Implementing A Body Weight Warm Up Could Help Improve Your Next Respiratory Treatment

Implementing A Body Weight Warm Up Could Help Improve Your Next Respiratory Treatment

Improving lung function, or decreasing the rate of decline in lung function, is very important when battling a pulmonary condition. Lung function is the body’s ability to breathe air (inspire) into the lungs, pass oxygen through the blood and to the body’s tissue, pull carbon dioxide out and expel it when you breathe out (exhalation). These abilities change when battling a pulmonary condition because of cardiopulmonary and respiratory restrictions within the lungs and circulatory system. This increases the difficulty and makes it harder to breathe at a normal rate. This is where at home respiratory training can become beneficial.

If you have respiratory restrictions during breathing, you will have muscular restrictions. When your muscles are tight, your posture changes, as your respiratory muscles are also postural muscles. When your body is fighting to continuously increase oxygen to the muscles, the body will primarily focus on getting air into the lungs, rather than using the respiratory muscles for posture and strength. This alteration can cause increased tightness and tone throughout your body. Have you ever woken up from a long nights sleep and felt stiff? We all have, so what do you do? You get up and stretch out a little and move and the tightness starts to subside. This happens because you were sleeping in a few positions for an increased amount of time, causing the body to increase muscle lengthen some areas and increasing tone and tension in other areas. So, when you get up, by moving around your body starts to loosen up and you are able to feel more mobile.

This is the same thing as performing a warm up before you complete a workout. You do not start a workout with some progressive warm up. You start off slow and get the body moving, increase blood flow, and then start your workout. This same approach can be used for your respiratory treatments. If you integrate exercises that focus on your breathing, ribcage and thoracic expansion integrity, you will progressively warm up the muscles that aid in respiration and posture. When you warm these muscles up and get the body on track for treatment, you will allow the body its full potential to clear mucus and get the most out of your next treatment.

Remember to think of your respiratory treatment like your workout. Pick 1-3 warm up exercises that focus on ribcage and thoracic mobility and integrate them before your next respiratory treatment. With our clients, we have observed improved mucus clearing, some have felt as if they could get more air into their lungs when they breathe in, and over time they have felt as if they could breathe easier. All the things you are looking for from respiratory treatments. Of course, everyone is different, so pick the exercises that work best for you.

Spend 3-5 minutes warming up before your treatment. This may take a few sessions, so allow your body to understand what your trying to do before you change or modify an exercise. Take your time and reassess every couple of weeks.

Below are some examples of exercises that have worked well for our clients.

Stretches:

90 Degree Pec Stretch Staggered Stance Intercostal, Lat. and QL Stretch

1-2 sets/20-30 sec hold 1-2 sets/20-30 sec hold

Ribcage and Thoracic Spine Exercises

90/90 Breathing Wall Supported Rib Tuck Quadruped T-Spine Rotations

1-2 minutes 1-3 sets 3-5 breaths 1-3 sets 4-8 per side

For full length videos check out our YouTube Channel: Cystic Fibrosis Fitness Institute

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The Complexity of Respiratory Training: What The Trainer Should Know

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The Complexity of Respiratory Training: What The Trainer Should Know

Respiration is a complex process that delivers us the ability to create energy to move. The respiratory system pulls in oxygen and expels carbon dioxide through a never ending circulatory cycle within the body. The complexity of breathing makes respiratory training unique based on each individual. How people move and how they behave is based on their contributions and withdrawals of movement engrams over the course of their lives. Every individual is in a different place in their lives and respiratory training should reflect that. Respiratory rates range from 12 to 60 breaths per minute based on the age of an individual. That is anywhere from 17,280-86,400 neuromuscular respiratory contractions a day. The range is too big to approach respiratory training the same way for each individual.

Wilkens et al. (2010) looked at 39 patients post lung transplants and found that after patients with either cystic fibrosis (n=9), COPD (n=21), or pulmonary fibrosis (n=9) had distinct differences in breathing mechanisms for respiration after lung transplant. Cystic fibrosis is a defect in the CFTR protein in the lungs creating inflammatory responses leading to scaring within the lungs, COPD is an umbrella term that progressively obstructs airflow over time, and pulmonary fibrosis is a lung disease that also causes thickening in the lung tissue making it difficult for the lungs to expand.

