Exercise and Pulmonary Hypertension
If you’ve searched the Internet for advice about exercising and pulmonary hypertension, you probably have not found much. There is a very simple reason for this. There is no such thing as a standard PH patient and therefore no “one size fits all” exercise plan appropriate for everyone.
In general, gentle or moderate regular exercise for stable PH patients is beneficial to everyone, including those with severe pulmonary hypertension. Toned muscles utilize oxygen more efficiently than flabby muscles. Also, prolonged periods of inactivity can lead to depression. But perhaps the most compelling reason for people with PH to adopt a regular exercise program is an expected improvement in their PH symptoms.
Before you jump on that treadmill, you do need to discuss your activities with your physician BEFORE you begin a program. You should not be exercising if you are a new PH patient with a disease that is not yet stable and/or controlled.
In their article Exercise Training in Pulmonary Hypertension - Implications for the Evaluation of Drug Trials, John H. Newman, MD and Ivan M. Robbins, MD of Vanderbilt University describe their findings in a study to compare the benefits of a carefully monitored exercise program with that of various PH medications for a group of thirty patients. The findings of the study were surprising. The authors summarize it this way, “This is an important study that shows that exercise training can have an impact on short-term functioning and well-being in selected patients with PH that is equal to the best current drug therapies.”
If you’ve searched the Internet for advice about exercising and pulmonary hypertension, you probably have not found much. There is a very simple reason for this. There is no such thing as a standard PH patient and therefore no “one size fits all” exercise plan appropriate for everyone.
In general, gentle or moderate regular exercise for stable PH patients is beneficial to everyone, including those with severe pulmonary hypertension. Toned muscles utilize oxygen more efficiently than flabby muscles. Also, prolonged periods of inactivity can lead to depression. But perhaps the most compelling reason for people with PH to adopt a regular exercise program is an expected improvement in their PH symptoms.
Before you jump on that treadmill, you do need to discuss your activities with your physician BEFORE you begin a program. You should not be exercising if you are a new PH patient with a disease that is not yet stable and/or controlled.
In their article Exercise Training in Pulmonary Hypertension - Implications for the Evaluation of Drug Trials, John H. Newman, MD and Ivan M. Robbins, MD of Vanderbilt University describe their findings in a study to compare the benefits of a carefully monitored exercise program with that of various PH medications for a group of thirty patients. The findings of the study were surprising. The authors summarize it this way, “This is an important study that shows that exercise training can have an impact on short-term functioning and well-being in selected patients with PH that is equal to the best current drug therapies.”
Exercise Induced Pulmonary Hypertension
Exercise stress tests of the pulmonary circulation show promise for the detection of early or latent pulmonary vascular disease and may help us understand the clinical evolution and effects of treatments in patients with established disease.
Exercise stresses the pulmonary circulation through increases in cardiac output and left atrial pressure. Recent studies have shown that exercise-induced increase in pulmonary artery pressure is associated with dyspnea-fatigue symptomatology, validating the notion of exercise-induced pulmonary hypertension.
Exercise in established pulmonary hypertension has no diagnostic relevance, but may help in the understanding of changes in functional state and the effects of therapies.
Exercise stresses the pulmonary circulation through increases in cardiac output and left atrial pressure. Recent studies have shown that exercise-induced increase in pulmonary artery pressure is associated with dyspnea-fatigue symptomatology, validating the notion of exercise-induced pulmonary hypertension.
Exercise in established pulmonary hypertension has no diagnostic relevance, but may help in the understanding of changes in functional state and the effects of therapies.
News on Exercise and Pulmonary Hypertension
Discover 9 tips for exercising with pulmonary hypertension Click
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Here are a few tips to ensure your safety and a positive outcome in getting off that couch:
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- Don’t push yourself too hard. You never want to exercise to the point where you are too short of breath to speak, experience chest pain, or feel light-headed or dizzy.
- Don’t be alone when you are getting started in your training program. It’s best to begin to exercise in a clinical setting where you can be monitored closely, but if that is not practical, make sure someone is with you ( e.g.. a family member or friend) when you are getting started.
- Avoid exercising out-of-doors if the temperature is either too hot or too cold.
- Stop exercising immediately if you begin to feel unwell.
- If you have a pulse oximeter for home use, test yourself often. Choose a pace that keeps your blood saturation in the 90’s.
Your plan does not have to be elaborate. Anything you do to get moving is a good thing. Maybe just walking the aisles of your favorite market several times a week instead of taking the store’s scooter would be a good way to begin.
