Pulmonary fibrosis (PF) is a progressive lung disease characterized by the scarring of lung tissue, which impairs the ability to breathe. This blog will explore what pulmonary fibrosis is, what patients can expect, and how an exercise physiologist can play a crucial role in managing the condition.

Primarily pulmonary fibrosis involves the formation of excess fibrous connective tissue in the lungs, which leads to stiffening and thickening of the lung tissue. This scarring can result from various causes, including:
- Idiopathic Pulmonary Fibrosis (IPF): The most common form, where the cause is unknown.
- Environmental Factors: Long-term exposure to certain toxins, pollutants, or industrial chemicals.
- Medical Conditions: Some diseases like rheumatoid arthritis, scleroderma, and sarcoidosis can lead to PF.
- Medications: Certain drugs, particularly some chemotherapy agents and antibiotics, may contribute to lung damage.
 
Symptoms of pulmonary fibrosis can vary in severity; it may include and can be more than:
- Shortness of breath, especially during exertion
- Persistent dry cough
- Fatigue
- Unexplained weight loss
- Aching muscles and joints
As the disease progresses, these symptoms can worsen, significantly impacting the patient’s quality of life.
 
What to Expect
Living with pulmonary fibrosis can be challenging. The disease is progressive, meaning symptoms may gradually worsen over time. While there is currently no cure, there are treatment options that can help manage symptoms and improve quality of life. These include:
- Medications: Anti-fibrotic drugs can slow disease progression.
- Oxygen Therapy: Supplemental oxygen may be necessary as lung function declines.
- Pulmonary Rehabilitation: A program designed to improve the well-being of individuals with chronic respiratory issues.
- Lung Transplant: This can be to replace a damaged or diseased lung, and can be used as an effort to improve quality of life.
- Clinical trials: can be particularly important when treatment options are limited, as they are with PF. A clinical trial is a research study that tests whether a treatment works or not.
 
The Role of an Exercise Physiologist in the Management
An exercise physiologist (EP) specializes in developing safe and effective exercise programs tailored to individuals with various health conditions, including pulmonary fibrosis. This scope of practice places an Exercise Physiologist in the above Pulmonary Rehabilitation category which can consist of:
1. Personalized Exercise Plans
An EP will assess the patient’s fitness level, limitations, and specific needs to create a customized exercise program. This plan may include:
- Aerobic Exercise: Walking, cycling, or swimming to improve cardiovascular fitness and lung function.
- Strength Training: Exercises to build muscle strength, which can enhance overall endurance and functionality.
- Flexibility and Balance Training: Activities such as stretching or yoga to improve mobility and reduce the risk of falls.

2. Improving Respiratory Function
Through guided exercises, an EP can teach patients breathing techniques that enhance lung capacity and efficiency. Techniques such as pursed-lip breathing and diaphragmatic breathing can help alleviate breathlessness.

3. Monitoring Progress and Adjusting Programs
An exercise physiologist will monitor the patient’s response to exercise and adjust the program as needed to ensure safety and effectiveness. Regular assessments help in tracking improvements and addressing any concerns promptly
.
4. Education and Support
EPs provide valuable education about the importance of exercise, self-management strategies, and lifestyle modifications that can improve overall health and well-being. They can also offer emotional support and motivation, fostering a sense of community and encouragement.

5. Collaboration with Healthcare Teams
Exercise physiologists often work alongside other healthcare providers, including pulmonologists, physical therapists, and dietitians, to provide comprehensive care for individuals with pulmonary fibrosis.
 
Where to from here
Pulmonary fibrosis is a serious condition that can significantly impact quality of life. While there is no cure, understanding the disease and its management options can empower patients. Exercise physiologists play a vital role in helping individuals with pulmonary fibrosis maintain physical activity, improve respiratory function, and enhance their overall quality of life. If you or a loved one are dealing with this condition, consider reaching out to an exercise physiologist to explore how tailored exercise programs can support your health journey along with the other professionals involved in this process.

Extra Resources
Lung Foundation Australia: https://lungfoundation.com.au/patients-carers/living-with-a-lung-disease/pf/overview/

Exercise Right: https://exerciseright.com.au/lung-conditions/

Written by 
Thomas Harrison
AEP, AES, ESSAM

What is Chronic Obstructive Pulmonary Disease (COPD)?
Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term for a cluster of lung conditions which include Emphysema, Chronic Bronchitis and Chronic Asthma. These conditions cause narrowing of the bronchial tubes (tubes that carry air to the lungs) which can make it hard and difficult to breathe.

Smoking and air pollution are currently the most common causes of COPD. Having COPD also places and individual at greater risk of developing other health conditions. Common methods to improve symptoms include avoiding smoking, avoiding exposure to air pollution, undergoing oxygen and pulmonary rehabilitation, and taking medication. Whilst COPD is uncurable, early treatment and diagnosis may help individuals manage their condition and ultimately breathe better.  

