This blog post was written by Katie Keating, RN, MS, patient advocate

Regular exercise and self-care are the best gifts a patient with lung disease can give to him or herself. The goal of exercise is to improve quality of life through physical activity.

Exercise has a multitude of positive benefits; it improves blood circulation, helps with the exchange of oxygen as well as carbon dioxide. It improves your overall physical health, including heart health, ability to fight infection, blood sugar levels, and sleep quality. Physical activity decreases angst and depression, while improving ones energy level and the ability to be functionally independent.

Warm-up and Cool-Down consists of gentle stretching or low intensity exercise that lasts 5-10minutes prior to and after a workout. Warm ups prepare your heart, lungs and muscles for the work to be done during exercise and cools them after a workout to prevent muscle soreness or injury. The best practice is to inhale as you move into a stretch and exhale while you hold the stretch. Relax into each stretch for 30 seconds and repeat each stretch 5 times.

Aerobic exercise gets the heart and respiratory system working over an extended time and it is the best type of exercise a lung patient can do. Better endurance and less breathing difficulty allows patients to accomplish more and feel better.    Examples of aerobic exercises are walking, treadmill, bicycling, stationary cycling and swimming. Frequency and consistency matter. A minimum of three days a week will be most beneficial. Chronic lung disease patients may need several breaks to get all of their aerobic work in, but endurance will build little by little, over time.

Pace is the exercise level at which the lungs can move enough air in and out while putting enough oxygen in the blood to support the exercise. It is not uncommon for patients to only be able to do a few minutes when they start. Don’t get discouraged, instead set as a goal to increase your time or distance a little every week.

There was a time when I could not walk an extra block; I once had to take a cab for the last NYC block. We all know that NTM is debilitating at times. The cabbie gave me a dirty look, alluding to the assumption that I was a very lazy woman.

Strengthening exercises build individual muscles and muscle groups, and can help patients with chronic lung disease to be more functional. Light free weights, 2-5 pounds, 10 to 15 reps, three times a week, should accomplish this goal, increasing strength in the upper arms and legs. Light weights and more repetitions are better than heavy weights and fewer repetitions.

Disuse atrophy occurs when muscles weaken due to inactivity. Lack of muscle use results in muscle loss, which further decreases ability to perform activities of daily living, including exercise. For example, if lung patient stops doing regular household chores, because it makes one eventually the patient loses strength that comes from the muscle exercises of performing everyday tasks. Less strength means the patient may eventually shy away from some other tasks of daily living; activity level declines, as well as quality of life. Strength training can help break the downward spiral.

Other forms of exercise include yoga, lite jazzercise, tai chi, pilates and some forms of dance. It is wise to observe a class to see if it will be suitable for you. Often, I take the spot in the last row so no one can watch me or need to follow my movement since I may not be able to completely participate in the class. I inform the teacher after that I might be doing only half the class or what my energy level dictates on that particular day. The connection with other people is good for our psyche. In the book, Happier, written by Tal Ben Shahar, he writes that “not exercising is like taking a depressant and goes on to say that your body releases endorphins while exercising which leads to an increased feeling of happiness.

Often, NTM patients are able to push through the fatigue and perform the tasks of everyday living; somedays, they are unable to do so. I suggest attempting exercises on your good days. I am unable to exercise on many rainy days and severely humid days; hence, I exercise on the other days at a local gym during a time when it is not too crowded. Working out on the good days enables one to cope when the not so good days occur.

If you skip a day, it is okay. You can start right where you left off. A few tips as you get into an exercise routine:

• Don't push too much which may result in feeling flared for several days
• Set small, realistic goals
• Pick an activity that works well with your interests, lifestyle and what is available where you live

Remember, NTM patients must take infection control precautions, such as cleaning the weights, exercise equipment and/or treadmill with antibacterial wipes before beginning a workout.

If you are unable to get out of the house, there are many healthy aging exercise classes’ online and wearable fitness devices or apps. If you need oxygen to exercise, I strongly recommend a pulmonary rehabilitation program to get started since staff will monitor your heart rate and your oxygen saturation levels closely while exercising. Staff will advise you how to exercise, both in warm and cold weather, teach you the basics on nutrition, respiratory medications, air pollutants and other possible irritants, stress management and infection prevention measures.

What exercise are you presently doing? What type of exercise would you like to do? Please share your experience; what has worked or hasn't worked?

What small action steps are you willing to take?

As Oprah says, "You design your life!" I hope that you make exercise part of your design. If you do, you will reap multiple benefits.

The COPD Foundation advises that before you make any changes to your medication or therapies that you first consult with your doctor.