Catching Your Breath: Exercise with a Chronic Respiratory Condition

In my early teens, I started having trouble breathing. I noticed it mostly during gym period (cue traumatic recall of the Presidential Fitness Test) and dance class. I don't remember the process of being diagnosed, but before long I had an inhaler for exercise-induced asthma. Then, in my junior year of high school, while preparing for the role of Diana in A Chorus Line, I completely lost my voice. For weeks. 

The ENT doctor performed a laryngoscopy and determined that the steroids in my inhaler had caused chronic laryngitis. My inhaler was changed and I got my voice back. But, I had to sit out the first weekend of A Chorus Line performances and when I finally stepped into the role the following weekend, I made the only error I've ever made on stage (completely blanking on my song lyrics). 

This humiliation was one of many low points of high school and frequently shows up in my nightmares. I would later realize that growing up with a coal furnace for heating where one of my winter chores was to shovel a fresh, dusty pile into the flames each afternoon, wasn't great for my lungs. Things improved when I moved away for university, though it still flares up during allergy season or if I get a cold. I was lucky that avoiding pollution was an option for me.

Every Breath You Take

Chronic respiratory diseases (CRD) are a group of common disorders associated with inflammation or damage in the trachea, bronchi, alveoli (gas-exchanging tissues of the lungs), and chest cavity. 1 in 5 people in Scotland and the UK has a long-term respiratory condition. Asthma is the most common, with roughly 1 in 10 children and 1 in 15 adults affected globally. According to Asthma and Lung UK, 8 in every 100 UK residents is living with asthma. A Lancet report in 2020 found that roughly 14 percent of all children globally are affected by asthma.The ability to diagnose and treat asthma varies widely around the world, alongside access to health care services and clean air. Unfortunately, an asthma diagnosis is a risk factor for developing another CRD later in life, such as chronic obstructive pulmonary disease.

Chronic Obstructive Pulmonary Disease (COPD) is the umbrella term for lung conditions where airflow during exhale is compromised due to permanent narrowing of the airways and/or damaged lung tissue. It includes chronic bronchitis and emphysema. COPD is the fourth leading cause of death according to the World Health Organization. Common COPD symptoms include chronic cough (sometimes with phlegm), shortness of breath (dyspnea), wheezing, and tiredness. COPD is the second most common lung disease in the UK. An estimated 1.2 million people in the UK have a diagnosis of COPD, affecting approximately 4.5 percent of people over the age of 40.

Because of the variation and frequent overlap in presentation of the spectrum CRDs, they share many characteristics, such as breathlessness on exertion, recurring acute exacerbations and sensitivity to allergens. Smoking and household pollution (such as that caused by use of solid fuels for heating) are the predominant risk factors for developing chronic respiratory disease worldwide. There are many other types of CRD but because of its significant contribution to worldwide disability,  mortality and cost, COPD is the one most frequently studied. Findings from these studies can be applied to most other CRDs since there’s some commonality of symptoms.

Whole Body Impacts

For patients with COPD, exercise is almost always recommended except in extreme cases of hospitalization and/or with additional health risks (e.g. recent myocardial infarction). Typically, exercise training is accompanied by education and inspiratory training to improve daily clearance of phlegm from the lungs. Increasing strength makes it easier to complete the required tasks of daily life, extending independence. Improved cardiorespiratory endurance through aerobic training can minimize fear of breathlessness, leading to a greater sense of agency and self-reliance. And for someone living with a chronic illness, getting back a sense of control can be life-changing.

CRDs may be situated in the lungs but may have effects elsewhere in the body. Metabolic changes may result in nutritional depletion and unfavorable changes in body composition. Loss of muscle mass throughout the body, but in the legs in particular, is common among advanced CRDs. The combination of reduced oxygen absorption and long term corticosteroid use also increase risk of osteoporosis, for which muscle mass has a protective function. The combination of low bone mineral density and muscle loss can open the door to frailty and related health risks that directly impact quality of life and longevity.

For CRDs as with so many other chronic conditions, exercise can play a powerful role in reversing or slowing negative effects. Exercise has not only been found to improve quality of life and mental health in respiratory conditions. It has also led to improved maximal oxygen uptake (marker of cardiorespiratory fitness) and overall capacity for exercise.

Gain Strength, Stay Independent

Working to restore muscle volume, endurance and power is an important part of rehabilitation for every CRD. Strength training is a part of first line treatment with osteoporosis, as loading of the muscles has been shown to improve bone mineral density in the areas trained. While aerobic training is ideal for slowing ventilatory decline and preserving function, recent research has begun to show clinical improvements in respiratory capacity from resistance training alone. This is particularly relevant for individuals with significant ventilatory limitations where strength training may be prioritized due to reduced demand on the cardiorespiratory system. Resistance training is recommended 2-3 times per week.

Improve Exercise Tolerance, Stay Active

For many, fear of breathlessness is a major obstacle to getting active with a CRD. This sensation understandably provokes fear and for most, avoidance is the more comfortable option. Exercising at the appropriate intensity can desensitize the participant to breathlessness over time. This coupled with the physical adaptations accommodate consistent exercise can result in improved stamina and endurance, not to mention overall function.  In other words, the asthma may not change, but positive adaptations to exercise are STILL possible in the face of airway resistance. This includes tolerance of, and comfort with, respiratory limitations.

Reduce Exacerbations, Stay out of Hospital

The tendency toward acute exacerbation is a hallmark of chronic respiratory diseases. High frequency of exacerbations is an important factor in health-related quality of life for patients with a CRD. The general systemic benefits of repeated bouts of exercise include improved immune system function, reduced inflammation and improved mood. All of these are relevant in the prevention of exacerbations in CRD and reducing time spent in hospital as a result. This is essential for overall longevity and quality of life as hospitals carry their set of risks - particularly among older adults. Physical activity of all intensity levels has been associated with reduced hospital admission and overall risk of mortality.

The Role of Pilates in CRDs

In general, all adults should engage in some combination of aerobic, resistance and balance training to reduce health risks and sustain an active life. Persons living with a CRD should target roughly 80 percent of cardiovascular capacity in aerobic exercise and extend the duration as able with repeated practice. Pilates will never offer the equivalent aerobic challenge as say, fast-paced walking, swimming or cycling. Its strength lies in making resistance and balance training accessible to all fitness levels, as well as incorporating breathwork to improve the capacity of respiratory muscles, particularly in exhalation.

A 2025 study published in the Canadian Journal of Respiratory Therapy found that adding a Pilates exercise program to pulmonary rehabilitation resulted in superior strength of respiratory muscles, higher resistance to exercise-based fatigue, and improved balance. Improvements were seen consistently at 6 and 9 months compared to the control group. As a movement rehab clinic incorporating both clinical exercise physiology and Pilates training, Movement Remedies can offer both in-person sessions and at-home programming in support of CRD rehabilitation. Get in touch to learn more.