Hello and welcome to the Canadian Lung Association's BREATHE Better, Stay STRONG virtual pulmonary rehabilitation program. I'm very happy that you decided to join us today.

If you have COPD, which includes emphysema and chronic bronchitis, if you have asthma, bronchiectasis, or cystic fibrosis, this program is for you.

If you have interstitial lung disease, which includes sarcoidosis and many types of pulmonary fibrosis, this program is for you, too.

But if you have pulmonary hypertension or waiting for lung transplant or volume reduction surgery, talk to your provider about a supervised pulmonary rehabilitation program.

This program is intended for Canadians living with moderate to severe chronic lung disease who've had a lung function test and whose healthcare provider has recommended or prescribed pulmonary rehab.

You might wonder how exercise helps your breathing, especially since it makes you feel short of breath.

Lung disease causes a cycle where you begin to feel more breathless doing activities that you enjoy, so you tend to do less. This causes your muscles to get weaker and deconditioned. When this happens, the muscles require more oxygen to function, which makes you feel more breathless.

As your fitness level declines, it becomes more difficult to perform the same daily functions. As a result, less is done and the decline continues.

To reverse this cycle, performing exercises through live or virtual lung health and rehabilitation programs helps you to increase your fitness level. Exercise also allows your heart and your lungs to work more effectively together so that you can circulate oxygen throughout your body.

As your muscles get stronger, you're able to accomplish more and suffer less from breathlessness.

Finally, exercise not only helps you physically but also emotionally.  As you gain confidence in your physical ability and feel less restricted by symptoms of your disease, your level of  anxiety is likely to decrease and your sense of joy and optimism is likely to increase.

BREATHE Better, Stay STRONG is an eight-week program that offers education, exercise and resources.

For you to benefit most from this program,  be sure to follow this program sequence from beginning to end, participating three times per week.

This might seem challenging at first, but if you start small you're sure to finish strong.

The education portion of this program will cover important health topics that focus on understanding your disease, managing your symptoms, conserving energy, understanding your medications and oxygen therapy. The education topics will also cover breathing techniques, airway clearance, nutrition mood, advanced directives and, of course, smoking cessation.

The exercise portion of this program will focus on retraining your respiratory muscles, stretching upper and lower body strength and aerobic exercise. These exercises will help improve your stability and flexibility, strength and endurance, making it easier and safer for you to perform activities of daily living.

After completing the BREATHE Better, Stay STRONG program, you might have fewer symptoms of cough, fatigue and shortness of breath.

You may find that your energy level is higher, your stress level is lower and your quality of life is improved.

You will feel better able to make healthy choices that manage how well you live with your lung disease.

The BREATHE Better, Stay STRONG mission is to help you live happier and more confidently so that you can do the things that you enjoy with the ones that you love, 
living with fewer symptoms of chronic lung disease and fewer hospitalizations.

Please note: if you are having increasing symptoms of a flare-up or an exacerbation, start your action plan if you have one, or contact your healthcare provider.

When this is the case, wait for your symptoms to settle down completely before starting or restarting the program. It's okay to take a break, just come back when you're well enough.

So now, if you're ready let's get started, click below to learn how this program works.

Before we begin exercising, let me say that your safety comes first. I want to make sure that your provider says that it's safe for you to exercise. I also want to make sure that you exercise safely.

• Keep your workspace clutter free to avoid accidents.
• Wear shoes with traction to avoid slipping.
• Wear comfortable clothes that are not restrictive around the waist to make it easier to breathe.
• If you use oxygen, make sure that your oxygen is set correctly for exercise.
• If you have a pulse oximeter, periodically check your oxygen saturation level. You want to keep it over 90%.
• Feel free to pause the video do some recovery breathing or pursed-lip breathing and join us again when you're ready.

If you have hand weights or ankle weights at home, that's great, but there's no need for special equipment. Household items can be used instead of weights. You can use water bottles, soup cans, shampoo or detergent bottles. You can use fruits if you have them handy.

As your fitness level increases, the number of repetitions that you will perform will increase as well. We will start with eight repetitions and increase to 15.

If you can perform 15 repetitions at a specific weight, then it's time to increase your weight by half a kilo or a kilogram and return to eight repetitions of the new weight.

