Feeling Out of Breath? 5 Physical Therapy Exercises to Improve Lung Function

According to the American Lung Association, about 37 million Americans are affected by pulmonary diseases. COPD (emphysema and chronic bronchitis) is the most prevalent. With the onset of COVID-19 in 2020, the number of individuals that may be affected by pulmonary and respiratory conditions has increased to affect a larger portion of the US population, but studies have yet to provide accurate numbers. You may add to this, the continued prevalence of smoking and e-cigarette use with the most recent published smoking rate of 14% in adults (2022 State of Tobacco Control). Additionally, according to the 2020 National Youth Tobacco Survey, 23.6 % of high school students reported the use of at least one tobacco product such as smoking or e-cigarettes in the last year.  Among the survivors of symptomatic COVID-19, there is an increased prevalence of “Long Covid” breathing issues and chronic pulmonary diseases. With the combination of COPD, Acute COVID-19, Long Covid, and the continued prevalence of smoking and vaping, and its lasting effects, it is appropriate to suggest some exercises to improve lung function and to decrease or slow down the progression of lung disease of those affected.  We must understand and agree that the most effective treatment for lung disease is to remove yourself from the harm causing the illness to the lungs or prevent it altogether by Smoking cessation, COVID-19 prevention, or absence from any environment that may cause lung injury.

Here are five of my favorite exercises I use with my patients. I keep it simple so that there is more compliance, and these exercises can be done anywhere with little to no help.

1. Breathing Exercises:
   • Pursed lip breathing (PLB): Although it may not be considered a typical exercise, PLB is a very effective way to reduce the feeling of shortness of breath (SOB) and improve the lungs and diaphragmatic function.  Breathe in slowly through your nose and exhale with parted lips (pursed but not puckered). Exhale slowly as it should take you at least twice as long to breathe out as it took you to breathe in. Be careful that the exhalation is not forced, and only do this a couple of cycles so that you don’t get lightheaded.
   • Diaphragmatic breathing: Excellent way to manage the cycle and depth of breathing with different activities. Recommend this to be done in supine (lying down), sitting, standing, and while walking. Self-assisted works well by placing your hand on your diaphragm (just below the ribs) and monitoring the rise and fall with each breath. Give a little resistance to emphasize the use of the diaphragm.  This will strengthen the breadth and allow you to slow it down with activity.
2. Stretching:
   • Thoracic (chest) mobility: There are limitless ways thoracic mobility may be achieved. This is highly effective in increasing the thoracic space to provide the lungs with less restriction and more space to expand when you breathe in. Some Yoga poses and moves are excellent as they incorporate not only movement (stretch) but also breathing. Strive for 5 days a week. An example of a thoracic mobility exercise is to place your hands behind the head and the elbow in front of the face. Inhale (breath in) as you bring the elbows back and hold the breath for a count of three and exhale (breath out) as you bring the elbow back together. If no spine issues, try leaning forward a little while exhaling.  If there is tightness, stretch back a little more and hold. If you have shoulder issues or pain, or recent shoulder surgery, check with your PT, OT, or MD first. 
3. Walking: One of the most fundamental ways you can improve your lung function is by walking. You can walk your dog or go out with your partner or friends. It doesn’t have to be hard, but it would be more beneficial if you put in some effort so that you feel like you are breathing harder than at rest, and that your heart rate goes up while doing it.  For a challenge walk up hills and you will feel the effect which is good for your heart and lungs.  If you have had a PT evaluation, ask what your capacity is. Ask if they can do a 6-minute walk test and discuss the results so that the PT can give you parameters for you to follow. Have them test you again after 6 weeks and you will see a difference. As we hit winter, take the walking indoors to a mall or your local high school indoor walking track. Your goal should be 30-minute walks at a moderate pace.  If you do the treadmill or stationary bike, or any other equipment, a whole new set of precautions needs to be considered so talk to your PT.
4. Dancing: Crazy as it sounds it is a recommendation from the clinical practice guidelines. Dancing is fun, easy, and can be done with a partner or alone. It can also be done in the privacy of your home or head out to your favorite dance spot.  Turn on your favorite streaming music device put on a fun song (fast-paced is best and my favorite is Spanish salsa) and move. Move for 3-5 songs total of 12-20 minutes and you are done! Monitor your heart rate and breathing rate. If they increased when you are done, you are doing it right.  Spotify: Salsa for Dancing, or Best of 80’s Dance Music.
5. Strengthening: Strengthening, but more specific resistance training is a must to help your lungs work more efficiently. The stronger you are the easier it will be to do the things you like. If you get your legs stronger walking and dancing will be easier. If you strengthen your arms and chest, carrying and moving things will be easier. You will be less short of breath, and you will have more energy. Try resistance bands as they are inexpensive, may be provided by your PT, and don’t take up much room at home. The darker the band, the harder the resistance with most exercise bands, but make sure to start gently and increase resistance gradually.  Some examples of resistance to exercises that I like are:
   • Chest Fly with resistance band: Wrap a long resistance band to a solid object behind you and grab each end of the band at shoulder level, with arms straight out and hands facing each other. With the arms in open position breathe in.  Pull the band out in front of you and exhale slowly as you bring your hands to meet fully extended in front of you. Release and bring them back to the side and breath in.  Repeat 10-15 times one or two sets to fatigue.
   • Chest Press: Similar exercise in the same position except this time bring your arms straight forward out in front of you keeping hands at the shoulder and palms facing down as you hold the band. Same breathing sequence.  Repeat 10-15 times one or two sets to fatigue.

These are just a few exercises to help improve lung functions. There are too many to list in this blog. Good luck and always check with your primary care provider or physical therapist to adjust these or any exercises to your capabilities.

Dr. Henry Lozano

Henry Lozano PT, DPT (he/him) graduated from Montclair State University with a BS in Biology and Chemistry Minor, obtained his Physical Therapy Degree from New York University, and tDPT from Boston University.  He is currently the Director of Rehab at Capitol View, a TCU within Regions Hospital in St. Paul, MN. He has been teaching as an associate faculty for 24 years, at the University of Minnesota- Twin Cities teaching the Cardiopulmonary Course in the Doctor of Physical Therapy program. He has also lectured across the US on the topics of cardiac, pulmonary, trauma, and stroke rehabilitation for over 20 years. Henry has been a member of the APTA, APTA-MN, and the Cardiovascular and Pulmonary Section for more than 13 years. Henry is currently involved as a DEI mentor through several organizations and has a vested interest in breaking down barriers to have all patients receive excellent care regardless of racial, sexual orientation, cultural, and economic diversities. 

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