As the study cited above shows, exercise can be as effective as a drug and think about this: there is no co-pay either. For Further Reading: The Best Yoga Exercises for Pulmonary Hypertension (Source: Mayo Clinic)
As the study cited above shows, exercise can be as effective as a drug and think about this: there is no co-pay either. For Further Reading: The Best Yoga Exercises for Pulmonary Hypertension (Source: Mayo Clinic)
Introduction to YOGA for PH Patients Click Here
Breathe Better with Improved Diagnostics for Pulmonary Hypertension
In this video from 2015, watch Dr. Franz Rischard as he explains how pulmonary hypertension can be hard to diagnose, but Banner University Medical Center has a unique and specific diagnostic test which can help give an accurate diagnosis at an earlier stage.
Pulmonary Hypertension: How to Increase Your Lung Capacity
In this video from 2013, by David Benjamin, learn how you can increase your lung capacity “by playing a wind instrument, breathing in through a bamboo straw, or breathing exercises.”
In this video from 2013, by David Benjamin, learn how you can increase your lung capacity “by playing a wind instrument, breathing in through a bamboo straw, or breathing exercises.”
Pulmonary Hypertension: Safe Exercises for Lung Disease Patients
Meet Dr. Jack Coleman, Jr., M.D., a Lung Institute physician, discussing the importance of exercising for people with lung diseases, on Dr. Michael Smith’s RadioMD show, Healthy Talk. The video is from Lung Institute, where Dr. Coleman is the director.
Meet Dr. Jack Coleman, Jr., M.D., a Lung Institute physician, discussing the importance of exercising for people with lung diseases, on Dr. Michael Smith’s RadioMD show, Healthy Talk. The video is from Lung Institute, where Dr. Coleman is the director.
Pulmonary hypertension (PH) is a chronic, heart and lung condition that increases the blood pressure in the pulmonary arteries, causing shortness of breath, dizziness, and chest pain among other symptoms.
Did you know that after the age of 35 we lessen the signal between the diaphragm and our brain? This “loss of connection” does not allow the diaphragm at its maximum efficiency and our breathing becomes more difficult. Because of that, as the years go by, we become weaker and our lung capacity also becomes weaker. This is especially worrying for pulmonary hypertension patients.
One of the most concerning symptoms of pulmonary hypertension is shortness of breath. Patients who suffer from PH have a very difficult time breathing. To improve their lung capacity and help them breathe a little bit better, there are several exercises that they could try.
In this video, shared by motivationaldoc, listen to Dr. Mandell as he explains how to improve your breathing with some belly breathing exercises to strengthen the lungs. Belly breathing refers to breathing that uses the diaphragm, allowing maximum intake of oxygen into the body for use in the heart and lungs.
Here are some tips on how to manage your shortness of breath.
Did you know that after the age of 35 we lessen the signal between the diaphragm and our brain? This “loss of connection” does not allow the diaphragm at its maximum efficiency and our breathing becomes more difficult. Because of that, as the years go by, we become weaker and our lung capacity also becomes weaker. This is especially worrying for pulmonary hypertension patients.
One of the most concerning symptoms of pulmonary hypertension is shortness of breath. Patients who suffer from PH have a very difficult time breathing. To improve their lung capacity and help them breathe a little bit better, there are several exercises that they could try.
In this video, shared by motivationaldoc, listen to Dr. Mandell as he explains how to improve your breathing with some belly breathing exercises to strengthen the lungs. Belly breathing refers to breathing that uses the diaphragm, allowing maximum intake of oxygen into the body for use in the heart and lungs.
Here are some tips on how to manage your shortness of breath.
8 RED FLAGS TO pulmonary hypertension...
Unfortunately, pulmonary hypertension symptoms are generally not apparent early on in the onset of the disease, and this may be the case for years to come.
However, as PH progresses, signs and symptoms of the disease will become apparent. Check out this list we’ve put together to discover more about eight red flag pulmonary hypertension symptoms you should be aware of:
1. Fatigue, which may be due to poorly oxygenated blood You’ll probably become more tired than you used to be before you had pulmonary hypertension in your life.
2. You may experience shortness of breath. Shortness of breath will be one of your pulmonary hypertension symptoms and in the early phase, this may only occur when you’re exercising, but later will progress and become apparent when you are resting also.
3. You may experience pain or perhaps pressure in the chest area You will, literally, feel under pressure.
Unfortunately, pulmonary hypertension symptoms are generally not apparent early on in the onset of the disease, and this may be the case for years to come.