Exercise should not hurt. Only you know the limits of your range of motion. If you cannot raise your arm over your head due to shoulder pain, only do what is comfortable.

Exercising at a moderate level will cause some muscle fatigue, some shortness of breath and some perspiration. This Scale of Perceived Exertion is your guide to the intensity of your workout. You should exercise between a three and a five on the scale.

Another quick reference to know that you're exercising at the right level is that you should be able to speak your phone number in one breath. If you develop dizziness, chest pain or extreme shortness of breath at any time, stop exercising. If it does not resolve, get medical attention.

Many of the exercises that have been selected are to help maintain or improve your daily functions. The goal is to be able to exercise with us two to three times per week.

Alex will lead you through most of the exercises and I will join him to show modifications or progressions for different ability levels.

Another goal is to stretch and do 30 minutes of cardio five to seven days per week.

The exercise program has been set up so that you can access the warm-up and the cool down stretches separately.

A home walking program chart has also been added to help you increase your cardio to 30 minutes over the eight-week program.

If you're ready, let's begin!

Warm Up

Pursed-lip breathing

Using a tall posture, which means sitting tall and shoulders relaxed and away from your ears, feet hip width apart for stability.

We begin with pursed-lip breathing. Take a normal breath in through your nose for a count of 2, pucker or purse your lips, and exhale through your pursed lips for a count of 4.

Inhale through the nose for 2, pursed-lips to exhale for 4.

Neck stretches

Still using a tall posture, place hands on thighs.

Inhale through your nose. Turn your head to look over your right shoulder and then down to the floor.

Exhale through your mouth as you bring your chin back over your right shoulder again, and then back to center.

Inhale and look over your left shoulder, then down to the floor.

Exhale through your mouth to bring your chin over left your shoulder again and back to center.

Shoulder rolls

Tall posture, relaxed shoulders, let your arms relax by your sides.

Inhale as you roll your shoulders up and back, opening the space in your chest,

And exhale as you roll your shoulders down and to front center.

Perform two more times.

Let’s go the other way now. Shoulders relaxed, arms by your side. Inhale as you roll your shoulders down and back, opening your chest, exhale as you bring your shoulders up, forward, and then back to center.

Elbow presses

Tall posture, raise your elbows shoulder height with your arms bent in front of you.

Inhale as you pull you elbows away from each other.

Exhale as you press your elbows together again in the center.

Inhale to pull them apart, and exhale to press them together.

You can also do a doorway stretch by placing your forearms on a door frame, with your feet staggered shoulder width apart. Inhale as you lean into the doorway, exhale as you return to a resting position.

Overhead stretch

Sitting tall, inhale and reach your arm straight up to the ceiling. Feel the stretch in your side.

Do not lean when you are doing this stretch. Exhale to return your arm down to your side.

Switching arms, inhale and reach for the ceiling. Feel the stretch and bring your arm back by your side. If you have shoulder pain, only go as far as is comfortable.

Wrist circles

With your hands in front of you, roll your wrists 3 times in one direction, and 3 times in the opposite direction.

Hamstring stretch

Tall posture, sitting toward the front of your chair, inhale and stretch your right leg forward.

Keep your back straight, exhale as you bring your chest toward your thigh and hold the stretch for 3 to 5 seconds.

Inhale to sit tall, and relax. Inhale and bring your left leg forward, exhale to bring your chest to your thigh and hold the stretch for 3 to 5 seconds. Inhale to sit tall and relax.

Hip flexor stretch

Tall posture, place your hands on your knees.

Keep your knees facing forward as you bring your right leg from center to the right side and back to center. Perform two more times.

Then the left leg: center, left, and center.

To make it a little harder, keep your hands on your knees, move your feet and knees apart at the same time, then back together.

Glute squeezes

Tall posture, sitting at the edge of your chair, inhale and squeeze or clench your bottom and pelvic floor for 3 seconds.

Exhale to release the hold.

And again, inhale as you squeeze for 3,2,1 and exhale to relax.

Ankle circles

Relax, sitting tall, do ankle circles in one direction 3 to 5 times, then in the other direction.

Upper Body Strength

As you begin this section, please remember that if you should feel short of breath, you can pause the video, do some pursed lip breathing or recovery breathing and press play to continue when you are ready.

