Exercise at Home

Why it matters

Inactivity sets off a downward spiral: less movement leads to weaker muscles and a less efficient heart and circulation, which makes breathlessness come on sooner, which leads to doing even less. Exercise breaks that cycle — improving stamina, strength, balance, mood and independence, and reducing flare-ups and hospital visits. See Decreased Exercise Tolerance and Cardiorespiratory Rehabilitation.¹

Before you start

Check with your treating team first — particularly if you have unstable or recently changed heart disease, are recovering from surgery, have just had a flare-up, or use home oxygen. If oxygen is prescribed for exertion, use it while you exercise, at the flow rate you have been given. Do not change the rate yourself. See Oxygen in the Home.²

Then set the room up so that safety isn't an afterthought: a sturdy chair that doesn't roll, a clear space to move in, shoes with a firm heel rather than slippers, water within reach, and your reliever inhaler in the room with you. Exercise indoors when it is very hot, very cold or smoky — all three make breathing harder.

How hard should it feel?

You are aiming to be moderately breathless but still in control. Two checks tell you where you are:

• The talk test — you should be able to speak in short sentences. Holding a comfortable conversation means you can push a little harder; managing only single words means ease off.
• The 0–10 breathlessness scale, where 0 is none at all and 10 is the worst you can imagine. Most home exercise should sit at 3 to 4 — moderate to somewhat severe.³

Being moderately breathless while you move is safe and expected, and it is not damaging your lungs. It should settle within a few minutes of stopping. Breathlessness that stays high long after you stop means the session was too hard — not that exercise is wrong for you.

A week that works

A balanced week mixes three ingredients. Build up gradually — a little more each week rather than a lot in one go:^4,5

• Aerobic work, for stamina — walking, marching on the spot, or a stationary bike, on most days, working towards 20–30 minutes. Three ten-minute blocks count as much as one long walk.⁶
• Strength work — the five exercises below, on two or three days a week, with a rest day in between.
• Breathing and flexibility — pair movement with breathing retraining and gentle stretches on most days.

Start where you are, not where you think you ought to be. If ten minutes of walking is too much today, three minutes repeated three times is a real session and counts fully.

The exercises

These need nothing but a chair, a wall and a step. Begin with one set of each; add a second set once the first feels comfortable, then a third. Breathe out on the effort — as you stand, push or lift — and never hold your breath.

1. Sit-to-stand

Sit tall towards the front of the chair, feet flat and hip-width apart. Stand up without pushing off your hands if you can, then sit down slowly under control. 5–10 repetitions. This is the most useful single exercise for keeping your independence, because it is the movement you make dozens of times a day. To progress: fold your arms across your chest, or take four seconds to sit down.

2. Heel raises

Stand behind the chair with your hands resting on the back for balance. Rise onto your toes, hold for a second, and lower slowly. 10–15 repetitions. To progress: use one hand, then one finger, then do them one leg at a time.

3. Wall push-ups

Stand an arm's length from a wall, hands flat at shoulder height. Bend your elbows to bring your chest towards the wall, then push back. 8–12 repetitions. To progress: stand further from the wall, or slow the movement down.

4. Step-ups

Use the bottom step of a staircase with a rail to hold. Step up with one foot, bring the other up, then step down the same way. 10 repetitions leading with each leg. To progress: add repetitions before you add height.

5. Seated arm work

Sitting tall, curl and press two tins or water bottles — forwards to shoulder height, then overhead if your shoulders allow. 8–12 repetitions each. Arm exercise often feels more breathless than leg exercise, because the muscles that lift your arms also help you breathe. Build it up more slowly, and use the breathing below.

Warming up and cooling down

Spend three to five minutes at the start moving gently — walking on the spot, rolling your shoulders, marching your arms — so your heart, lungs and muscles are not asked to change gear all at once. At the end, slow down for another few minutes rather than stopping dead, then stretch the muscles you used while they are still warm. Cutting the cool-down is the most common reason people feel light-headed after a session.

When breathlessness catches you out

Breathlessness is uncomfortable and frightening, but on its own it is not dangerous. If it builds beyond your control, stop and use a recovery position that lets your breathing muscles work more easily:

• Sitting — lean forwards with your forearms on your thighs or on a table.
• Standing — lean forwards onto a bench or windowsill, or lean your back against a wall with your hands on your thighs.

Then slow the breath down: breathe in through your nose and out gently through pursed lips, making the out-breath longer than the in-breath, until you are back in control. Breathing retraining covers this in detail. If your reliever is part of your plan, use it as prescribed — and if this is happening at rest or far more easily than usual, treat it as a possible flare-up and follow Recognising a Flare-up.

Pacing, progression and the bad days

The rule that keeps people going is little and often beats occasional big efforts. Add roughly one change at a time — a few more minutes, or a few more repetitions, or one more set — and hold it for a week before adding the next. If a session leaves you wiped out for the rest of the day, it was too much; repeat the previous week instead of pressing on.

On a bad day, drop the intensity rather than stopping altogether: a slow five-minute walk and one set of sit-to-stands keeps the habit alive. After a flare-up, expect to restart lower than where you left off — that is normal, not a setback, and most people rebuild faster than the first time. Keep it in step with the routine in your plan.

Keeping track

A few lines a day is enough, and it turns guesswork into evidence:

• What you did and for how long — minutes walked, sets completed.
• How breathless you got, using the 0–10 scale.
• How you felt afterwards, and the next morning.

Bring it to your appointments. A fortnight of honest notes tells your physiotherapist far more than a single measurement in the clinic, and it is the quickest way to find out which part of the week needs changing.

What a clinic programme adds

Supervised rehabilitation is more effective than exercising alone, because the programme is measured, progressed and adjusted around your condition rather than a general pattern.^1,5 An assessment establishes your starting point — exercise tolerance, oxygen levels on exertion, strength and function — and the same tests then show what has changed. Home-based programmes with proper support achieve outcomes comparable to centre-based rehabilitation, so distance from Rockhampton need not be the deciding factor.⁴

References & evidence base

1. McCarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2015;(2):CD003793.
2. Alison JA, McKeough ZJ, Johnston K, et al. Australian and New Zealand pulmonary rehabilitation guidelines. Respirology 2017;22(4):800–819.
3. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982;14(5):377–381.
4. Holland AE, Mahal A, Hill CJ, et al. Home-based rehabilitation for COPD using minimal resources: a randomised, controlled equivalence trial. Thorax 2017;72(1):57–65.
5. Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013;188(8):e13–e64.
6. Australian Government Department of Health and Aged Care. Physical activity and exercise guidelines for all Australians: adults (18 to 64 years). Canberra: Department of Health and Aged Care.

References are numbered in citation order (Vancouver/BMJ style) and were current at the time of writing. Guidelines are living documents — verify against the latest version before clinical use.