercise, Oxygen Use and Conserving Energy

At the ILFA Open Day March 24, 2007, IRENE BYRNE, Senior Physiotherapist, Heart and Lung Transplant Programme, Mater Misericordiae University Hospital, Dublin, spoke about EXERCISE, OXYGEN USE, and CONSERVING ENERGY.

EXERCISE - what you should do and what you can do.

A big problem for people with IPF is the fear of breathlessness, and this fear can lead to immobility and disability. It is important to break out of this cycle and to manage your breathlessness rather than be controlled by it. We all get breathless doing things because we need to take more air in to do something. Moderate shortness of breath is acceptable and necessary, and should not prevent you doing things and getting out and about. Just stop and get your breath back when you need to – find your own strategies for doing this- like stopping to look in a shop window for a while even though you are not remotely interested in buying anything.

EQUIPMENT

You don’t need a lot of equipment to exercise. All you need is one set of arms and one set of legs, a bit of will power, and some very cheap equipment like the steps of the stairs; a small plastic bottle full of water can be used as a weight for arm exercises. If you have an exercise bicycle in the house so much the better, but it is an optional extra.

HOW TO EXERCISE

It is important to start with a low amount of repetitions.

If you launch off with great intentions and overdo it you’ll end up shattered and will never feel inclined to exercise again. Build up gradually; two repetitions of an exercise is nothing, but two becomes six, six becomes twelve, and after a few weeks you’ll be surprised at how many you can do.

Do single limb exercises. Don’t lift your two arms over your head together, this will put you under pressure and increase your breathlessness; you can raise your arms over your head one at a time. Right arm, rest; alternate to the left arm, rest. Alternate upper and lower limbs.

Do your exercises regularly throughout the day, every day. Particularly in the early stages when you are doing a low amount of repetitions try to do them at least twice a day. Make it part of your daily routine like taking your medication.

UPPER LIMB EXERCISES

SINGLE ARM EXERCISES WITH A WEIGHT– this could be your bottle half-filled with water. Start in a seated position. Before you begin consciously lower your shoulders – roll them backwards, bring them up to your ears and drop them down.

Do four or five single arm movements to the front, punching forward, first on one side then the other side; four or five arm movements reaching up to ceiling, one arm then the other arm; four or five movements lifting straight arm with weight out to side. You can time it to music if you like. Start with four or five movements and add one or two a day.

A low weight and high repetitions is better than using a heavy weight and not doing as many repetitions.

LOWER LIMB EXERCISES

MARCHING ON THE SPOT: lift your knees so they are parallel with your hip. March for a count of five to start and build it up gradually. Counting slowly helps you control your breathing.

SIT TO STAND FROM A CHAIR: use an ordinary kitchen chair. Initially you might need your hands on your knees to help you stand up. Our large leg and bottom muscles eat up oxygen so they need to be kept reasonably fit. Again start doing a few and build up.

STEPS OF STAIRS: step up and down for a count of three, four or five. Again build it up gradually and please use the bottom step of the stairs, not the top!

WALKING is a challenge to anyone with breathing problems but it is important to do it. Walk outside every day if possible even if it’s only to the garden gate. You might manage it once, twice, or you might manage it more often than that. No other exercise gives you a total all over body exercise. The large muscles of your body with your heart and your lungs all work together when you walk. You can do it anywhere even in the hospital. Try to challenge yourself every day to do some walking. The bigger the muscle the more oxygen it needs, and the less a muscle does the more unfit it becomes and the more oxygen it will eat up on you. If you can make your muscles a little bit fitter you’ll find it easier to do things. The idea is to change what we can change. If you can’t change the condition of your lungs try to change the condition of your muscles.

BICYCLE: if you have one start off doing 30 seconds and build up to three minutes, maybe five. Build up slowly. The most important item of equipment on a bicycle is a comfortable seat and a good window to look out of while you’re on it so you don’t get bored!

THE F.I.T.T.PROGRAMME

FREQUENCY: How often should you exercise?

Twice a day.

INTENSITY: How hard should you exercise?

Judge it by your breathlessness. Aim for moderate breathlessness. This will vary from day to day depending on how tired you are, and whether you are recovering from an infection or not. If you keep it to this level you won’t overdo it.

TIME: How long should I exercise for?

Begin low and build up. You’ll find a point where you’ll plateau- that’s ok, stay there. If you get a knock back or have an infection you start low and build up again.

TYPE: What kind of exercise should I do?

High repetitions, doing the exercises a lot, and low weights.

REMEMBER

Don’t set impossible goals for yourself.
Gradually increase the time you exercise for, and don’t overdo it.
Don’t deplete yourself, you’ll feel awful and get discouraged if you do.
If you have been sick, start back gently.
Weather conditions will affect your ability to exercise – very cold weather will increase breathlessness. So choose your time to do things.
Do not exercise too soon after a meal or drinking alcohol. Your blood supply is a closed system, so if it’s gone to your stomach, your gut and your liver it can’t go to your lungs and your heart. Have a rest after your meals and then go do your exercises an hour or two later.
Do not exercise when you have a fever or an infection.

OXYGEN USAGE

Your body needs a decent supply of oxygen so use it. You won’t become addicted to it! Particularly use it when you eat, when you have friends in and are chatting, when you are washing and having a shower, and when you are active. Adjust the level to the level of your activity. If you are sitting down you might need two litres, if you are moving around increase it to four. Turn it up when you are exercising

Use your portable oxygen when you go out. It may not look beautiful, and we all have pride, but you have to be practical. It is much more disconcerting to be standing somewhere totally caught for breath, and it will enhance your ability to do things and to enjoy life more fully.

If you do not have a portable supply of oxygen talk to your doctor about getting one.

CONSERVING ENERGY

Plan. If you are going somewhere allow yourself plenty of time to do things so you are not rushed.

Use seats where possible, - in the shower, in the kitchen, and sit down when you are drying your hair or shaving.

Get wheels for your portable oxygen. Home Craft in Athlone can provide these. They cost about €40/€45

When you go out use a Rollator or a shooting stick that you can use as a seat if you need to stop and rest. Lean on the shopping trolley when you are in the supermarket.

The Wheelchair Syndrome: most people resist using a wheelchair, but why waste energy walking down the road to go somewhere you want to go and then have no energy left to enjoy it or use up your energy walking into the shopping centre and then have no breath to browse the racks and try on the clothes. No one wants to be in a wheelchair, but it is about getting a balance between Pride and Practicality.

Wheelchairs can be rented or bought from the Irish Wheelchair Association.

LOOKING FORWARD

Exercise should be a basic part of your life – a formulated exercise programme is important.
Do it every day – you can’t store the benefits of exercise; you have to keep up the good work every day.
Put exercise on the same level of importance as your tablets.
Never waste energy that could be used for better things.