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Instructor Showing Health Results On Clipboard To Senior Couple

Respiratory Disease and Exercise

According to the World Health Organization (WHO), hundreds of millions of people suffer every day from chronic respiratory diseases (CRD).  Currently in the United States, 24.6 million people have asthma1, 15.7 million people have chronic obstructive pulmonary disease (COPD)2 while greater than 50 million people have allergic rhinitis3 and other often-underdiagnosed chronic respiratory diseases.  Respiratory diseases do not discriminate and affect people of every race, sex, and age.  While most chronic respiratory diseases are manageable and some even preventable, this is what is known about the nature of chronic respiratory diseases4:

  • Chronic disease epidemics take decades to become fully established.
  • Chronic diseases often begin in childhood.
  • Because of their slow evolution and chronic nature, chronic diseases present opportunities for prevention.
  • Many different chronic diseases may occur in the same patient (e.g. chronic respiratory diseases, cardiovascular disease and cancer).
  • The treatment of chronic diseases demands a long-term and systematic approach.
  • Care for patients with chronic diseases should be an integral part of the activities of health services, alongside care for patients with acute and infectious diseases.

Exercise and CRD

If you are a health and fitness professional, some of your clients may be suffering from a chronic respiratory disease and you may be an important source for relief.  Moderate exercise is known to improve use of oxygen, energy levels, anxiety, stress and depression, sleep, self-esteem, cardiovascular fitness, muscle strength, and shortness of breath. While it might seem odd that exercise improves breathing when one is short of breath, exercising really does help one with respiratory disease.  Exercise helps the blood circulate and helps the heart send oxygen to the rest of the body.  Exercise also strengthens the respiratory muscles which can make it easier to breathe.

Beneficial Types of Exercise

There are several challenges to exercise prescription and physical activity participation in this population, but a large body of evidence demonstrates important health benefits from aerobic exercise.  Resistance training has also been shown to increase muscle mass and strength, enhancing individuals’ ability to perform tasks of daily living and improving health-related quality of life.5

Aerobic exercise is good for the heart and lungs and allows one to use oxygen more efficiently. Walking, biking, and swimming are great examples of aerobic exercise. The guidelines are approximately the same as generally healthy individuals.  One should attempt to train the cardiorespiratory system 3-5 days a week for 30 minutes per session.  One should exercise at an intensity level of 3-4 on the Rating of Perceived Exertion Scale (Scale Rating from 0 Nothing at All-10 Very, Very, Heavy).

Resistance exercise increases muscular strength including the respiratory muscles that assist in breathing.  Resistance training usually involves weights or resistance bands but using one’s own body weight works just as well depending on the severity of the symptoms.  It is recommended that one should perform high repetitions with low weight to fatigue the muscles.  This type of resistance training also improves muscular endurance important for those with CRD.  Resistance training should be performed 2-3 days a week working all major muscle groups.

Stretching exercises relax and improve one’s flexibility.  When stretching, one should practice slow and controlled breathing.  Not only does proper breathing help to deepen the stretch, but it also helps one to increase lung capacity.  One should gently stretch all major muscles to the point of mild discomfort while holding the stretch for 15 to 30 seconds, slowly breathing in and out. Repeat each stretch 2-3 times.  Stretching is an effective method to warming up and cooling down before and after workout sessions.

When exercising, it is important to remember to inhale in preparation of the movement and exhale on the exertion phase of the movement.  An individual should take slow deep breaths and pace him/herself.  It is recommended to purse the lips while exhaling.

Use of Medication

If an individual uses medication for the treatment of respiratory disease, he/she should continue to take the medication based on his/her doctor’s advice.  His/her doctor may adjust the dosage according to the physical activity demands.  For example, the doctor may adjust the flow rate of oxygen during exercise if one is using an oxygen tank.  In addition, one should have his/her inhaler on hand in case of a need due to the increase of oxygen demand during exercise.

Fitness professionals can effectively work with those who have a chronic respiratory disease providing them with a better quality of life through movement.  You as their health and fitness coach can provide a positive experience to facilitate an effective path to better health and wellness.

Join CarolAnn for her upcoming webinar, Exercise and Allergies: How to Train Clients When They Can’t Breathe

Known as the trainers’ trainer, CarolAnn has become one of the country’s leading fitness educators, authors, and national presenters. Combining a Master’s degree in Exercise Science/Health Promotion with several fitness certifications/memberships such as FiTOUR, ACSM, ACE, AFAA, and LMI, she has been actively involved in the fitness industry for over 25 years. She is currently the Founder and Director of Education for Chiseled Faith, a Faith Based Health and Fitness Program for churches. Visit her website, www.CarolAnn.Fitness


  1. 2015. NHIS Data; Table 3-1. www.cdc.gov/asthma/nhis/2015/table3-1.htm
  2. Mannino DM, Gagnon RC, Petty TL, Lydick E. Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey 1988-1994. Arch Intern Med. 2000;160:1683–1689.
  3. CDC, Gateway to Health Communication and Social Marketing Practice. Allergies. https://www.cdc.gov/healthcommunication/toolstemplates/entertainmented/tips/Allergies.html
  4. World Health Organization http://www.who.int/gard/publications/chronic_respiratory_diseases.pdf
  5. Eves ND, Davidson WJ. Evidence-based risk assessment and recommendations for physical activity clearance: respiratory disease. Applied Physiology Nutrition and Metabolism. 2011;36(Suppl 1):S80–100. [PubMed]
Fibromyalgia signs

