Pulmonary Rehabilitation Exercises at Home

Is exercise safe for my parent?

For most people with stable chronic lung disease, regular exercise is beneficial and safe. But check first with the doctor, especially if your parent:

• Has had a recent flare-up, hospital stay or chest infection.
• Has heart disease, high blood pressure that is not controlled, an irregular heartbeat or chest pain on effort.
• Uses home oxygen; the doctor must say whether to use it during exercise and at what flow.
• Has dizziness, fainting, joint or back problems, or a history of falls.
• Has diabetes and takes medicines that can cause low sugar.
• Has severe osteoporosis; see exercise for osteoporosis.

Do not start exercise during a flare-up, with fever or if breathlessness is worse than usual. Wait until the doctor says it is safe.

Principles

• Start low, go slow. Begin with a few minutes and build up over weeks.
• Aim for "somewhat hard" breathlessness, a level where your parent can still speak in short sentences. A simple 0 to 10 scale helps: 0 is no breathlessness and 10 is the worst. Aim for about 3 to 4 (moderate), and stop at 5 to 6 or higher.
• Pace and rest. Rest before breathlessness becomes severe, and recover fully before the next effort.
• Be regular. Little and often beats a big effort once a week.
• Use breathing control during all exercise: breathe out on the effort, use pursed lips, never hold the breath.
• Take medicines first. If the doctor has prescribed a reliever inhaler before exercise, use it as advised. Do not take extra doses on your own.
• Use oxygen as prescribed. If your parent is on oxygen, ask whether to use it during exercise, and which flow. Never change the flow yourself. See oxygen flow rates and prescriptions: what families should know and portable oxygen concentrators: travel and daily use. Keep tubing from tripping.
• Choose a safe place and time: a stable, non-slip floor, good lighting, a sturdy chair, a cool, ventilated room, and the cleanest air of the day; avoid exercising outdoors on Poor air days; see a pollution season plan for older adults and exercise in summer and monsoon indoors.
• Wear comfortable clothing and non-slip footwear.
• Have a helper nearby at the start, and keep a phone within reach.

Using an oximeter

If the doctor has advised, an oximeter can guard against low oxygen during activity. Agree in advance on a lowest safe reading, which differs by person and which the doctor sets; some people with COPD have a target range around 88 to 92 per cent. If the reading falls below the number the doctor gave, stop, rest, sit upright and breathe slowly; if it does not recover, call the doctor, and call 112 if your parent is distressed. Readings during exercise can be unreliable with moving hands and cold fingers; see pulse oximeters: how they work and how to use one and pulse oximeter accuracy. Symptoms matter more than the number.

A sample session (about 20 to 30 minutes)

Adapt this with a physiotherapist. Rest as needed between items.

### 1. Warm-up (5 minutes), seated in a firm chair with arms

• Breathing control: sit tall, shoulders relaxed. Breathe in through the nose for two counts and out through pursed lips for four, for about one minute.
• Shoulder rolls: roll the shoulders backwards ten times, slowly.
• Ankle circles and marching on the spot: lift each foot a little while seated, ten times each side.
• Arm swings: gently swing the arms forward and back.

### 2. Strength and mobility (10 to 15 minutes)

Do each for 8 to 10 repetitions, once or twice through, with rests. Breathe out on the effort.

• Sit to stand: from a chair with arms, stand up slowly, using the hands if needed, then sit down slowly. Builds leg strength for daily life.
• Heel raises: holding a counter, rise onto the toes and lower.
• Seated knee extensions: straighten one leg, hold for a moment, lower; alternate.
• Wall push-ups: stand an arm's length from a wall, push the chest towards the wall and back.
• Arm raises: raise both arms forward to shoulder height (or as high as comfortable) with light weights, such as small water bottles or tins if the physiotherapist agrees, and lower slowly.
• Biceps curls with light weights.
• Side steps holding a counter.

For a wider range of safe exercises, see chair exercises for seniors, strength after 60: how much is enough and resistance band routine for seniors.

