​​Pulmonary Rehab Programs and Breathing Exercises That Can Help Improve COPD

If you have a chronic breathing problem, a physical therapy program may seem like the last thing you would want to do. After all, how could exercise ever help to improve breathlessness? 

Pulmonary rehabilitation is a science-backed, highly effective way to improve symptoms in people with long-term breathing problems. Even people with severe shortness of breath can take part and benefit. 

What is pulmonary rehabilitation?

Pulmonary rehab (PR) is a supervised outpatient treatment program. It is scientifically proven to improve symptoms and quality of life for people with COPD and other long-term lung diseases. 

Pulmonary rehabilitation is a structured program that involves: 

• Learning how to manage medications and symptoms

• Physical therapy, exercise, and strength training

• Breath training

• Psychological counseling

• Help to stop smoking

• Nutrition advice

• Social support

Different PR programs vary in how they are structured and run. The program does not replace your treatment with inhalers and other medications. But together with your medications, PR can improve the way you feel and how well your treatment helps you. 

Who qualifies for pulmonary rehabilitation?

Chronic obstructive pulmonary disease (COPD) is the main reason why people get referred to pulmonary rehab. 

But PR can help people with other chronic lung conditions, too, like:  

• Asthma

• Sarcoidosis

• Lung fibrosis

• Pulmonary hypertension

• Bronchiectasis

• Cystic fibrosis

• Lung cancer

• Lung transplant

• Long COVID

So, if you have any of these conditions, and you’re struggling with breathlessness, PR may be an option for you. You can find out more about pulmonary rehab programs near you here. You will need a referral from your healthcare provider. Even then, it’s possible you may have to join a waitlist and/or travel a considerable distance to attend a program.  

What to expect if you join a pulmonary rehab program for COPD 

Pulmonary rehab programs typically take place in an outpatient department. This might be in a hospital or clinic, including Veterans Administration (VA) hospitals. 

Pulmonary rehab programs are usually led by a physical therapist, respiratory physician, or a trained respiratory nurse. Enrolling in a PR program requires commitment. You have to attend regularly until the program is complete. 

Before you start the program, or at your first session, your care team will carry out baseline tests to find out more about you and your health. 

Your pulmonary rehab assessment will typically include: 

• Your medical history 

• Your symptoms

• Your medications 

• Your home setup

• Your mental health

• Your support network

• Your diet

• Lung-function testing

• Exercise testing, usually a 6-minute walk test

• Blood tests

With this information, your team will make sure you have a PR plan that suits your needs and goals. 

How long is a typical pulmonary rehabilitation program for COPD?

Most PR programs require you to attend once or twice a week, for between 8 to 12 weeks. This can be a real commitment, especially if the PR program you are attending is far from where you live, and you need help getting there and back. If you can make it happen, the results are worth it. 

How does pulmonary rehab improve lung function in COPD patients?

PR programs improve exercise ability and lung function mainly through mind, behavior, and body training:  

• Psychological coaching and peer support. This part of a PR program can improve the fear and loss of control that can come with feeling short of breath and having a lifelong lung condition. 

• Disease, medication, and nutrition education. This part of the program helps people improve symptoms by teaching them how and when to self-treat, how and what to eat, and how to conserve energy.

• Physical coaching and training. This part of the program helps to build muscle strength and endurance. Strength training is centered on the muscles needed to breathe, as well as those needed to exercise. The stronger your breathing muscles, the better your lung function will be. Not only that, but your cough and swallow will get stronger.

The combined effect of treating the whole person is more strength, better fitness, fewer symptoms, improved mood, and a healthier you.    

How exercise helps people with COPD

Regular exercise is beneficial to everyone, regardless of age or health. For people with COPD, there are specific benefits which feed into each other and improve overall health. 