All three of the complications increase inflammatory responses, damage lung tissue and decrease lung function over time, but they do so differently. Even after the patient’s received new lungs, the patient’s respiratory patterns still varied based on the individual. Wilken’s study leads us to hypothesize that lung health and function are not the only factors that need to be addressed when improving lung function. Respiratory muscles are not built solely for respiration but are also built to control the body through movement and gravitational forces, which also need to be taken into consideration when designing a training program. When designing a training approach, intensity, frequency, duration and volume must be addressed in an approach that best fits the individual.

Respiratory neuromuscular training is similar to cardiovascular endurance training. To train cardiovascular endurance, an individual would run over a period of time. As the sessions progressed, the individual would change the stimulus by running further, speeding up their pace, or increasing the time at which they run. From healthy individuals to individuals fighting pulmonary diseases, the concept is the same, but respiratory neuromuscular training is formulated based on each individual. Progressing the individual from low to high intensities, and/or low to high volume of work, is important in creating improved lung capacity.

To give you an idea of what we are talking about, here are a couple of examples for how we have progressed our client’s respiratory exercise capacity:

Focusing on Improving Lower Intensity Respiratory Endurance

Low-Medium Intensity/Low Volume/Short Rest

Low-Medium Intensity/Medium Volume/Medium Rest

Low-Medium Intensity/High Volume/Medium-High Rest

Focusing on Improving Higher Intensity Respiratory Endurance

Medium Intensity/Low Volume/Medium Rest

Medium Intensity/Medium Volume/Medium-High Rest

High Intensity/High Volume/High Rest

Examples of Volume:

* Low Volume: 1-3 sets per exercise

* Medium Volume: 2-5 sets

* High Volume: 4-8 sets

Example of Intensity:

*Low-Medium Intensity: Slow, controlled breaths

* High Intensity: Short, high effort/forced breaths

As you can see in these different progressions, there is an interplay between the intensity, volume and rest. It is very important to understand that respiratory training recruits the cardiopulmonary and neuromuscular systems at the same time and as the intensity increases or decreases, so will the demand of each system. The biggest component that is lost in this type of training is the adequate amount of recovery in between sets and which exercise is paired with respiratory exercises.

You do not want to pair a high intensity/high volume respiratory exercise with a heavy deadlift because of the neurological demand that is required for both however, with that being said, pairing a heavy deadlift with a high intensity/volume respiratory exercise may be what is needed to get someone’s tension levels dialed in because the volume is low, which may heighten neuromuscular facilitation for the deadlift.

On the other end of the spectrum, meditation is a low intensity neuromuscular strategy. This is great approach to improving lower threshold endurance in breathing. This however, wouldn’t be the optimal approach to take right before a heavy deadlift if the volume was high however, it could be beneficial post deadlift at a low volume to recharge the system before increasing the tension for the next set. The variance of respiratory demand is important in building a system to balance the oxygen to carbon dioxide ratio within the blood, lungs and muscles. It however, is part of an intricate system that is unique based on the individual and must be programmed in a way that fits the individual and his/her goals. Low to higher volume/intensity is required to improve breathing patterns and cycles. Everyone needs the ability to breathe through high respiratory stress and low respiratory stress but more importantly, learn to improve respiratory recovery between and at the end of training sessions.

Respiratory training is not just about improving breathing patterns and respiratory rates, but it is also about improving mental focus, neurological recovery, and balancing the mind and body’s ability to create tension and then release it. The best athletes in the world understand how to tense and relax, and respiratory training aids in that process. Respiratory training should be integrated into an individual’s warm up, between resistance and cardiovascular training blocks, and within the cool down. Don’t just use breathing as a method to down regulate the system from a set, but use it as an approach to progress lung capacity and endurance through tension and relaxation.

Reference

Wilkens, H., Weingard, B., Lo Mauro, A., Schena, E., Pedotti, A., Sybrecht, GW., & Aliverti, A. (2010). Breathing pattern and chest wall volumes during exercise in patients with cystic fibrosis, pulmonary fibrosis and COPD before and after transplant. Thorax, 65, 808-814.

For more content check out our YouTube Channel: Cystic Fibrosis Fitness Institute

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Why Resistance Training Can Help Improve Lung Capacity In Cystic Fibrosis

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Exercising can provide a therapeutic benefit to individuals with cystic fibrosis (CF) by improving muscular strength, endurance and aerobic capacity. Resistance training causes adaptive changes in skeletal muscle and has shown to increase VO2 max. Increasing skeletal and respiratory muscle strength is important in the maintenance of lung function and exercise tolerance. Beyond the increase in skeletal muscle strength, resistance training effects respiratory muscle efficiency and can affect 02, C02, and pH levels. The CFTR protein in CF has shown to cause a physiological impairment in oxidative metabolic properties due to systemic inflammation.