### 3. Walking (5 to 20 minutes, built up gradually)

• Walk indoors, on a corridor or a safe, flat route. Start with two to five minutes, with rests, once or twice a day.
• Walk at a pace where you can talk in short sentences.
• Add one to two minutes every few days if the previous level feels comfortable.
• If your parent uses a walking aid, a rollator with a seat can help; see walking programme for older adults.
• If using oxygen, take the portable supply, with enough for the walk plus a margin. Carry a reliever inhaler and a phone.
• Break the walk with short rests, using pursed-lip breathing, and avoid cold, windy or polluted conditions.
• A stationary or pedal exerciser at home is an option; see pedal exerciser guide.

### 4. Cool-down (3 to 5 minutes)

• Sit and breathe slowly with pursed lips.
• Gentle stretches of the arms, shoulders, neck and legs; see stretching for stiff older bodies.
• Sip water, unless restricted.

Breathing exercises through the day

• Pursed-lip breathing, as above, during exertion and when breathless.
• Diaphragmatic breathing, for a few minutes twice a day when calm, if the physiotherapist agrees.
• Positions of ease for recovery; see breathlessness: positions and breathing techniques that help.
• Airway clearance techniques if there is a lot of sputum: the physiotherapist may teach the active cycle of breathing or other methods. Do not use steam or home tricks; see steam inhalation: benefits, burns and safer habits.
• Singing, humming and playing a wind instrument can be enjoyable breath training, if comfortable.

How often and how much

A usual target is some activity on most days, with the exercise session two to three times a week and shorter walks on other days. Many programmes last six to eight weeks, and maintenance continues afterwards. Progress slowly; if your parent feels exhausted the next day, reduce the load. Keep a simple diary: date, activity, duration, breathlessness score, oximeter if used, and how they felt afterwards. Share it with the doctor or physiotherapist. See keeping a health record at home.

Nutrition, rest and mood

Exercise needs fuel. Small, frequent, protein-rich meals help; avoid a heavy meal just before exercise, and wait about an hour after eating. See how much protein do seniors need and malnutrition in older adults. Good sleep helps recovery. Exercise lifts mood, but if your parent seems persistently low or anxious, tell the doctor; see depression in older adults.

When to stop

Stop and rest at once if your parent has:

• Chest pain, pressure or tightness.
• Severe breathlessness that does not ease within a few minutes of rest and breathing control.
• Dizziness, light-headedness, faintness or a cold sweat.
• Palpitations, a very fast or irregular heartbeat.
• Blue or grey lips.
• Confusion, nausea or unusual weakness.
• Pain in the joints or a calf that is new or severe.
• Oxygen reading below the lowest safe value set by the doctor.

If symptoms persist after a few minutes of rest, or are severe, call 112. Tell the doctor about any episode before restarting exercise.

Safety at home

• Keep floors dry and clear of rugs, cords and clutter; see flooring, rugs and trip hazards.
• Keep oxygen tubing short or taped, and no smoking or flames nearby; follow the rules in using an oxygen concentrator safely at home.
• Do not exercise in a hot, humid or poorly ventilated room.
• Do not exercise alone if your parent is unsteady.
• Keep the reliever inhaler and the action plan at hand; see building a COPD action plan with your doctor.

Finding supervised help

Ask the doctor about pulmonary rehabilitation in a hospital, a physiotherapy clinic or a home visit by a respiratory physiotherapist. Some programmes also offer teleconsultations; see using home readings in a teleconsultation. Ask whether exercise should be done with oxygen. A physiotherapist can also teach airway clearance and adapt the programme to arthritis, heart disease or frailty.

When to ask a professional

Ask the doctor to clear your parent for exercise, to explain oxygen use during exercise and to set safe oximeter limits. Ask a physiotherapist to design and review the programme. Ask a dietician about nutrition. Call the doctor if breathlessness worsens, if your parent cannot keep up the exercise or if symptoms such as chest pain or dizziness occur. Call 112 for severe breathlessness, chest pain, collapse or blue lips.