These benefits include:

• Helping the body use oxygen more effectively

• Improved energy levels

• Increased lean muscle mass, which improves metabolism and overall health

• Stronger heart and lung muscles, which improves shortness of breath

• Improved mood, including mental health disorders like anxiety and depression

• Better quality sleep

• Better self-esteem

• Promoting more social interaction, which helps reduce feelings of isolation

What is the difference between pulmonary rehab and physical therapy?

Pulmonary rehab programs include physical therapy and are often run by physical therapists. But there’s more to a PR program than physical therapy. 

Firstly, physical therapy in a PR program is specific to the needs of people with chronic breathing problems. 

Secondly, PR programs also include education, psychological support, coaching, help with quitting smoking, group support, nutrition advice, and more.     

How much does pulmonary rehab cost, and is it typically covered by insurance?

How much pulmonary rehab costs for you depends on where you live, what program you attend, and your insurance coverage. Most insurance plans and Medicare will cover pulmonary rehabilitation for COPD and other lung conditions, provided you meet certain criteria.  

Tips and tricks to improve your COPD symptoms on your own

Unable to join a pulmonary rehab program? Or, maybe there is a long wait time? Below are some evidence-based lifestyle changes you can start to make on your own. 

Stop smoking

You’ve probably heard it before, and maybe you’ve even tried before. If you smoke, the most important part of any treatment plan for a chronic lung disease is to try to quit, or cut back. No matter how advanced your disease is, and no matter how many times you may have tried to quit before, it’s never too late. 

Stopping smoking can slow the progression of COPD, no matter how long you have had it. It can also prevent other complications of smoking, such as heart disease, stroke, and lung cancer. 

Get your vaccines

Getting COVID-19, the flu, or pneumonia, can make your breathing much worse if you have an underlying lunch condition. Making sure you’re up to date with all the recommended vaccines can stop chest infections before they happen. 

Eat well

Some people with severe breathing problems are not able to eat enough because they are too breathless. Weight loss and malnutrition can make symptoms worse and put you at more risk of chest infections. Working with a dietitian or nutritionist can help you be more tactical in your food choices in order to get more calories in. 

Some people with chronic lung diseases have too much weight, which can also make breathing symptoms worse. In this case, losing weight will be part of your COPD treatment program, and your care team will help you achieve this. 

Keep well hydrated

Staying well hydrated when you have a chronic cough helps to moisten a dry mouth. It also keeps chest mucus thinner and easier to cough up. If you have heart trouble in addition to your lung condition, then you may need to limit your fluid intake. In this case, it’s best to check with your healthcare provider on how much fluid you need. 

Exercise

There are three main forms of exercise, and all three help people with COPD: 

1) Flexibility, like stretching and yoga

2) Cardiovascular/aerobic exercise, like walking, jogging, hiking, biking, and swimming

3) Strength training, like squats, lunges, crunches, pushups, and lifting small weights

Joining a gym, or working with a friend or personal trainer, can be a great way to ease into exercise. The British Lung Foundation and the COPD Foundation provide online instructional videos, but there are plenty more available on YouTube.  

Breathing exercises

Regular breathing exercises — such as pursed-lip breathing and belly breathing — can help improve breathlessness by: 

• Strengthening the muscles involved in breathing

• Increasing the amount of air you are able to take in and breathe out with each breath

• Working through the feelings of anxiety that come with feeling short of breath

You can practice these wherever you are and without needing any special equipment. The more you practice, the easier and more effective they will feel. 

Stay busy

Keeping yourself busy is good for your emotional well-being and your mental health. Spend time with friends and family. Explore new or old hobbies. Try a singing group or meditation to help with breath. Spend time in nature if you have access to it. Puzzles, games, reading, writing, or arts and crafts can all help to keep your brain stimulated. Cooking classes or joining a community garden can foster a love for nutritious food. 

Attend regular health checkups

Making time for regular checkups with your health care team is key. They can keep an eye on your symptoms, your inhalers and other treatments, and any other health problems that could affect your breathing. Most people with lung disease should see their provider every few months. 

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Written by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Reviewed by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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