Peripheral muscle strength is an important component in respiration. Respiratory muscles correspond with peripheral muscles to control the posture needed to perform a task, while adequately supplying air to utilize an O2 to CO2 ratio needed to complete the task. The integration of the respiratory and peripheral muscles also regulates the duration at which it takes metabolic homeostasis to occur within the body. During inspiration, the diaphragm descends down towards the pelvic diaphragm or pelvic bowl, while the external intercostal contract concentrically, pulling the ribs up through external rotation and torsion, expanding the chest cavity and decreasing intrapulmonary pressure (negative) within the lungs, allowing for an increase in air to move into the lungs. During expiration, the transverse abdominis, internal intercostals, and the oblique muscles concentrically contract to pull the ribcage (ribs internally rotate and pulled down) and pelvis (posterior tilt) closer together, increasing intrapulmonary pressure within the thoracic cavity, increasing expiratory volumes of air. These same muscles that are important for inhalation and exhalation aid in our ability to stand, sit, walk, jump, or run at any given moment. Breathing

Hodges (2001), noted that as inspiration increased during movement, respiratory muscles (inspiration and expiration) increased their role as respiratory muscles and decreased their activity as postural muscular control muscles, comprising trunk stability and dynamic movement integration between upper and lower halves.

Resistance training improves mechanical muscle function, it increases bone mineral density, connective tissue strength and can increase VO2 max. Resistance training has shown to be an important therapeutic approach to improving diaphragmatic breathing in pulmonary diseases. Resistance training increases adaptive changes in skeletal muscle and improves postural stability, respiratory rate, while also leading to adaptive changes in neuromuscular function. These adaptive changes in skeletal neuromuscular function have been linked to increased maximal contractile forces and power output in both children and adults. Resistance training not only improves mechanical muscle function, it also increases motor unit recruitment in skeletal muscle, increases frequency excitability and proprioceptive awareness in respiratory muscles. Due to alterations in the CFTR synthesis in cystic fibrosis, resistance training supplemented with diaphragmatic breathing exercises could be a beneficial starting point to respiratory capacity in CF. Resistance that encourages increased skeletal muscle strength will encourage better motor and sensory awareness within the body. Improving proprioceptive feedback during exercise can encourage better sensory awareness through space, resulting in better utilization of respiratory and dynamic postural muscles. PPI 26

The increase in the rhythmic utilization of these muscles would reduce energy expenditure during every day activities, decreasing the amount of air needed to perform the activities, while increasing the capacity to consume more air if needed. This is an important component because in situations where respiratory function is increased due to postural and/or daily stress or exercise fatigue, the ability of respiratory muscles to perform their postural task is reduced. The increase in energy demand increases physiological and psychological recruitment increasing the rate of fatigue.

Resistance training has shown to be an important therapeutic intervention for improving lung function in cystic fibrosis. Resistance training increases adaptive changes in skeletal muscle and improves postural stability, while also causes adaptive changes in neuromuscular function. These adaptive changes in skeletal neuromuscular function have been linked to increased respiratory muscle strength and increased lung volume potential. Resistance training not only improves mechanical muscle function, it increases motor unit recruitment and its frequency excitability during and after exercise. The increase in postural and respiratory muscle strength decreases neuromuscular and physiological stress on the body, reducing respiratory demands during everyday movements such as; standing, sitting, walking and running. The direct integration of these systems generates a potential to improve lung capacity by integrating resistance training into one’s exercise routine; if not to improve overall strength, then to improve overall respiratory strength and capacity.

Reference

Hodges, P. W., Heijnen, I., & Gandevia, S. C. (2001). Postural activity of the diaphragm is reduced in humans when respiratory demand increases. The Journal of Physiology, 15(537), 999-1008.

3 Tips to Improve Your Next Breathing Treatment

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3 Tips to Improve Your Next Breathing Treatment

The goal of breathing treatments is to maintain and/or improve lung function, increase mucociliary clearance, improve quality of life and improve overall breathing. Breathing treatments often last 20-30 minutes per treatment and 1-3 times per day, depending on who the person is. This takes time out of an individual’s day and adds up over the week. Well, what if we could boost how much you get out of these treatments? What if we could help you improve your next treatment? We can’t guarantee anything, however; we have put together 3 strategies that we have given to our pulmonary clients that have helped them improve their approach to their treatments.

