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How to Exercise With Idiopathic Pulmonary Fibrosis
When you have idiopathic pulmonary fibrosis (IPF), shortness of breath, chronic fatigue, and a nagging, dry cough can make exercise feel uncomfortable and even seem intimidating for some.
However, not getting enough physical activity can lead to deconditioning, or a gradual loss of muscle strength and stamina, says Ali Khawaja, MD, a pulmonologist and an assistant professor of critical care and pulmonology at UTHealth Houston. Regular exercise, he adds, can keep the body strong, improve endurance, and reduce breathlessness. It can also support better sleep and mood, and help you maintain your independence.
Knowing the best types of exercise for people with IPF can help you enjoy your workouts and stay healthy and safe. Be sure to check with your doctor before starting a new exercise regimen, especially if you haven't been physically active in a while.
Types of Exercise and Movement for IPF
Your symptoms and overall health can help you determine the best exercise choices for you when you have IPF, but there aren't many activities that are completely off-limits, says Amy Hajari Case, MD, the chief medical officer for the Pulmonary Fibrosis Foundation and the director of the interstitial lung disease program and pulmonary and critical care research department at Piedmont Healthcare in Atlanta. Types of exercises you may want to consider include the following.
Pulmonary Rehabilitation
Your healthcare team may recommend pulmonary rehabilitation (or "pulmonary rehab" for short) after an IPF diagnosis or if your symptoms are worsening. In fact, pulmonary rehab is considered standard of care for IPF, says Karyi Coyle, MD, director of outpatient pulmonary practice at Westchester Medical Center Health Network and assistant professor of medicine at New York Medical College in New York.
In pulmonary rehab, trained healthcare professionals guide you through personalized, supervised aerobic and strength exercises, while teaching breathing techniques, oxygen use, and nutrition and medication management. You'll learn how to be more active without getting short of breath and build a safe exercise routine that you can continue on your own, says Dr. Coyle.
Michael Marsh, MD, a pulmonologist specializing in chest and lung conditions at Jupiter Medical Center in Jupiter, Florida, agrees that pulmonary rehab is one of the most effective tools and often the best starting point for IPF patients. "I find that it also helps reduce anxiety around the diagnosis by building confidence," he says.
If you prefer working with a private trainer, Dr. Marsh recommends choosing a physical therapist or trainer experienced in chronic lung conditions who can also coordinate with your medical team. But before seeking this out, discuss it with your pulmonologist.
Aerobic Exercises
Aerobic exercise, or "cardio," is a type of physical activity that helps keep your heart and muscles working efficiently and can also boost endurance.
A small study in the United Kingdom of 15 people with IPF found that those who followed a 40-minute aerobic interval training program twice a week for eight weeks improved their endurance by the end of the program.
With IPF, the focus should be on low-intensity aerobic activity that gently raises your heart rate while avoiding significant breathlessness, says Coyle. Aim for three to five days per week, working toward 20 to 60 minutes per session at an intensity where it's challenging enough but not so hard that you can't catch your breath. Start with shorter sessions and build gradually from there, says Coyle, who shares the following aerobic exercise options for people with IPF:
- Walk at a slow, steady pace, either outdoors or on a treadmill
- Cycle on a stationary or recumbent bike
- Use an upper-body cycle (a machine you pedal with your arms)
- March in place while standing or seated, with arm swings to build endurance
- Perform half jacks (a lower-impact version of a jumping jack, done by tapping one foot out to the side at a time while bringing one or both arms up to shoulder height)
- Try step-ups (stepping up and down a bottom stair repeatedly) while holding a handrail for support
Many people with IPF also enjoy activities like pickleball, tennis, or swimming, Dr. Hajari Case says.
Strength Training
The stronger your muscles are, the less oxygen they need to move your body, which can help take some of the strain off your lungs, says Coyle. For that reason, strength training is an important part of exercising with IPF, as it helps you build muscle and use oxygen more efficiently.
For most healthy adults, strength training is recommended at least two days per week. With IPF, the goal is to start where you are, build gradually, and keep your routine well-rounded, says Hajari Case. And you don't have to lift heavy weights, either. "Light weights and resistance bands are often a great place to start, especially for the upper body and core," she adds.
Coyle recommends using a weight you can lift about eight to 12 times with good form, where the last few repetitions feel challenging but still manageable. Start with one set of each exercise and gradually work up to two or three sets as your strength improves. Focus on your breathing throughout, exhaling as you lift and inhaling as you lower, and use supplemental oxygen if prescribed, she says.
If you're new to strength training, a supervised setting, like pulmonary rehab, can help you learn how to pace yourself safely.
Stretching
Stretching helps reduce tightness around the rib cage and improve flexibility to make breathing a little easier, says Coyle.
One type of stretching to try if you have IPF is the doorway stretch, says Coyle, as it can help open the chest. To do it, stand in a doorway with your arms at shoulder height on the frame, then gently lean forward until you feel a stretch across your chest, she explains.
Seated options include shoulder rolls, a side stretch where you raise one arm overhead and lean to the opposite side, and a shoulder blade squeeze where you bring your elbows back and squeeze your shoulder blades together, Coyle adds. These stretches can also help loosen the muscles around the chest and upper back for easier breathing.
Coyle recommends moving slowly and holding each stretch for about 10 to 30 seconds while continuing to breathe normally. Stop if you feel pain or discomfort, and use supplemental oxygen if prescribed.
Breathing Exercises
Breathing exercises can help manage shortness of breath, improve lung function, and, with regular practice, make breathing more efficient overall, says Charlisa Gibson, MD, an attending pulmonary and critical care physician at University of Maryland Baltimore Washington Medical Center in Glen Burnie, Maryland. These exercises can also help reduce anxiety caused by breathlessness.