Exercise can loosen mucus in your lungs. You can pause the video for airway clearance and huff coughing and press play to continue when you are ready.

Shoulder press

Tall posture, relaxed shoulders, feet hip width apart. You can be seated or standing, with or without weights, keeping your back straight.

Begin on the right. Place your right hand by your right shoulder, inhale as you press up to the ceiling, exhale as you lower to your shoulder.

Know your limits. If you can not raise your arm up completely, try raising your elbow toward the ceiling.

Other side. Bring your hand to your shoulder, inhale and press up to the ceiling, exhale to lower.

Bicep curl

Sitting or standing tall, feet shoulder width apart. Start with your arms by your side, palms facing your leg.

Inhale and bend at the elbow to bring your right hand up to your shoulder, with your palm facing up.

Exhale to control your arm as you lower it to rest.

You can choose to do all of the repetitions on one side first, and then all on the other side or you can choose to alternate right, then left, right then left.

Grip strength

Grip strength exercises can be done with a ball, a fruit or a weight.

Raise your arms in front of you to shoulder height.

Holding your ball in the right hand, bring it to the right side, no further than your shoulder.

Return to center and grasp it with your left hand.

Bring your left hand laterally to the left side and return to center to grasp the ball with your opposite hand.

Triceps kickback

Seated or standing with your feet staggered, one in front of the other, hip width apart.

Bend your elbow 90 degrees with your hand by your hip, push back to straighten your arm behind you. Return your hand to hip height.

Do the right side first, and then the left. If you are standing for this exercise, you can alternate.

Oblique crunches

Tall posture, seated or standing, with feet flat on the floor, palms facing your inward.

Keep your body straight, inhale then exhale to lean to the right bringing that arm closer to the floor.

Inhale again, engage your abs and exhale as you use your left-side muscles to return you to the starting position. Do not hold the seat of your chair as you should be using your abdominals.

For a deeper exercise, place the palm of your left hand on the back of your head with your elbow pointing to the left. Inhale, then exhale to lean to the right. Inhale, engage your abs, then exhale as you use your left elbow to pull yourself straight.

Check your rate of perceived exertion.

The intensity of your workout should be between 3 to 5. Can you say your 10-digit phone number in one breath?

Upper Body Endurance Exercises

Upper body endurance exercises are designed to improve flexibility, stability, balance, functional living. Perform each of the following exercises for 30 seconds while seated or standing.

Shake it off

Shake out your arms to release tension, increase circulation especially good after strength training.

Buckle up

This exercise mimics putting on your seatbelt.

Playing the piano

This exercise is great for moving objects in a sweeping motion shifting your weight.

Don and doff

To find the correct movement, pretend you are taking off a sweater.

Shadow boxing

Work through a repetitive sequence of jab – jab - upper cut – upper cut.

Stirring the pot

This is a good exercise for strengthening your abdominal and back muscles.

Up-downs

This exercise mimics putting items on or removing items from a shelf.

Breaststroke

This swimming motion is also similar to the movement required to open curtains.

Pulling weeds

This is a great exercise for improving balance as you reach for bend to the side to pull or pick up items.

Renew

This move uses your hands, arms, shoulders, chest and back. Use pursed-lip breathing to inhale, bringing new energy into your body, and exhale to push old energy away from your body. Go at your own pace.

How’s your exertion?

Are you still between 3 and 5? Can you carry on a small conversation?

Lower Body Strength Exercises

Larger muscle groups are found in the lower body. Using these muscles often causes increased shortness of breath.

Sit-to-stand

Tall position, sitting at edge of seat, with your feet staggered or even hip width apart.

Place your hands on your thighs, inhale and lean your chest over your knees.

Exhale to lift to standing.

Inhale, bend slightly at the waist and exhale to return to sitting.

For a modified version of this exercise cross arms over chest, or hold weight at chest level. If feet are staggered, change the lead foot after 4 repetitions.

Knee raises

Tall posture, seated. Lift your right knee and hold for 3 seconds, repeat with your left knee and hold for 3 seconds, continue to alternate until you complete your repetitions.