Treatment goals are to help you improve your ability to breathe, right? Well, let’s look at how we can help you target that and possibly improve your quality of life and breathing mechanics.

Number 1: Posture

Your posture directly affects your breathing mechanics. The human body is a fascinating organism. Our bodies are built to do amazing things however, when our body does the same thing over and over again it adapts and can alter our posture. This isn’t a bad thing if you’re are training for a particular goal however, it can directly affect your breathing mechanics if you do not allow your brain to enrich its self with other postures. For example, when you sit at work all day your muscles will adapt to the seated position at which you maintain. That is why it has been recommended to stand up and walk around for a minute every hour when you have a job that is highly sedentary. In the seated position, your hip, neck, and lower back muscles will tighten. These muscles are highly utilized in respiration. When they live in a prolong state of shortening, the brain will tell other muscles to lengthen; hamstrings, glutes, pelvic floor and core muscles, to balance out the adapted seated posture.

This causes imbalances throughout the body and changes your breathing mechanics without you even realizing it. The sitting will cause your head to subtly shift forward, your ribcage to flare up and recruit your lower back, while your neck and chest muscles help low intensity breathing to keep occurring. These muscles are primarily used when we have a higher elevated breathing pattern, so when they are recruited for other jobs, they will become tired and overworked, which causes more tension and stress. Our body’s number one goal is to survive and if we limit its ability to breathe efficiently, it will compensate and use other muscles, such as the neck, chest and lower back muscles to drive your respiration. This can carry over to your breathing treatments and you may not even realize it.

Here is a posture strategy for your next treatment:

Screen Shot 2018-07-23 at 7.19.53 PM

Sit up right, with your ribcage subtly tucked down and your knees at a 90-degree angle under a 2-inch block. Sit in this position for as long as you feel comfortable throughout your treatment.

If you have something to squeeze, Screen Shot 2018-07-23 at 7.15.26 PM place it between your knees and subtly squeeze to increase core activation.

Number 2: Hydration

The adult human body is made up of over 60% of water. The brain and heart are composed of 73% water, the lungs are comprised of about 83% water, and our muscles are comprised of around 79% of water. Now if we are dehydrated, our brain isn’t going to be as efficient at operating and at sending signals to the lungs and muscles for respiration. This could then change our physiological chemistry, making it more difficult to breathe. When something becomes more difficult to accomplish, there is an added stress that is placed upon it to survive.

This could decrease our energy levels and make us have to work even harder to breathe, all just because we are dehydrated. We always recommend drinking water throughout the day, from the moment you get up, to 30 minutes before you go to bed. Try having a glass of water 30 minutes before your next treatment. It could help hydrate your brain, lungs, and muscles and keeping your organs hydrated allows them to function at a higher output.

Number 3: Warm Up

When we exercise, we have been taught to perform a 5-10 minute warm up before our workout of the day. The goal of these warm ups is intended to help improve blood flow to our muscles,increase our tissue extensibility, and get our respiration on par for what we are about to accomplish. This same idea and concept can be used for your next treatment. Think of your breathing treatment as if it was your exercise workout for the day. When you breathe in and out, some of your muscles have to contract and shorten, while others have to relax and lengthen. Screen Shot 2018-07-09 at 4.24.18 AM When these muscles haven’t been properly warmed up, they may not contract or relax like they would if they were warm. Now, if you perform a couple of your favorite upper and lower body exercises before your treatment, you could put your muscles in a better position to contract and relax to improve your breathing during your treatment. Picking exercises that focus on breathing and muscle tissue stretching are always the best bet. Your muscles connect to your bones and your ribcage is a big component in getting air into the lungs. If you focus on warming up the muscles around your upper body and ribcage, you can get higher quality of ribcage expansion, increasing oxygen consumption and utilization.

We have a great library of exercises and mini warm up routines you can use before your next treatment. Go to our YouTube channel, Cystic Fibrosis Fitness Institute, for more options.

Just remember that everyone is different and will need to approach these strategies differently. These are tips that we have seen help our clients fighting a pulmonary disease. You do not have to use them all to be successful. The biggest thing is keeping it consistent. It is better to focus on one tip for a few weeks and see how it goes for you before you move on to the next one. We cannot guarantee instant improvements after your next treatment, but if you apply at least one of these strategies with consistency, we believe it could help you improve your treatments and quality of life overtime.

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