Question: “What is an optimal way to train with a diminished lung capacity? Ex. smokers, COPD sufferers, asthmatics, or people maybe a bit hesitant to take that first step due to decreased lung function. My lung function is around 40% due to cystic fibrosis and I've struggled with finding a good answer to this, besides just training like everyone else and powering through like I do. Thanks!”
DR. NEAL: Thank you for your question. I’m sorry to hear that you have been dealing with cystic fibrosis.
I so admire that you are hoping to improve your fitness and lung function, in particular. You actually DON’T want to necessarily train like everyone else. In fact, the American College of Sports Medicine has specific training recommendations for those with decreased lung function which I will discuss.
But, before we get to that, let me reset and mention what cystic fibrosis is all about.
What is Cystic Fibrosis?
To put this very simply, a person with cystic fibrosis experiences repeated lung infections.
Think about it this way: what happens when you get a cold or the flu? Often, you get a runny nose. Or, sometimes a cough. The runny nose and, sometimes the cough, can be due to the buildup of mucus.
When your nose is filled with mucus, it makes it more difficult to breathe. When mucus is in your lungs, it can also make it difficult to breathe. You may wheeze and try and cough to rid the lungs of the mucus. But, eventually, that mucus dries up and then you feel normal again.
In those with cystic fibrosis, the body has difficulty getting rid of that mucus. So, that mucus tends to stick around. As you can imagine, this is not a good thing. You feel like you can’t breathe normally, just like when you have a cold or the flu. Plus, mucus has the tendency to hang on to harmful bacteria. This is why those with cystic fibrosis are more likely to suffer from chronic infections.
We’re also learning that this buildup of mucus may prevent the pancreas from working properly. This can then affect how the body absorbs nutrients.
Are there any Cures for Cystic Fibrosis?
At this point, you may be wondering, “Is there a way to prevent cystic fibrosis?”
On this podcast, I often talk about diseases that are preventable.
In this case, cystic fibrosis is kind of an exception. Rather than being related to lifestyle behaviors, like consuming a diet that’s low in nutrients, not exercising regularly, not managing stress and so on, it is believed that cystic fibrosis is mainly caused by genetics. So, if a blood relative has it, then you’re more likely to get it.
When it comes to treatments, there are some available, but unfortunately there is no cure for cystic fibrosis at this time.
I’m keeping my fingers crossed that we see a cure within our lifetimes.
Tips for Exercising with Cystic Fibrosis
So the good news for the listener who asked today's question is that you are well enough to stay active.
As I mentioned, the American College of Sports Medicine has some specific suggestions for those with any form of lung dysfunction, even those with asthma, chronic bronchitis, emphysema [both of which are types of chronic obstructive pulmonary disease (or, COPD)], and of course, cystic fibrosis.
The first step is to be sure you discuss anything and everything with your pulmonologist. They need to carefully monitor your progress and be sure that the benefits are outweighing any risks to your health. Once you’ve done that, here are the overarching goals we hope to achieve through exercise:
- Increase your endurance while maintaining the health of your lungs
- Increase your ability to breathe normally
- Strengthen the muscles that support your ability to breathe normally, like the intercostal muscles
How do we meet these goals? Here’s what ACSM recommends.
First, cardio: any type of cardio you prefer and that your body can tolerate is fine. Your pulmonologist may recommend you keep some supplemental oxygen around, so again, it’s good to speak with them first.
If you like to jog or run, go for it. If you like to go for a bike ride, enjoy. If you like to swim, that’s fine, too. But, when it comes to swimming, we’re learning that chlorinated pools may aggravate lung conditions. The chlorine gas may irritate the airways. So, if you prefer to go for a swim, do so in non-chlorinated pools.
Aim to incorporate cardio 3-5 days per week. When it comes to the duration of your workout, because each person’s lung capacity varies, you and your doctor will need to determine what’s best for you. But, ACSM recommends you build up to 60-90 minutes of low-intensity cardio 3-5 days per week.
As an example, let’s say you are able to walk for 10 minutes. But, around the 15-minute mark, you start to feel uncomfortable. What you can do is rest after those 15 minutes and when you start to feel good again, try and walk for another 15 minutes. So, you can break up the workout into lower intensity intervals. Again, the goal is to slowly build up your stamina so that you can walk (or jog, or bicycle, etc.) for at least 60 minutes. Slow and steady progress are the keys to success here. No need to overdo it.
Next, resistance training. If you’re new to this, ACSM recommends the following:
- Aim for 2-3 days per week, with at least 1 day of rest in between.
- Think about working all of the major muscle groups. So, instead of just focusing on arms or chest and calling it a day, think about working the legs, arms, chest, back, and shoulders during the workout.
- Start with lighter weights. The weights should be light enough so that you can lift them 10-12 times without stopping. Then, repeat the exercise 2-3 more times with the goal of performing 10-12 repetitions each time. If you’re more experienced, or the weight feels too light, you can increase the weight so that you can perform anywhere from 6-10 repetitions. Repeat this movement 1-3 times with rest in between.
- So, here’s what it might look like. Say, you’re performing a shoulder press. What you would do is find a weight that you can lift 10 times. You would then perform the movement, ideally, without stopping. (If you need to stop, please do!) Then, you would rest. After the rest, you pick up those weights and perform another set of shoulder presses with the goal of lifting the weights another 10 times. Now, you would rest again. After the rest period, you could choose to perform 1 more set of 10 repetitions or move on to another body part and repeat these same steps.
- How long should you rest in between sets? After you’ve performed your 10-12 repetitions (or 6-10 repetitions if you’re feeling strong), rest for at least 2-3 minutes before repeating the exercise.
Again, the key to success is to progress slowly. It’s better to underestimate your strength and stamina than go all out and hurt yourself. Actually, this is great advice for anyone, even the most experienced of gym rats.
I wish you all continued success.