However, as PH progresses, signs and symptoms of the disease will become apparent. Check out this list we’ve put together to discover more about eight red flag pulmonary hypertension symptoms you should be aware of:
1. Fatigue, which may be due to poorly oxygenated blood You’ll probably become more tired than you used to be before you had pulmonary hypertension in your life.
2. You may experience shortness of breath. Shortness of breath will be one of your pulmonary hypertension symptoms and in the early phase, this may only occur when you’re exercising, but later will progress and become apparent when you are resting also.
3. You may experience pain or perhaps pressure in the chest area You will, literally, feel under pressure.
Fast heart beat or skipped beats
4. Your heart will beat faster than it usually would and this is a sign that maybe something is not quite right.
5. You may feel faint or dizzy, which is known as syncope Hang in there, because dizziness will be happening.
6. Your lips or skin may turn blue, this is referred to as cyanosis This will happen because you’ll have a lack of oxygen in the blood – that’s what cyanosis means.
7. Swelling in your legs and ankles or feet also known as edema Brace yourself – swelling is coming.
8. Internal lung bleeding and coughing up blood (hemoptysis) Bleeding internally, specifically in your lungs will probably occur. You maybe coughing up some blood – this is called hemoptysis.
4. Your heart will beat faster than it usually would and this is a sign that maybe something is not quite right.
5. You may feel faint or dizzy, which is known as syncope Hang in there, because dizziness will be happening.
6. Your lips or skin may turn blue, this is referred to as cyanosis This will happen because you’ll have a lack of oxygen in the blood – that’s what cyanosis means.
7. Swelling in your legs and ankles or feet also known as edema Brace yourself – swelling is coming.
8. Internal lung bleeding and coughing up blood (hemoptysis) Bleeding internally, specifically in your lungs will probably occur. You maybe coughing up some blood – this is called hemoptysis.
In this video from khan academy medicine, learn more about the process of inhaling and exhaling, and how breathing works.
Iyengar Yoga (IY) may be able to increase the quality of life in patients who suffer from pulmonary arterial hypertension (PAH). This conclusion is from a research team at the universities of Calgary and Alberta in Canada, and was recently presented at the 36th Annual International Society for Heart and Lung Transplantation (ISHLT) Meeting & Scientific Sessions.
Investigators from the Canadian universities tested the effects of Iyengar Yoga on patients at different stages of PAH to evaluate the benefits of two-hour sessions of the exercise.
Iyengar Yoga is a type of yoga that is tailored for each individual’s needs. Volunteers in the study underwent yoga classes over the course of 12 weeks. The investigation was focused on the effects of yoga on improvements in the quality of life of PAH patients, especially anxiety and depression.
“This study provides evidence that alternative therapies such as Iyengar Yoga may be effective in improving the quality of life for a patient suffering from PAH,” said Andrew Fisher, FRCP, Ph.D., 2016 ISHLT meeting and scientific session program chair, in a press release.
Investigators from the Canadian universities tested the effects of Iyengar Yoga on patients at different stages of PAH to evaluate the benefits of two-hour sessions of the exercise.
Iyengar Yoga is a type of yoga that is tailored for each individual’s needs. Volunteers in the study underwent yoga classes over the course of 12 weeks. The investigation was focused on the effects of yoga on improvements in the quality of life of PAH patients, especially anxiety and depression.
“This study provides evidence that alternative therapies such as Iyengar Yoga may be effective in improving the quality of life for a patient suffering from PAH,” said Andrew Fisher, FRCP, Ph.D., 2016 ISHLT meeting and scientific session program chair, in a press release.
“A highlight in the findings is that this therapy did not result in adverse side effects to the patient, which is promising as a supportive approach for PAH patients.”
The research included 48 volunteers who were diagnosed with PAH at different levels. Their health was evaluated based on the Hospital Anxiety and Depression Scale (HADS), Chronic Respiratory Questionnaire (CRQ), and a 6-minute walk test.
The study revealed that Iyengar Yoga is able to decrease levels of anxiety and depression without side effects. The HADS-anxiety score decreased by 2.25 from the baseline of 6.97 and HADS-depression decreased by 2.78 from the baseline score of 7.81.
Investigators believe this will encourage the adoption of this alternative therapy into the management of PAH patients as well as patients with other chronic lung conditions.
Iyengar Yoga is an original type of yoga created by the Indian guru B.K.S. Iyengar, who is also credited for bringing yoga to the western world. Iyengar Yoga is characterized by the use of props during the sessions, as well as by the importance of alignment.
