Parameters taken into account can be examined easily in patients with a high degree of severity without performance diagnostics and technical tools. This enables the implementation of a training program. At this point, an extensive demonstration of heart rate on exertion and the metabolism's reaction (lactate) will be left out.
In general, it is possible and reasonable to control a training program in terms of heart rate ("heart rate monitor watch", "exercise pulse rate") in cases of mild COPD or if an exercise stress test has been conducted.

Tab.1: With an increasing degree of severity of COPD the following applies

Performance is, above all, restricted by not enough air [ventilatory limitations] and not by cardiac output or other factors.

The maximum work rate (Wmax or the so-called maximum oxygen intake [VOmax]) is reduced. Determining an exercise intensity based on general insights (e.g. Basic endurance at 60-70% of VO2 max) is not possible anymore.

Further, general formulas (often recommended as "the ideal training zone" in brochures and on the internet, e.g. heart rate 180, age etc.) increasingly lose their validity. General experiences with training programs for healthy people and people of older age can only be used to a limited extent or need to be modified.

Breathing: how often and which rhythm

Breathing is an important point of reference in controlling the training. It is ascertained:

  • How often one breathes (Breathing frequency (Bf): number of breaths in a minute)
  • In which rhythm one breathes (Respiratory rhythm; e.g.: 2 steps inhaling, 4 steps exhaling.
Tab. 2: Intensity and respiratory rate at moderate-low exercise tolerance
Intensity of activity Breathing frequency (breaths/minute) Time/breath (theoretical, rounded)
Rest 12-15 4 Sekunden
Light to moderate intensity 18-24 3 Sekunden
Vigorous intensity 30 2 Sekunden
Extemely vigorous intensity 35/40 1,5 Sekunden
In practice, the respiratory rate is examined by counting breaths over a period of 10 seconds.1 x inhaling + 1 x exhaling equals a complete breath. In order to convert this to a period of 1 minute the result is multiplied by 6.

Important: apply pursed-lips breathing but never intend to breath more slowly in order to achieve a "better" respiratory rate. This method can only work if it examined how one actually breathes.

Helpful exercise
Place a watch with a seconds hand next to you. Take a long straw in your mouth and try to breath according to the times for different kinds of exertion one after another for approx. 1-2 minutes through the straw (1 breath = 1 inhaling +1 exhaling). In due time, you will find that the time for exhaling does not suffice anymore; usually at 3 seconds or less. You can press as much air as you want through the straw. If a COPD patient "pressed", meaning no slow, controlled and cautious exhalation using pursed-lips breathing, the airways would collapse and in no time, the patient would not be able to move anymore air. The consequence would be termination of exertion after a short time due to breathlessness- not enough litres of air for the given exertion.

Recurring movements (such as walking, climbing stairs, cycling) can reveal the rhythm of inhalation and exhalation. The number of steps is assessed, this is done during inhalation in relation to the number of taken steps during exhalation (e.g. 4 steps inhaling: 4 steps exhaling=4:4) or cycles when bicycling, respectively. Illustrations of appropriate respiratory rhythms for certain activities in daily life, for endurance and strength exercises can be found in the respective chapters.

Did you know?
You are not able to feel desaturation/dropping oxygen saturation. It can only be measured. This helps in controlling and avoiding damages (up to which level of exertion does the saturation stay constant?).