Physical Therapist's Guide to
Chronic Obstructive Pulmonary Disease (COPD)
Chronic obstructive pulmonary disease (COPD) causes breathing difficulty and leads to other systemic problems. COPD is the tenth most prevalent disease worldwide. It's estimated that by 2050, COPD will be the fifth leading cause of death in the world. Although COPD used to be more common among men, it now affects women nearly as equally in developed countries.
Physical therapists can work with your pulmonary rehabilitation team or with you individually to help improve:
- Your exercise capacity
- Your overall strength
- Your health and quality of life
What Is Chronic Obstructive Pulmonary Disease (COPD)?
In chronic obstructive pulmonary disease, the airways in your lung lose their normal shape and elasticity, and can become inflamed. The result is that the airways are less efficient at moving air in and out of your lungs. Primary risk factors for developing COPD include:
- Inhaling toxic substances
- Indoor and outdoor pollutants
- Genetic/environment interactions
- Respiratory insult to the developing lungs during prenatal or early childhood stages of life
Current research indicates that COPD is no longer considered a “smoker’s” or “older person’s” disease.
The most common types of COPD are:
- Chronic bronchitis—a chronic inflammation of the medium-size airways, or "bronchi" in the lungs, causing a persistent cough that produces sputum (phlegm) and mucus for at least 3 months per year, in 2 consecutive years.
- Emphysema—a condition in which small air sacs in the lungs called "alveoli" are damaged. The body has difficulty getting all of the oxygen it needs, resulting in shortness of breath ("dyspnea") and a chronic cough.
In addition to causing breathing difficulty, COPD results in cough, sputum production, and other symptoms. The disease can affect the whole body and lead to:
- Weakness in the arms and legs
- Balance problems and increased risk of falls
- Nutritional problems (weight loss or gain)
People with COPD are likely to have other health problems that can occur at the same time or be related to COPD, such as:
- Reduced blood supply to the heart (ischemic heart disease)
- High blood pressure (hypertension)
- Lung cancer
- Congestive heart failure
- Coronary artery disease
- Atrial fibrillation
Over time, COPD leads to a progressive decline in physical function because of increased shortness of breath (dyspnea) and loss of muscle strength. There are 4 stages of COPD — mild, moderate, severe, and very severe — based on measurements of the amount or flow of air as you inhale and exhale. People with COPD may need to take medications, or may require supplemental oxygen.
How Can a Physical Therapist Help?
Your physical therapist will perform an evaluation that includes:
- A review of your history, including smoking history, exposure to toxic chemicals or dust, your medical history, and any hospitalizations related to your breathing problems
- A review of your medications
- Assessment of what makes your symptoms worse, and what relieves them
- Review of lung function test results that may have been performed by your physician
- Muscle strength tests of your arms, legs, and core
- Walk tests to measure your exercise capacity
- Tests of your balance and your risk of falling
Pulmonary rehabilitation, including exercise training for at least 4 weeks, has been shown to improve shortness of breath, quality of life, and strategies for coping with COPD. Your physical therapist will serve as an important member of your health care team, and will work closely with you to design a program that takes into account your goals for treatment. Your physical therapist's overall goal is to help you continue to do your roles in the home, at work, and in the community.
Improve Your Ability to Be Physically Active
Your physical therapist will design special exercises that train the muscles you use in walking and the muscles of your arms, so you can increase your aerobic capacity and reduce your shortness of breath. You may also use equipment, such as a recumbent bike, treadmill, or recumbent stepper to improve cardiovascular endurance.
Research has shown that strength training in people with moderate to severe COPD increases muscle mass and overall strength. Your physical therapist will provide strengthening exercises for your arms and legs using resistance bands, weights, and weighted medicine balls
Improve Your Breathing During Activity
People with COPD often have shortness of breath and reduced strength in their "inspiratory muscles" (the muscles used to breathe in). Your physical therapist can help you with inspiratory muscle training, which has been shown to help reduce shortness of breath and increase exercise capacity. Your physical therapist can instruct you in pursed-lip and diaphragmatic breathing, which can help make each breath more efficient, and helps to reduce shortness of breath during your physical activities.
Improve Your Balance
The decrease in function and mobility that occurs with individuals who have COPD can cause balance problems and risk of falls. People who require supplemental oxygen can be at a greater risk for a fall. If balance testing indicates that you are at risk for falling, your physical therapist can help by designing exercises aimed at improving your balance, and helping you feel steadier on your feet.
Can this Injury or Condition be Prevented?
One of the most important ways to prevent COPD is to stop smoking, which also can delay the onset of COPD, or delay the worsening of breathing difficulty. If you are a smoker who has a cough or shortness of breath but whose tests don't yet show a decline in lung function, you may be able to avoid a diagnosis of COPD, if you stop smoking now! The American Lung Association offers an online Freedom From Smoking® program for adult smokers. Your physical therapist also can help you get in touch with local smoking cessation programs.