“Yoga is for everyone. No one is too old or too stiff, too fat or thin or tired. A certified Iyengar Yoga teacher can guide students of all ages and physical conditions to an experience of yoga which is safe, accessible, and rewarding,” according to the Iyengar Yoga National Association of the United States.
“Iyengar Yoga teachers modify the classic asanas (yoga postures) for individual students with the use of props — such as blocks, blankets and belts. Props allow for a deeper penetration into the posture, as well as a longer stay,” the association added.
The research included 48 volunteers who were diagnosed with PAH at different levels. Their health was evaluated based on the Hospital Anxiety and Depression Scale (HADS), Chronic Respiratory Questionnaire (CRQ), and a 6-minute walk test.
The study revealed that Iyengar Yoga is able to decrease levels of anxiety and depression without side effects. The HADS-anxiety score decreased by 2.25 from the baseline of 6.97 and HADS-depression decreased by 2.78 from the baseline score of 7.81.
Investigators believe this will encourage the adoption of this alternative therapy into the management of PAH patients as well as patients with other chronic lung conditions.
Iyengar Yoga is an original type of yoga created by the Indian guru B.K.S. Iyengar, who is also credited for bringing yoga to the western world. Iyengar Yoga is characterized by the use of props during the sessions, as well as by the importance of alignment.
“Yoga is for everyone. No one is too old or too stiff, too fat or thin or tired. A certified Iyengar Yoga teacher can guide students of all ages and physical conditions to an experience of yoga which is safe, accessible, and rewarding,” according to the Iyengar Yoga National Association of the United States.
“Iyengar Yoga teachers modify the classic asanas (yoga postures) for individual students with the use of props — such as blocks, blankets and belts. Props allow for a deeper penetration into the posture, as well as a longer stay,” the association added.
Breathing techniques and exercises for people living with pulmonary disease
Source: FSH Physiotherapy Dept WA Govt
Source: FSH Physiotherapy Dept WA Govt
Pursed lip breathing
Pursed lip breathing is a simple way to help control shortness of breath. It provides a quick and easy way to slow your pace of breathing, making each breath more effective.
What does pursed lip breathing do?
Pursed lip breathing:
- Improves ventilation
- Releases trapped air in the lungs
- Keeps the airways open longer and decreases the work of breathing
- Prolongs exhalation to slow the breathing rate
- Improves breathing patterns by moving old air out of the lungs and allowing for new air to enter the lungs
- Relieves shortness of breath
- Causes general relaxation
When should I use this technique?
Initially it will be beneficial to practice this technique 4-5 times per day so you can get used to the technique. If you can master the technique, you may try the technique during difficult activities such as bending, lifting or stair climbing. You can also try it if you are becoming anxious.
Acknowledgement: Cleveland Clinic Health System - Sourced from FSH produced by the Government of WA Dept Health.
Controlled Breathing
The diaphragm is the most efficient muscle for breathing. It is a large, dome-shaped muscle located at the base of the lungs. Your abdominal muscles help move the diaphragm and give your more power to empty your lungs. But chronic obstructive pulmonary disease and other respiratory conditions (like PH) may prevent the diaphragm from working effectively.
When you have pulmonary disease, air often becomes trapped in the lungs, pushing down on the diaphragm. The neck and chest muscles must then assume an increased share of the work of breathing. This can leave the diaphragm weakened and flattened, causing it to work less efficiently. It also means that the neck and chest muscles become more tense from working hard all of the time.
Pursed Lip Breathing Technique
- Relax your neck and shoulder muscles.
- Breath in (inhale) slowly through your nose for two counts, keeping your mouth closed. Don't take a deep breath; a normal breath will do. It may help to count to yourself: inhale, one, two.
- Pucker or "purse" your lips as if you were going to whistle or gently flicker the flame of a candle.
- Breathe out (exhale) slowly and gently through your pursed lips while counting to four. It may help to count to yourself: exhale, one, two, three, four.
Controlled breathing is intended to help you use the diaphragm correctly to:
- Strengthen the diaphragm
- Decrease the intensity of breathing by slowing your breathing rate
- Decrease oxygen demand
- Use less effort and energy to breathe
- Give the neck and chest muscles an opportunity to relax
Controlled breathing technique
At first, you may find it difficult to use this technique. It is important that you practice it a few times before you determine whether it will help you or not. While you are practicing it is important that you:
Controlled breathing in the lying position
When you first learn the diaphragmatic breathing technique, it may be easier for you to follow the instructions lying down.
