When a client has trouble breathing because of Chronic Obstructive Pulmonary Disease (COPD), it changes the approach to physical fitness. Armed with the physiology of respiratory dysfunction, personal trainers can safely compile a workout regimen that respects the client’s unique challenges while still enabling him to reach his goals.

For individuals living with COPD or chronic respiratory failure, the simple act of drawing in a breath requires a tremendous amount of energy.

Respiratory Care Week, traditionally celebrated in October, is a good time for personal trainers to educate themselves on breathing conditions that may hamper clients’ abilities to succeed in the gym.

Many clients come to us with a goal of improving endurance and cardiovascular health; we are well prepared to train them for the results they desire. However, while the respiratory system may go hand-in-hand with the human body’s cardiovascular function, this is not often the main focus when creating an exercise protocol.

The Physiology of Breathing

The respiratory system involves a transfer of oxygen and carbon dioxide. When we inhale, the body absorbs oxygen and releases carbon dioxide upon exhaling. The diaphragm muscle, which sits directly below the lungs, plays a key role in facilitating this process. There are 12 total torso muscles that assist with inhalation.

blowing a dandelion

Photo by Maciej Ostrowski on Unsplash

Circulating oxygen levels in individuals with COPD tend to be lower than their healthier counterparts. If the levels decrease too dramatically, the brain sends signals to the diaphragm and supporting muscles, compelling them to work harder.

Recruitment of neck and shoulder muscles typically occurs, in an attempt to coerce the lungs to perform. Thus, what many of us consider automatic can turn into an exhausting and sometimes debilitating endeavor.

Respiratory Challenges and Exercise

Carefully executed hands-on studies demonstrate evidence that exercise training improves the performance of daily activities for those with chronic pulmonary dysfunction. Experts feel that many factors contribute to these benefits, such as an uptick in aerobic capacity, and enhanced peripheral muscle function. For patients whose breathing issues necessitate hospitalization, those who have been incorporating exercise into their lives often benefit from a shorter hospital stay.

In addition to increasing aerobic capacity, individuals with chronic respiratory challenges may benefit from exercise in other ways. Ideally, over time, the heart grows stronger, thereby increasing overall circulation and even lowering blood pressure.

Patients notice that they are able to achieve a better night’s sleep; a rested body has more energy to expend the following day, which translates to less effort when moving through life’s activities.

Program Design for COPD

A triad approach has been shown to yield positive results. Such a program consists of 3 basic exercise components: stretching exercises to encourage and enhance flexibility; strengthening exercises performed with light dumbbells, specifically addressing the muscles in the upper trunk region; and aerobic exercises to improve breathing while increasing endurance of the cardiorespiratory system.

Of equal importance to knowing what to include during program design, a trainer must be keenly aware of the exercises that experts view as strongly contraindicated. Lifting very heavy weights, or pushing excessive loads, places too great a demand on compromised clients.

Similarly, push up’s and sit up’s should not be included, along with isometric exercises, which necessitate pushing force against an immovable object. Modifying strength training moves simply involves lessening the period of intensity within exercise sets.

By including moves that focus on using arm motions to opening the chest muscles, breathing will over time become less labored.

Environmental factors should also play a role when planning an outdoor workout routine. Clients who already have difficulty breathing may find the problem exacerbated in weather that is humid or excessively hot or cold. Even on a perfect autumn day, avoid taking through a circuit-training course that involves the climbing of steep hills.

Unique Skills Support a Unique Niche

Many trainers are certified in areas of expertise that do not require machines and weights. For example, the breathing techniques and slow movements taught in a Tai Chi class can help to improve a client’s posture, which is often a weakness for those living with compromised breathing issues.

Balance too seems to get easier with these movements. A major goal of many Tai Chi programs is helping an individual relax, calming his mind and restoring energy.

Aqua therapy in a warm-water pool also yields great results. If the humidity is not too much for the client, being temporarily buoyant eases the movement of limbs without placing undue strain on the respiratory system. Deep breathing exercises can be practiced in the water and can serve to improve circulation and flexibility.

The Exercise-Induced Asthma Client

In addition to COPD, other commonly experienced respiratory conditions can render exercise more of a battle than it already is for many individuals. Exercise-induced asthma, or EIA, is present in many who already suffer from asthma or bronchitis. Aside from being overweight and/or deconditioned, both of which are significant risk factors during exercise, there are a multitude of triggers that can exacerbate EIA.

Prior to embarking upon working with such an individual, the trainer should familiarize himself with the triggers that specifically affect that client. A common trigger is cold, dry air. A high pollen count, air pollution and accompanying allergies/sinus infections can easily bring on an episode of EIA, particularly during bouts of high-intensity training. Such knowledge is the trainer’s cue to begin each session with a warm-up at least 15 minutes in duration.

If a workout program includes extended cardiovascular activity, such as 10 minutes on the treadmill or stationary bike, a trainer may notice that the client shifts from normal inhalation to strictly mouth breathing. This can result in each inhaled breath consisting of drier air, in the absence of moisture provided by the nasal passages.

Despite attempting to increase the client’s endurance, this very effort may actually bring on an episode of EIA. The tried-and-true “talk test” will provide a fairly clear picture of how the client’s body is responding to the exertion. It is prudent to ask the client beforehand how you can best help him if symptoms begin or intensify.

Ways to Help This Population

Reaching out establishing connections with pulmonologists in your area can point you towards a new sales market. Share your expertise, setting the stage for potentially creating exercise programming for their patients, either at your gym or in a conference room of the medical facility. You now possess the knowledge to integrate yourself into a professional respiratory team and start improving patients’ quality of life.

Meet with your facility’s Fitness Center Director and discuss hosting an event to raise both awareness and funds for the American Respiratory Care Foundation(ARCF). Encourage your co-workers to help you support respiratory research and education for professionals and the patients they serve.

[info type=”facebook”]Join the Facebook Community Group to meet other trainers.[/info]



Cathleen Kronemer

Cathleen Kronemer is an NFPT CEC writer and a member of the NFPT Certification Council Board. Cathleen is an AFAA-Certified Group Exercise Instructor, NSCA-Certified Personal Trainer, ACE-Certified Health Coach, former competitive bodybuilder and freelance writer. She is employed at the Jewish Community Center in St. Louis, MO. Cathleen has been involved in the fitness industry for over three decades. Feel free to contact her at trainhard@kronemer.com. She welcomes your feedback and your comments!