If you already have COPD, your physical therapist can guide you to help slow the progression. The therapist will show you how to continue an exercise program at home or at a fitness center, after you've completed your physical therapy treatment. Regular exercise that is continued after pulmonary rehabilitation for COPD helps slow the decline in quality of life and shortness of breath during activities of daily living. It has been found that patients who continue exercising after completing a pulmonary rehabilitation program, maintained the gains that had been made, whereas those who stopped their exercise program had a major decline in their exercise endurance and physical functioning.
When COPD is accompanied by excessive body weight, breathing can be more difficult. Excessive weight can also inhibit the ability to exercise and decrease overall quality of life. Your physical therapist can help you manage your weight, or prevent unnecessary weight gain by designing an exercise program specifically targeted to your current abilities. Your physical therapist also can also refer you to a dietician for help with proper nutrition to support a healthy lifestyle.
Real Life Experiences
Thomas is a 68-year-old man who recently was diagnosed with COPD. He smoked 1.5 packs of cigarettes for 40 years before quitting 2 years ago. He is referred to a cardiopulmonary physical therapist after telling his physician that he is having more difficulty climbing up and down stairs, as well as trouble golfing. He notes that he is having increased shortness of breath and now has to ride the golf course in a cart, rather than walking. He reports that his other main problem is leg fatigue with walking, which further contributes to his movement limitations.
The physical therapist performs an evaluation and notes that Thomas has a reduced exercise capacity based on a test called the "6-minute walk test." Based on other tests, the therapist finds that Thomas has decreased leg strength and decreased endurance. Thomas says that he feels like he doesn't have much control over his breathing, which is affecting his quality of life.
Over the course of his physical therapy treatment, the physical therapist teaches him how to use the treadmill, stationary bicycle, and upper-body ergometer (a kind of bicycle that's pedaled using only the arms), and strengthening exercises with weights. The therapist instructs him in how to do pursed lip breathing and diaphragmatic breathing, how to pace himself during his activities, and how to best conserve his energy.
At the end of his physical therapy, Thomas is able to walk 200 feet farther on the 6-minute walk test with reduced shortness of breath and leg fatigue. He resumes golfing, and is able to walk half of the course before requiring a cart. He reports that he also feels much more at ease on the stairs, and has an improved overall sense of control of his breathing. He joins a local gym, where he plans on continuing his walking program 3 times per week.
This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat a variety of conditions and injuries. You may want to consider:
- A physical therapist who is experienced in treating people with pulmonary problems.
- A physical therapist who is a board-certified clinical specialist, or who completed a residency or fellowship in cardiovascular and pulmonary physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist:
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapist's experience in helping people with COPD.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of COPD. The articles report recent research and give an overview of the standards of practice for treatment both in the United States and internationally. The article titles are linked either to a PubMed abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Polkey MI, Spruit MA, Edwards LD, et al. Six-minute-walk test in chronic obstructive pulmonary disease: minimal clinically important difference for death or hospitalization. Am J Respir Crit Care Med. 2013;187(4):382–386. Free Article. Article Summary on PubMed.
US Department of Health and Human Services, National Heart, Lung, and Blood Institute. Prevention of COPD. Published July 31, 2013. Accessed May 29, 2015.
Chen H, Liang BM, Tang YJ, et al. Relationship between 6-minute walk test and pulmonary function test in stable chronic obstructive pulmonary disease with different severities. Chin Med J (Engl). 2012;125(17):3053–3058. Article Summary on PubMed.
Spruit MA, Polkey MI, Celli B, et al. Predicting outcomes from 6-minute walk distance in chronic obstructive pulmonary disease. J Am Med Dir Assoc. 2012;13(3):291–297. Article Summary on PubMed.
Beauchamp MK, O’Hoski S, Goldstein RS, Brooks D. Effect of pulmonary rehabilitation on balance in persons with chronic obstructive pulmonary disease. Arch Phys Med Rehabil. 2010;91(9):1460–1465. Free Article. Article Summary on PubMed.
Global Initiative for Chronic Obstructive Lung Disease. “Global strategy for diagnosis, management, and prevention of COPD”. Updated December 2009. Accessed March 2011.
Nield MA, Soo Hoo GW, Roper JM, Santiago S. Efficacy of pursed-lips breathing: a breathing pattern retraining strategy for dyspnea reduction. J Cardiopulm Rehabil Prev. 2007;27(4):237–244. Article Summary on PubMed.
Heppner PS, Morgan C, Kaplan RM, Ries AL. Regular walking and long-term maintenance of outcomes after pulmonary rehabilitation. J Cardiopulm Rehabil. 2006;26(1):44–53. Article Summary on PubMed.
Dechman G, Wilson CR. Evidence underlying breathing retraining in people with stable chronic obstructive pulmonary disease. Phys Ther. 2004;84(12):1189–1197. Free Article. Article Summary on PubMed.
Emery CF, Shermer RL, Hauck ER, Hsiao ET, MacIntyre NR. Cognitive and psychological outcomes of exercise in a 1-year follow-up study of patients with chronic obstructive pulmonary disease. Health Psychol. 2003;22(6):598–604. Article Summary on PubMed.
Authored by Kara Schworm, PT, MS, and APTA's Cardiovascular & Pulmonary Section. Reviewed by the editorial board.