Fibromyalgia and Exercise

According to the National Institute on Health (NIH), fibromyalgia affects over 5 million U.S. adults and an estimated 3-6% of the world population. While fibromyalgia is most prevalent in women (75-90% of those with fibromyalgia), it also occurs in men and children of all ethnic groups. People with fibromyalgia experience aches and pain all over the body, fatigue (extreme tiredness that does not get better with sleep or rest), and problems sleeping.

Fibromyalgia may be caused by a problem in the brain with nerves and pain signals. In other words, in people with fibromyalgia, the brain misunderstands everyday pain and other sensory experiences, making the person more sensitive to pressure, temperature (hot or cold), bright lights, and noise compared to people who do not have fibromyalgia. Fibromyalgia has been compared to arthritis. Like arthritis, fibromyalgia causes pain and fatigue. But, unlike arthritis, fibromyalgia does not cause redness and swelling, or damage to the joints.

Diagnosis and Causes of Fibromyalgia

Up until recently, fibromyalgia has been very difficult to diagnose coining the condition as the “invisible disease” believing that the syndrome was “all in the head” of those who suffer from fibromyalgia. However, currently fibromyalgia can be identified through a questionnaire and the Manual Tender Point Survey test. There has been a breakthrough recently with a blood test that may identify fibromyalgia making it even more possible to treat fibromyalgia. However, more testing is needed to be more widely accepted. Here is a short list of what may cause fibromyalgia:

  • Genes: Mutation or deficiency in the MTHFR or COMT genes specifically
  • Having other diseases such as arthritis
  • Family history
  • Emotional or physical abuse
  • Posttraumatic stress disorder (PTSD)
  • Gender:  Occurs mostly in women
  • Anxiety and depression
  • Not moving enough

Exercise and Fibromyalgia

Moderate exercise is known to improve use of oxygen, energy levels, anxiety, stress and depression, sleep, self-esteem, cardiovascular fitness, muscle strength, and mobility. While the pain and fatigue associated with fibromyalgia may make exercise and daily activities difficult, it is crucial to be physically active. Usually, there are no specific exercises to avoid if one has fibromyalgia. Aerobic exercise (running, jogging), weight training, water exercise, and flexibility exercises may all help.

Golf, tennis, hiking, and other recreational activities are also healthful. However, exercising hard (overexertion) leads to the problems people experience post-exercise, which are called “post-exertional malaise.” This occurs because people with fibromyalgia don’t have the energy to condition like others who can handle the increase in exercise and conditioning. Instead, if the exercise uses more than the limited amount of energy the body can make, their systems crash, and they feel like they were hit by a truck for a few days after. Because of this, the key is to find an amount of walking or other low-intensity exercises one can do, where he/she feels “good tired” after, and better the next day. Instead of ramping up in the length or intensity of the workouts, one should stick to the same amount while working to increase energy production.

Benefits of Exercise

Because the main focus of fibromyalgia is neurotransmitters and brain health, one key benefit of exercise is the boosting of endorphins and serotonin in the brain. Studies show that exercise can help restore the body’s neurochemical balance which in turn triggers a positive emotional state. Boosting levels of natural endorphins are essentially boosting pain-fighting molecules that help to reduce anxiety, stress, and depression which are symptoms of fibromyalgia. Elevating serotonin plays a vital role in mediating moods thereby helping relieve symptoms of fibromyalgia.

Other benefits of exercise include:

  • Burning calories and making weight control easier
  • Giving range-of-motion to painful muscles and joints
  • Improving a person’s outlook on life
  • Improving quality of sleep
  • Improving one’s sense of well-being
  • Increasing aerobic capacity
  • Improving cardiovascular health
  • Increasing energy
  • Strengthening bones
  • Strengthening muscles
  • Relieving pain

Join CarolAnn and Irene McCormick for a webinar on this topic, Tips for Fitness Professionals Training those with Fibromyalgia

CarolAnn (M.S., CPT, CN) is a 25+year fitness industry veteran holding positions such as program director, studio owner, educator, presenter, and author.  She develops health/fitness curriculum for organizations such as FiTOUR, Hydracize, MedFit Network, and PT Global.  Along with producing and starring in several fitness videos, she is an expert contributor for publications such as Livestrong, PFP, and New Tampa Style Magazine. She serves on the Health Advisory Board for MedFit Network.  She is now spreading the gospel of health and fitness targeting churches with Chiseled Faith®.  She has been selected to be a 2019-2021 National Fitness Hall of Fame Fitness Superstar.  You can find her work at CarolAnn.Fitness and ChiseledFaith.com.