As you become more familiar with the practice, you can try the controlled breathing technique while sitting in a chair.
To perform this exercise while sitting in a chair:
NOTE: You may notice an increased effort will be needed to use the diaphragm correctly. At first you'll probably get tired while doing this exercise. But keep persisting with it, because with continued practice, controlled breathing will become easy and automatic.
How often should I practice this technique?
At first, practice this exercise for 5-10 minutes around 3-4 times per day. Gradually increase the amount of time you spend doing this exercise. When you feel that you are able to control your breathing quite well, you should notice your shoulders and neck becoming more relaxed. And the feeling of breathlessness may be reduced. If you feel these benefits, try to use this technique while you are feeling breathless. You can try to use this controlled breathing in any position, although it may take a bit of practice.
Acknowledgment Fremantle Hospital Health Service Physiotherapy Dept.
Controlled breathing technique
At first, you may find it difficult to use this technique. It is important that you practice it a few times before you determine whether it will help you or not. While you are practicing it is important that you:
- Place yourself in a comfortable position
- Practice the technique when you are not too breathless, busy or anxious
- Are patient
Controlled breathing in the lying position
When you first learn the diaphragmatic breathing technique, it may be easier for you to follow the instructions lying down.
- On a flat surface or in bed, lie on your back with your knees bent and your head supported. You can use a pillow under your knees to support your legs and another under your head. Place one hand on your upper chest and the other just below your rib cage. This will allow you to feel your diaphragm move as you breathe.
- Breathe in slowly through your nose so that your stomach moves out against your hand. The hand on your chest should remain as still as possible.
- Tighten your stomach muscles, letting them fall inward as you exhale through pursed lips (see pursed lip breathing technique, previous page). The hand on your upper chest must remain as still as possible.
As you become more familiar with the practice, you can try the controlled breathing technique while sitting in a chair.
To perform this exercise while sitting in a chair:
- Sit comfortably with your knees bent and your shoulders, head and neck relaxed.
- Place one hand on your upper chest and the other just below your rib cage. This will allow you to feel your diaphragm move as you breathe.
- Tighten your stomach muscles, letting them fall inward as your exhale through pursed lips (see pursed lip breathing technique on previous page). The hand on your upper chest must remain as still as possible.
NOTE: You may notice an increased effort will be needed to use the diaphragm correctly. At first you'll probably get tired while doing this exercise. But keep persisting with it, because with continued practice, controlled breathing will become easy and automatic.
How often should I practice this technique?
At first, practice this exercise for 5-10 minutes around 3-4 times per day. Gradually increase the amount of time you spend doing this exercise. When you feel that you are able to control your breathing quite well, you should notice your shoulders and neck becoming more relaxed. And the feeling of breathlessness may be reduced. If you feel these benefits, try to use this technique while you are feeling breathless. You can try to use this controlled breathing in any position, although it may take a bit of practice.
Acknowledgment Fremantle Hospital Health Service Physiotherapy Dept.
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Positions to reduce shortness of breath
In conjunction with pursed lip breathing and controlled breathing, you can use these breathing positions to help you reduce shortness of breath.
These positions are helpful when you have shortness of breath during activity, emotional excitement, exposure to adverse weather conditions or when you feel tense and need to relax.
Sitting
OR
In conjunction with pursed lip breathing and controlled breathing, you can use these breathing positions to help you reduce shortness of breath.
These positions are helpful when you have shortness of breath during activity, emotional excitement, exposure to adverse weather conditions or when you feel tense and need to relax.
Sitting
- Sit in a chair
- Rest your feet flat on the floor
- Lean your chest forward slightly
- Rest your elbows on your knees or rest your chin on your hands
- Relax your neck and shoulder muscles
OR
- Sit in a chair at the dining table
- Rest your feet flat on the floor
- Rest your arms on a table
- Rest your head on your forearms or on some pillows
Standing
OR
Sleeping
OR
- Stand in front of the wall facing outward
- Stand with your feet shoulder width apart
- Lean your hips against the wall
- Rest your hands on your thighs
- Relax your shoulders, lean forward slightly and dangle your arms in front of you
OR
- Lean up against the dining table/desk
- Rest your hands on the furniture, just below shoulder height
- Relax your neck, resting your head on your forearms
- Relax your shoulders
Sleeping
- Lie on your side with a pillow between your legs and your head elevated with pillows. Keep your back straight.
OR
- Lie on your back with your head elevated by a pillow and your knees bent, with a pillow under your knees.
