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Saturday, July 12, 2014

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COPD sufferers benefit from Y’s therapeutic exercise

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Program co-ordinator Josée Baillargeon, right, supervises Marie Quesnel at the YM-YWHA’s therapeutic exercise program. [Marlene Eisner photo]

MONTREAL — There was a time in Susan Burt’s life when she was taking aerobics classes four times a week in addition to having a busy career as a nurse at the Jewish General Hospital (JGH).

But chronic obstructive pulmonary disease (COPD) gradually robbed her of that vitality as the airways in her lungs narrowed. Three years ago, she was diagnosed with COPD, now the fourth leading cause of death in Canada. The incidence of this incurable combination of chronic bronchitis and emphysema is growing, experts say.

Mount Sinai Hospital (MSH), which has specialized in respiratory illness since it was founded a century ago, in conjunction with the JGH, is directing patients like Burt to an innovative therapeutic exercise program at the YM-YWHA that was developed by Josée Baillargeon, the Y’s therapeutic exercise co-ordinator and a former intensive-care nurse, and Esther Dajczman, a clinical nurse specializing in pulmonary disease at both JGH and MSH.

The goal is not only to preserve lung function, but to actually improve it. Participants in the program, started over a year ago, report feeling better and demonstrate increased endurance, strength and confidence.

Their progress can be measured through oxygen saturation testing, which shows how well the red blood cells are carrying oxygen through the arteries.

Using a simple finger pinprick, clients are checked three times in each class, at the beginning, during the session and at the end.

Burt, now 65 and retired, quit smoking decades ago, but she believes the pervasive second-hand smoke she grew up with and the 15-year cigarette habit she had in her youth took their toll eventually.

Inhalers helped her keep going, but Burt feels the Y program has markedly improved her overall health.

She began last January and is now in her fourth 10-week session.

“I find my whole body has benefited – not only my lungs – and I’ve lost weight,” she said. “Before, I had problems with my knees and hips, now I’m so mobile I can go up and down stairs almost normally. Also I don’t seem to get as many colds.”

Standard COPD treatment uses medication to control it, lifestyle changes (stopping smoking, avoiding infectious diseases) and basic rehabilitation to preserve function.

The medical profession has been skeptical about the benefits of putting patients on a sustained fitness regime.

Getting patients to continue to exercise on their own is often unsuccessful. Burt admits she would never have gone to a gym on her own.

“I’m amazed at their progress – and their motivation,” Dajczman said.

What is certain is that there are few, if any, such exercise programs outside a hospital setting in Montreal, and what does exist within institutions is very limited, she said.

Prospective participants are screened by a doctor and nurse to ensure that they can exercise safely in the community, Dajczman said. Taken into consideration are not only pulmonary function, but also heart, bone and joint health.

They are then assessed by Baillargeon, who customizes a routine suited to their abilities.

Learning breathing techniques is important for all of them. Shortness of breath is the primary symptom of COPD.

Each session includes two one-hour sessions per week over 10 weeks. Participants are encouraged to continue for as long as they want.

Classes take place in a space off the main gym equipped with adapted equipment and supervised by specially trained animators. There’s plenty of individualized attention, as groups usually have no more than four participants at a time.

A class typically consists of a half-hour cardio, usually on a bike or a treadmill, and a half-hour of weight training, normally eight to 10 exercises done in a circuit.

Strength, flexibility and cardiopulmonary conditioning are targeted, with the aim of improving participants’ functioning in everyday life. Education in nutrition, weight management and controlling stress is also provided.

The program is open to anyone of any age, but participants must pay a fee since it is not covered by medicare. The age range has been from the 40s to 80s. Participants have full access to all of the Y’s facilities for the duration of the session, and some enjoy other classes including yoga, tai chi or aqua fitness.

Compliance is not a problem. In addition to the attention from staff, the camaraderie among participants is a motivator.

Robert Martino, a retired oil company employee, smoked heavily for 50 years and paid the price. A year ago, he received a diagnosis of advanced COPD.

With Dajczman’s guidance he stopped smoking “just like that. I had my last cigarette Jan. 24.”

He’s now in his second session at the Y, and can’t recommend it highly enough. He’s planning on coming for a third one.

“I see a big difference. I can do much more. I can breathe better, which means I live better,” he said. “Before, I was out of breath just taking a shower.”

Today, he works out on the bike and the treadmill, and has increased the number of repetitions in his weight training.

Trainer Loni Kupferberg said, “The social aspect is important. They cheer each other on and there’s no competition. They are proud of each other’s progress.

“COPD patients are often fearful of exerting themselves because they become short of breath, which is scary. This can lead to isolation and loneliness.

“This program not only improves their fitness, but their confidence. I’ve seen them go from lifting three-pound dumbbells to eight pounds in one session, a difference that means they can carry groceries.

“They have told me I changed their life, which is very rewarding.”

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