To get started, get into a comfortable seated or lying position and try one of these techniques, recommended by Coyle:
- Pursed lip breathing Inhale through your nose for two seconds, then exhale slowly through pursed lips, as if blowing out a candle, for about four seconds. This helps reduce shortness of breath.
- Belly (diaphragmatic) breathing Place one hand on your chest and the other on your abdomen. Inhale deeply through your nose, letting your stomach rise, then exhale slowly through pursed lips as your abdomen falls. This helps expand your lungs to take in as much air as possible.
- Deep breathing Take slow, deep breaths in and out to gently stretch the lungs and help counteract stiffness caused by fibrosis (scarring of the lungs, which is a defining characteristic of IPF).
Try to practice these exercises two to three times a day for 5 to 10 minutes, Coyle says.
Balance Exercises
Including balance exercises in your fitness routine can help you move around safely and maintain your independence. These exercises can help improve lower-body strength, stability, and gait. Coyle suggests the following balance exercises, some of which can be done while holding onto a sturdy chair for support:
- Single-leg stance Stand behind a chair and hold the back for support. Slowly lift one foot off the ground in front of you and hold for 10 seconds, then lower it back down. Repeat on the other side, up to three times per side, as tolerated.
- Heel-to-toe walking Walk in a straight line, placing the heel of one foot directly in front of the toes of the other with each step, as if walking a tightrope. Aim for at least five steps per foot, and repeat as tolerated.
- Side leg raises Stand behind a chair and hold the back for support. Slowly lift one leg out to the side, hold for a few seconds, then lower it back down. Repeat on the other side, up to three times per side, as tolerated.
- Marching in place Standing or seated, lift your knees one at a time in a slow, controlled marching motion. Repeat for as long as it feels comfortable.
- Sit-to-stand From a seated position, slowly rise to standing, then lower yourself back down with control. Repeat three to five times, as tolerated.
How to Select and Start a Routine
The right exercise plan is one that feels doable for you and that you can keep up over time. Here are a few things to consider.
Choosing Your Workout
As you choose a workout routine, consider your current fitness level, your goals, and how you can safely work toward them, says Hajari Case. A few factors to think about, according to Dr. Khawaja, Hajari Case, and Gibson, include:
- Your current health and disease status. IPF affects everyone differently, and an appropriate exercise routine depends on your disease severity, other health conditions you may have, and your symptoms, says Khawaja. Your routine may need to be adjusted, especially if your symptoms worsen, he adds.
- Your oxygen needs. Before starting, understand your oxygen requirements at rest and during activity, says Hajari Case. Some people need supplemental oxygen depending on the type of exercise, and your care team can help determine these needs and guide you.
- Your starting point. If you haven't been active in a while, start small. Walking a few times a week is a good way to start, says Gibson, then gradually do more as you build endurance.
- What you enjoy. You're more likely to stick with an activity you enjoy, says Hajari Case. Whether it's outdoor walks, biking, or a group class, choose something you look forward to.
Getting Started
Before your first session, Coyle recommends running through the checklist below to help you stay safe:
- Talk to your healthcare team before starting any new exercise program.
- Ask your care team for the typical ranges for your vital signs (heart rate, blood pressure, and oxygen saturation). Note these numbers and monitor them before, during, and after exercise. A pulse oximeter, which measures your oxygen level and heart rate, and a home blood pressure cuff — both available at most pharmacies — can help you track these numbers.
- Understand your provider's instructions for how to use supplemental oxygen safely during activity.
- Make sure your exercise space at home has enough room to move, with nonslip floors and no tripping hazards.
- Wear comfortable, supportive athletic shoes with good cushioning.
- Exercise when someone else is at home, in case you need assistance.
- Warm up with slow movements and cool down with stretching.
- Avoid exercising in extreme heat, humidity, or poor air quality to avoid symptom exacerbation.
- Exercise at a pace where you can still hold a conversation, and if you become too short of breath, slow down and rest.
Modifications
It's normal to adjust your exercise routine when needed, says Khawaja, but stay as active as you can within your limits. This might mean moving at a slower pace, keeping sessions shorter, or breaking activity into smaller intervals with rest in between instead of exercising continuously.
Low-impact options like walking, cycling, or chair-based exercises are generally easier on the body, and incorporating pursed-lip breathing during activity can help manage breathlessness, Coyle says.
At the same time, Coyle recommends avoiding high-intensity or high-impact exercises, like jogging, which can put too much strain on your breathing.
When to Push, When to Stop
Some days will be more challenging than others. If you're more tired than usual or your breathing feels off, it's okay to shorten your exercise session, slow your pace, or choose a gentler activity, says Khawaja.
But if you experience any of the symptoms below, Gibson recommends stopping your activity immediately and contacting your care team, as they may be signs that your body is under too much stress:
- Chest pain or tightness
- Dizziness, lightheadedness, or feeling faint
- Breathlessness that feels out of proportion to your usual level of exertion
- Heart palpitations, or a feeling that your heart is racing, skipping, or beating irregularly
- Oxygen saturation that drops to 88 percent or below (monitored using a pulse oximeter) and doesn't recover with rest, even with supplemental oxygen
- New or suddenly worsening fatigue
Also, stop exercising right away if you notice blue lips or fingertips, confusion, sudden weakness, or severe coughing fits, says Khawaja, as these are signs that your body isn't getting enough oxygen. And if any of these symptoms don't improve quickly with rest, seek medical attention promptly, he adds.
Once your symptoms have improved and your care team gives you the go-ahead, start back slowly with shorter, lighter exercises before returning to your usual routine, Gibson says.
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