Common symptoms associated with COPD
Individuals are often diagnosed with COPD from mid-life onwards. As COPD becomes worse individuals may find it more challenging to complete their normal activities of daily living. The most common symptoms of COPD include breathlessness and difficulty breathing, chronic cough (either with or without phlegm) and feeling tired and fatigued.

At times individuals can experience flare ups, which occur when COPD symptoms become worse. These flare ups usually last for 2 – 3 days and will require medication to treat.

Individuals with COPD are at a higher risk of developing other chronic health conditions which include.

• Depression
• Anxiety
• Cardiac concerns
• Lung infection and cancer
• Flu or pneumonia
• Weak muscles and brittle bones

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Severity of COPD
Like with most chronic health conditions, there are different severities and different diagnostic criteria for each. The below definitions may be useful to help understand the diagnostic criteria for the different severities of COPD.

• FEV1 = the amount of air that can be forced out of your lungs within 1 second
• FVC = the total amount of air that can be forced out of your lungs
• Bronchodilator = medications (usually administered via a puffer) that relax and open the airways in the lungs 

How is COPD diagnosed?
There are multiple types of tests that are used to diagnose COPD. Specifically, lung tests that test breathing (which is known as spirometry) is the most common assessment that is used to diagnose COPD. These assessments assess how much air you can breathe in and out of your lungs as well as how stretchy your lungs are (e.g how quickly you can forcefully expel air from your lungs).
Other assessments that may be performed include:

• X-ray: takes images of the lungs and the surrounding organs
• CT scans: takes images of the lungs and surrounding organs at a greater detail than x-rays
• Arterial blood analysis: determines how well your lungs are able to bring oxygen into the blood and remove carbon dioxide
• Laboratory tests: used to rule out the diagnosis of other conditions

 
How does exercise benefit those who have been diagnosed with COPD?
Like with many health conditions, multiple health benefits are achievable when participating in exercise that is specifically tailored to the individual. The below benefits can be viewed below.
Exercise can increase

• Energy levels
• Cardiovascular fitness
• Immune strength
• Muscle strength and endurance
• Sleep quality and duration
• Bone mineral density
• Reported self-confidence, self-esteem and body image

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Exercise can decrease

• Breathlessness and the sensation of being out of breath
• Risk factors for the development of other disease
• Blood pressure
• Cholesterol
• Medication side effects
• Hyperinflation – when the lungs expand upon their normal size
• Feelings of depression and anxiety
• The amount of air (or ventilation) required at a given work rate  

Things to consider when exercising with COPD

• Monitoring peripheral oxygen saturation levels using a pulse oximeter. Peripheral oxygen levels ≤ 88% is a contraindication for exercise.
• Managing breathlessness. The recommendation is nasal breathing on inhalation, pursed lips breathing during exhalation.  
• Managing fatigue levels. Often people with COPD may experience early onset fatigue due to reduced oxygen to muscles.

Exercise recommendations for those with COPD
According to the most recent research, the below is the evidence-based exercise recommendations for those who have been diagnosed with COPD.
Frequency

• Aerobic: 1-2 sessions, 3-5 days per week
• Strength: 2-3 days per week
• Flexibility: 3 or more days per week, preferably on days that aerobic or strength exercise is performed

Intensity

• Aerobic: 40 – 80% of maximal effort (modified borg 2 – 4)
• Strength: 60 – 80% of maximal effort (modified borg 3 – 4)
• Flexibility: low to moderate, depending on capability and function

Time

• Aerobic: 30 minutes, broken into smaller durations if necessary due to symptoms
• Strength: 1 set of 8-12 reps, 8-10 exercises or 30 – 40 minutes
• Flexibility: 30 seconds minimum for each static stretch

Type

• Aerobic: walking, cycling, swimming
• Strength: free weights, therabands, inspiratory muscle training, body weight exercise,
• Flexibility: stretching, tai chi, yoga

 
Written by - Rebecca Dostan: AES, AEP, ESSAM

 References
Exercise is Medicine 2024, Chronic Obstructive Pulmonary Disease (COPD) and exercise, viewed 16 October 2025, <2014-COPD-FULL.pdf (secureserver.net)>.

Lung Foundation Australia 2024, Overview – Chronic Obstructive Pulmonary Disease, viewed 11 October 2024, <Overview - Chronic Obstructive Pulmonary Disease (lungfoundation.com.au)>.

Lung Foundation Australian 2024, Exercise Prescription – A reduction in exercise tolerance is one of the main complaints of people with chronic lung disease, viewed 18 October 2024, <Exercise Prescription and Training | Pulmonary Rehabilitation Toolkit>.

World Health Organization 2024, Chronic obstructive pulmonary disease (COPD), World Health Organization, viewed 15 October 2024, <Chronic obstructive pulmonary disease (COPD) (who.int)>.