Tall posture, standing, holding the back of the chair, raise your right knee and hold for 3 seconds, lower, raise your left knee and hold for 3 seconds and lower. Continue until you have finished.

To modify this exercise, hold the back of the chair with all fingers, 4 fingers, 3 fingers, 2 or 1 finger based on your stability. Ankle weights can also be used.

Seated leg extensions

Tall posture with hands on thighs. Inhale as you raise you right leg straight forward.

Hold your leg up for 3 seconds. Exhale as you lower your leg.

Inhale as you raise your left leg and hold for 3 seconds. Exhale as you lower your leg.

For more comfort, you can place a rolled towel under your legs. You can use an ankle weight for more resistance.

Leg raises to the back

This exercise is more easily done standing but can also be performed seated.

Stand tall, ears over shoulders, shoulders over hips, abs and gluteus engaged.

Hold the back of your chair. Keep your knee facing forward and raise your leg to the back to tap your tow on the floor or lift you the floor. You can use an ankle weight for more resistance.

Heel–toe raises

This exercise can be performed seated or standing.

Using a tall posture, hold the back of a chair.

Raise up onto your toes, lifting your heels off the floor, and roll back onto your heels, lifting your toes off the floor.

As your strength and balance improve, you can use fewer fingers to hold the chair. Try to keep your body in line for better balance.

Leg raises to the side

Tall posture. Hands on the back of a chair or on your waist.

Keep your knee forward as you raise your right leg to the right side.

You can tap the floor and raise it completely off the floor. Ankle weights can be used.

Check your rate of perceived exertion.

There is usually more exertion felt with lower body exercises. Is your level of exertion still between 3 and 5? Can you say your 10-digit phone number in one breath? or maybe about your 7-digit number?

Lower body Endurance (Cardio)

Marching on spot

This can be done seated or standing. You can also stand beside a chair and hold with one hand.

To modify, this exercise can be performed using high knees or ankle weights.

Side step

This exercise is more easily done standing.

Standing tall, take a step to the right and kick your left foot back. Take a step to the left and kick your right foot back.

A modified version of this exercise would be a standing grapevine to the left and right.

Dead-lift lunge

This can be done seated or standing, with weights or without.

Use a tall posture, stagger your feet, keep your back straight and hinge forward from your hips.

Keep your gaze forward as you lower your arms by your side.

Inhale as you bend your left knee to lunge back with your right leg.

Raise your bent arms to chest level.

Exhale as you return to a standing or sitting neutral position.

Inhale as you bring bend your right knee to lunge back with your left leg, raising your bent arms to chest level.

Exhale to return to a standing or sitting neutral position.

Draw a triangle

Sitting tall at the edge of your chair or standing tall, looking forwards, not towards the floor. This improves your center of gravity and prevents accidental falls.

Inhale and slide or tap your right foot to the front and side.

Exhale to slide or tip your foot to the back and center.

Inhale and slide or tap your left foot to the front and side.

Exhale to tap or slide your foot to the back and center.

Stair stepping

You can use stairs in your home or a low stepstool. If you are using a stepstool, please hold the side of your chair or a countertop for balance.

With your right hand holding the rail or counter for stability, step up with your right foot, up with your left, down with your right, then down with your left.

Right up, left up, right down left down.

Perform for 30 seconds then lead with the left.

With your left hand holding the rail or counter for stability, step up with the left foot, then up with the right, down with the left foot, then down with the right.

Left up, right up, left down right down.

How is your exertion level? Are you still between 3 and 5?

Cool Down

Lower body

Tall posture. Inhale, bring your right heel onto your knee, hinge forward as you look forward and hold for 10 seconds, breathe.

Inhale, lower your leg into a hamstring stretch and hinge forward and hold for 10 seconds, breathe.

Flex your ankle for 3 seconds then point your toes for 3 seconds.

Exhale to return to neutral. Repeat with the left side.

Upper body

Tall posture seated or standing with your feet hip width apart.

Inhale and reach your right arm overhead as best you can.

Exhale to bend at the elbow and tap your back, because you’ve done a great job!

Hold that stretch for 10 second as you inhale and exhale.

Inhale and exhale to bring your right arm across your chest and hold for 10 seconds.

Inhale and bring your right arm forward, palm up, and stretch your fingers to the ceiling with just a little tension, for 3 seconds then flex them downward with a little tension for 3 seconds.

