But, the first thing to say is that exercising regularly, even when you have completely normal lungs (and heart and not to mention knee and hip joints), is not easy—if it were, everyone would be doing it…and every other commercial on TV would be for something other than a “get fit quick” remedy.
We’ve all heard it from the time we were youngsters, “Get out there and exercise!” But really, why should we? Let’s cover the non-physical effects first; there are ample data out there to prove that exercise leads to:
• More energy
• Reduced stress
• Improved sleep
• A sense of achievement
• Improved mood
• Improved cognition
The biochemical effects of exercise include—among several other things—better blood sugar and lower cholesterol. The physical effects include stronger bones, improved body shape, reaching and maintaining a healthy weight, better balance and mobility in addition to effects on the heart and skeletal muscles.
Aerobic exercise also improves cardiac conditioning; that is, the heart can pump blood (and by extension, oxygen) to working muscles more efficiently—the heart muscle itself can do more work with less fuel…it is better conditioned or “in better shape.” Exercise also makes the skeletal muscles work more efficiently: they are stronger, more resistant to fatigue and function more ideally at the cellular and molecular levels—in English, that means they can also do more work with less fuel (read “oxygen”). That is, they are better conditioned or “in better shape.”
But Doc, I have pulmonary fibrosis! Aren’t my lungs the stop gap here? Recall what I wrote in my last blog about the roles of the lungs, heart and muscles during exercise. Oxygen is the fuel; the lungs get it in the bloodstream; the heart pumps it to the muscles; and the muscles “pull” it out of the bloodstream and turn it into energy so they can do work. If the lungs are scarred (i.e., if pulmonary fibrosis is present) and not functioning normally—thus limiting the efficiency with which they do their job of getting oxygen into the bloodstream—a well-conditioned, efficiently working (read “in shape”) heart and skeletal muscle system is vital to “make up for” the under-performing lungs.
Remember, a conditioned—or “in shape”—heart and muscles are able to do more work with less fuel. Imagine if the lungs are under-performing AND the heart AND muscles were “out of shape!”…not a great situation.
Remember Judy from my last blog? Those big muscles that carried her to her mailbox and up that incline? Well, it turns out that, for IPF patients, fitness and strength of the large muscle groups of the lower extremities is really, really important. It shouldn’t be all that surprising to hear that if two IPF patients have the same forced vital capacity (FVC) and diffusing capacity (DLCO), the one with the stronger quadriceps muscles will have a better exercise capacity than the other. The interested reader can check out this article by clicking HERE by a very solid Japanese pulmonologist—Osamu Nishiyama—who also has an interest in exercise and quality of life in patients with pulmonary fibrosis.
So, patients with pulmonary fibrosis should exercise—not because exercise will make their lungs work more efficiently (although there are studies underway looking at respiratory muscle training for patients with lung disease)—but because it will allow the heart and muscles to do more with the oxygen that is available. For now, for patients with pulmonary fibrosis, we encourage aerobic exercise (the kind that gets your heart pumping fast and keeps it there for a while) and resistance training for the arms and legs (recall what Dr. Nishiyama’s work has shown). In my next blog I’ll cover the specifics.