Treadmill workout and oxygen

Question

Hello!

I have been dependent on oxygen for quite some time. Recently I was given a treadmill as a gift and would now like to work out effectively.

Currently I am trying intervals, alternating 8 km/h until the oxygen saturation sinks below 85% and 4 km/h in order to relax (at 6 l O2). I do this twice every day.

Does this make sense, or what would be a better way to do it?

Kind regards.

Answer

Hello,
as a rule, working out on a regular basis is very beneficial to patients with cystic fibrosis, regardless of their limitation in physical resilience. Apart from muscle formation, this particularly concerns physical working capacity as well. This is true even in a situation where the patient has started to become continuously dependent on oxygen. In endurance sports, workout regulation is frequently based on heart rate, or rather a certain percentage of the estimated maximum heart rate adapted to age and gender. Unfortunately, this is not ideal for CF patients, since in most cases they do not reach those maximum values due to their limited physical working capacity. However, corresponding heart rate cut-offs could be defined by an exercise testing.
There are general recommendations that the partial oxygen pressure should not fall below 90% during physical exercise; this corresponds to an arterial partial oxygen pressure of about 60mmHg.
A decline in partial oxygen pressure to 85% or below, corresponding to about 50mmHg or less, already means a significant reduction of the amount of oxygen that is available for the tissues. Therefore it is recommended not to fall below this threshold of 90% oxygen saturation during exercise. There are different ways in order to achieve this:

1) The oxygen supply during exercise is increased to a degree in order to maintain the borderline of 90% saturation. As you already exercise with 6l/min oxygen, this is probably still possible only to a certain extent.
2) Before exercise, inhalation in combination with physiotherapy is performed in order to clear as much secretion as possible from the bronchi, with the effect of an improvement of oxygen uptake during exercise.
3) The interval training can probably be modified in such a way that the marked decrease in oxygen saturation during exercise can be avoided and training still remains effective. Here could probably serve a program from cardiologic rehabilitation, that is also effective in severe lung disease in the frame of CF: 10 times 30seconds of exercise with a high intensity followed by 60seconds active pause. The degree of exercise intensity is defined with the help of a so-called “steep ramp- test”.
4) In special cases it also could be necessary to exercise with breathing support (BIPAP).
In addition to the exercise on the treadmill we would also recommend strength training one to two times a week, which does in general not lead to such a marked decrease of oxygen saturation. Especially at the beginning, the strength training should be performed under physiotherapeutic supervision, in order to avoid possible complications such as pneumothorax due to wrong breathing technique etc. Aim of the strength training is an increase of strength endurance not of the maximum strength, especially also of the upper body. After strength training a certain fatigue of the muscles is allowed, however you should not feel exhausted and should give your muscles enough time to recover before the next training. One possibility would be to realize this training via a so-called medical training therapy (this is offered by many physiotherapy offices).
Please discuss the above mentioned possibilities with your CF-center. It is necessary to investigate your physical working capacity in the frame of a so-called spiroergometry as exercise testing (bike-ergometry with measurement of breathing gases via a mask) for an optimal planning of the training and also for the detection of possible exercise-associated risks such as cardiac arrhythmias. Besides the measurement of heart rate and blood pressure, this investigation gives information on the oxygen uptake and on other important values for the measurement of the physical working capacity and the possibility of exercise intensity.
Best regards,
Wolfgang Gleiber und Helge Hebestreit

01.08.2012