Exercising with Pulmonary Fibrosis

Staying active is important in maintaining a good quality of life. There are many benefits to staying physically active in all aspects of your life. It can be challenging and may take time to build up the tolerance and confidence to exercise.

What is Pulmonary Fibrosis?

About 30,000 Canadians live with pulmonary fibrosis (PF), and more than 14,000(1) live with Idiopathic Pulmonary Fibrosis (IPF). PF is unpredictable, has no known cause, and is seen in older adults(2). It is an irreversible, chronic condition that causes scarring of the lungs. As the lungs become more scarred, it becomes more difficult to breathe. Those living with PF tend to be more breathless and are often less physically active(3). As the disease progresses, a dry, hacking cough may be present. In addition, fatigue, loss of appetite, and weight loss may be experienced.

Getting diagnosed with PF can be a tough and confusing time, trying to understand the disease and what to do after diagnosis is challenging. Find ways you can manage your PF.

If you are looking for additional resources for PF, please visit:

• Canadian Pulmonary Fibrosis Foundation (CPFF) at https://cpff.ca/
• Living Well With Pulmonary Fibrosis (LWWPF) at https://www.livingwellwithpulmonaryfibrosis.com/

“Exercise is generally recommended for people with Chronic lung disease including Pulmonary Fibrosis and is usually mandatory for people with pulmonary fibrosis waiting for a lung transplant”

Canadian Pulmonary Fibrosis Foundation.

How can exercise benefit someone with Pulmonary Fibrosis?

Exercise is important as an additional therapy in PF care. Exercise training is a significant component of pulmonary rehabilitation, with reported improvements in exercise and functional capacities and levels of dyspnea in patients with COPD(3).

This can mean a reduction in symptoms:

• Shortness of breath
• Fatigue
• Improves quality of life
• Helps with everyday activities
• Relieves anxiety and depression

With over-lapping characteristics between COPD and PF, those which are the impairment in exercise tolerance and Quality of life (QoL), the value in exercise can also be noted for PF. 

Additional benefits of exercise include:

• Weight control
• Stronger heart and muscles, which helps with oxygen moving around your body
• Better mood
• Better sleep

Finding a good exercise routine will help you in all aspects of your life and can ease your symptoms.

Why is exercise important?

Exercise does not improve lung condition, but it has an important role in maintaining lung function and minimizing deterioration. Programs that include aerobic training with breathing exercises can improve your:

• Physical and mental health (QoL)
• Shortness of breath(4).

Programs focusing on proper progression benefit those with PF(5). With exercise, a greater amount of oxygen gets delivered into the muscles, which can increase your energy. Exercise will increase cardiovascular conditioning, muscle strength, and endurance and may decrease symptoms of shortness of breath (6). These benefits are very important before or after a lung transplant. The body needs to be conditioned to maximize lung function, after transplant and will help in recovery(7).

The lasting effects of exercise training are essential to consider. It is noted that the benefits are at least 6 months in most people with PF(5).

It cannot be overstated how continuing functional exercise and movement is crucial to maintain a good quality of life and preventing falls. Functional exercises are meant to be simple and effective movements to mirror the exercises of your everyday routine.

What is Pulmonary Rehabilitation?

Pulmonary Rehabilitation (PR) programs are an excellent way to begin exercising. The structure of PR is 2 to 3 supervised sessions a week for about 8-12 weeks. However, it is sometimes difficult to access, due to distance, or spot availability within the program.

PR includes education on:

• The lung condition (PF, COPD, etc.)
• Medication
• Nutrition
• Ways to control shortness of breath
• and follows an exercise program

Where should you begin?

Check with your health care professional before beginning with any new exercise program (whether it is online or at home). 

It is important to begin any new exercise slowly, and gradually. You may begin by adding a few minutes of walking, into your normal routine. If you are at home for most of your day, try to stand up as often as possible. Try breaking up long periods of sitting as possible,

Your body will need time to get used to the new movement.

Finding a program that focuses on careful exercise prescription, monitoring of oxygen levels, steady and slow progression, and disease-related education will ensure a meaningful and safe experience. Careful monitoring of the exercises by a professional will hope to ensure the prevention of an exacerbation.

At WillKin, there was a demonstration of a program, PF ConnEx. It was a 10-week exercise and lifestyle education program for people living with Pulmonary Fibrosis. Led by WillKin’s specialist and experienced kinesiologists. This program showed some positive results in leg strength and mental health, read more on the report here.

Interested in joining?

Please reach out to julie@willkin.ca

References:

1. 1. Hopkins RB, Burke N, Fell C, Dion G, Kolb M. Epidemiology and survival of idiopathic pulmonary fibrosis from national data in Canada. European Respiratory Journal, 2016;48(1):187-195.
   2. Raghu G, Collard HR, Egan JJ, et al: An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med 2011;183:788–824.
   3. Vainshelboim, B., Oliveira, J., Yehoshua, L., Weiss, I., Fox, B. D., Fruchter, O., & Kramer, M. R. (2014). Exercise Training-Based Pulmonary Rehabilitation Program Is Clinically Beneficial for Idiopathic Pulmonary Fibrosis. Respiration, 88(5), 378-388. doi:10.1159/000367899
   4. Hanada, M., Kasawara, K., Mathur, S., Rozenberg, D., Kozu, R., Hassan, S., & Reid, W. (2020). Aerobic and breathing exercises improve dyspnea, exercise capacity and quality of life in idiopathic pulmonary fibrosis patients: Systematic review and meta-analysis. Journal of Thoracic Disease, 12(3). doi:10.21037/jtd.2019.12.27
   5. Dowman LM, McDonald CF, Hill CJ, et al. The evidence of benefits of exercise training in interstitial lung disease: a randomised controlled trial.Thorax 2017;72:610-619
   6. Vainshelboim B. Exercise training in idiopathic pulmonary fibrosis: is it of benefit? Breathe 2016; 12: 130–138.
   7. Langer D: Rehabilitation in Patients before and after Lung Transplantation. Respiration 2015;89:353-362. doi: 10.1159/000430451
   8. Ghanem M, Elaal EA, Mehany M, Tolba K. Home-based pulmonary rehabilitation program: Effect on exercise tolerance and quality of life in chronic obstructive pulmonary disease patients. Ann Thorac Med. 2010 Jan;5(1):18-25. doi: 10.4103/1817-1737.58955. PMID: 20351956; PMCID: PMC2841804.