Rotate your arm to palm down, point fingertips downwards with a little tension for 3 seconds, then upwards for 3 seconds.

And relax. Repeat with the left side.

Neck

Lean your right ear toward you right shoulder.

Gently rest your right hand on your head without pulling. Hold the stretch for 10 seconds, breathing through the stretch.

Repeat on the left.

Repeat, looking toward the floor. Finally, looking toward the ceiling.

Diaphragmatic breathing

Diaphragmatic breathing is a great way to end your workout. This allows more air to move in and out of the lungs by using your diaphragm and abdomen when your chest, shoulder and neck muscles are tired.

Sit back, relax your neck and shoulders. Place your right hand on your chest and your left hand on your stomach.

Your diaphragm is an important muscle just below your lungs. As you push your diaphragm down toward the floor, your belly will push outward and your lungs will fill with air.

As you move your diaphragm up toward the ceiling, your belly will squeeze inward and air will be pushed out of your lungs. You should notice that the hand on your chest remains still while the hand on your belly moves out and in with each breath.

Well done!

Pursed-lip breathing

This technique can be used to avoid shortness of breath while performing activities such as lifting, walking or climbing stairs. You can also use this technique to recover from breathlessness associated with activity, anxiety or baseline shortness of breath.

Practice this when feeling well so that it comes more naturally when you are exercising or feeling short of breath.

Relax your neck and shoulders.

Inhale normally through the nose with the lips closed for a count of two.

Pucker or purse your lips as if blowing out a candle.

Exhale gently through your pursed lips for a count of four.

Through your nose, inhale for a count of two. Through pursed lips, exhale for a count of four. Through your nose, inhale for a count of two. Through pursed lips, exhale for a count of four.

This can be done until the breathlessness has resolved. Stop if you feel any dizziness.

Exhaling should take twice as long as inhaling. You may have to adjust for your breathing pattern. For example, with more severe COPD, inhale for three, purse and exhale for six. For pulmonary fibrosis, inhale for one, purse and exhale for two.

Diaphragmatic breathing

This breathing technique helps strengthen your diaphragm, a major muscle of breathing. It also allows your chest and shoulder muscles to relax, which uses less energy to breathe.

Diaphragmatic breathing allows you to use much more of your lung capacity. It promotes relaxation, reduces respiratory muscle fatigue, reduces heart rate and blood pressure.

This technique can be used for chronic lung disease and for anxiety and stress release. Practice this when feeling well so that it comes more naturally when you are short of breath.

From a seated position or from a lying position with your knees bent, one hand on the center of your chest the other on your stomach, inhale through your nose for two to three seconds. Feel your abdomen balloon out. Exhale slowly and steadily for four to six seconds. Feel your abdomen tighten and shrink in. Note that the hand on your chest should not move.

Huff coughing

This technique allows mucus to separate from the lung wall and move to the central airways where it can be coughed out more easily. Doing this helps you to conserve energy when clearing mucus. You should have a tissue handy.

Practice this technique while you are well and make it part of your airway clearance regimen.

Sit up straight in a chair, tilt chin slightly up to open your mouth and airway. Take a slow deep, breath in to fill your lungs three quarters full. Hold your breath for two to five seconds. Exhale forcefully but slowly like fogging up a mirror.

As you exhale you will hear (exhale noise). This allows mucus to move to your central airways, making it easier to cough.

Follow this with one or two strong coughs to clear the mucus from your lungs. Cough the mucus into a tissue and dispose of it.

Recovery breathing

This technique can be used when you have trouble catching your breath during exercise if you suffer from obstructive lung diseases like COPD. It relaxes the chest muscles, widens the chest by lifting the rib cage and expels the carbon dioxide that has become trapped in your lungs. This allows more oxygenated air to fill your lungs.

Practice this technique when you feel good so that it feels more natural when you feel out of breath from the exercise.

From a seated position, lean forward. Place your elbows or hands on your knees.

Breathe in through your nose. Breathe out more forcefully and more prolonged through your mouth. Repeat this cycle for five breaths.

Stop if you feel light-headed.

This can also be performed leaning on a wall, leaning on a chair or leaning on a table.