5 Pilates Exercises to Improve Respiratory Function

Pilates is a total body exercise method that is highly effective for strengthening and lengthening the entire body. While Pilates is mostly known to improve core strength (the “Powerhouse”), posture, and range of motion, this exercise method can be used to improve respiratory function in those suffering from respiratory diseases. Respiratory diseases include asthma, COPD, chronic bronchitis, emphysema, lung cancer, cystic fibrosis, pneumonia, and now COVID-19.  These diseases affect the way one breathes and lowers oxygen saturation that the body needs to function properly. One of the main principles in Pilates is breathing, thus the need to take a closer look at the effects of Pilates on respiratory function.

Benefits of Pilates Related to Respiratory Disease

  • Improves postural cavity to breathe properly.
  • Expands breathing capacity with diaphragmatic breathing.
  • Increases pulmonary ventilation which is needed for better respiratory function.
  • Improves lung volume.
  • Develops intercostal muscles (respiratory muscles) to better “squeeze” out impure air.
  • Improves exhaling all impure air out of the body while inhaling pure air.
  • Improves thoracoabdominal mobility.
  • Improves circulation to deliver oxygenated blood more efficiently.
  • Increased SpO2 (blood oxygen saturation).
    • >95% indicates healthy respiratory function.
    • <95% indicates taxed respiratory function.

The Pilates Breathing Method

Joseph Pilates, the creator of Contrology, stated in his book Return to Life Through Contrology: “Lazy breathing converts the lungs, literally and figuratively speaking, into a cemetery for the deposition of diseased, dying and dead germs as well as supplying an ideal haven for the multiplication of other harmful germs.”1

  • Lateral Breathing: The main goal for Pilates breathing is to breathe deeply expanding the ribcage without raising the abdominal muscles training them to jet out. Therefore, deep lateral breathing through the ribcage is the hub of the breathing technique. Proper breathing is inhaling through the nose and exhaling forcefully through the mouth. When one inhales, the ribcage expands out to the sides using the intercostal muscles, and then when exhaling the ribcage knits together like one is being sinched in a corset. According to Joseph Pilates, one should exhale forcefully getting all impure air out of the lungs like wringing out every drop of water out of a wet cloth.
  • Set Breathing Pattern: When performing the Pilates exercises, one should inhale to prep for the movement and exhale as one performs the movement.
  • Rhythmic Breathing Pattern: In some exercises, one breathes in rhythm to the exercise. This breathing consciously activates respiratory muscles to enable the lungs to expand and transport oxygen.

5 Effective Pilates Exercises to Improve Respiratory Function

The Hundred (Rhythmic Breathing)

  • Begin a tabletop position with the shoulder blades and head lifted off the mat looking forward.
  • Pump the arms up and down 100 times vigorously so the abdominals respond to and control the movement.
  • Inhale through the nose 5 times to the rhythm of the arms pumping, then exhale 5 times to the rhythm of the arms pumping.
  • Keep the lower back imprinted to the mat at all times.

Single Leg Stretch (Rhythmic Breathing)

  • In a supine position, lift the shoulder blades and head off the mat looking forward.
  • Bend the right knee towards the chest as the left leg extends straight out hovering over the mat.
  • Inhale through the nose as you switch the legs 2 times, then exhale as you switch the legs 2 times.
  • Inhale, inhale, exhale, exhale as you switch, switch, switch, switch.
  • Keep the lower back imprinted to the mat at all times.
  • Perform 8 sets.

Dying Bug (Set Breathing Pattern)

  • In a supine position, position the legs in table-top and arms extend straight up towards the ceiling.
  • Press the right hand firmly on the right thigh and press the right thigh to the right hand in opposition.
  • Inhale through the nose as you extend the left arm back overhead and the left leg extends straight out hovering over the mat.
  • Exhale through the mouth and draw the arm in and the leg back to tabletop. Repeat on same side and switch.
  • Keep the lower back imprinted to the mat at all times.
  • Perform 8 reps on each side.

Toe Taps (Set Breathing Pattern)

  • In a supine position, lift the legs into tabletop keeping the upper body and head down on the mat.
  • Anker the arms next to the body pulling the shoulders back and down on the mat.
  • Inhale through the nose as you lower both feet and legs together towards the mat. Keep the knees at 90º and the feet away from the glutes.
  • Exhale as you pull the legs back up to tabletop.
  • Keep the lower back imprinted to the mat at all times.
  • Perform 10 reps.

Thread the Needle (Set Breathing Pattern)

  • Start in a side kneeling position with the hips lifted off the mat and one forearm down on the mat with the other arm straight up to the ceiling.
  • Inhale through the nose as you lean the body back an inch to expand the ribcage.
  • Exhale through the mouth as you rotate forward and thread the arm under the armpit towards the back. Crunch the obliques and transverse abs.
  • Inhale through the nose as you un-rotate and return to the start position with the arm lifted towards the ceiling.
  • Perform 8 reps on each side.

Pilates, respiratory function and research

The literature is scarce and sometimes conflicting about the benefits of Pilates breathing related to the respiratory system. However, there are some existing studies that look at the increase in lung volumes, respiratory motion, SpO2, and the reduction in respiratory rate using Pilates breathing exercises. More research needs to be conducted. Refer to suggested reading at bottom of article.

CarolAnn, M.S. Exercise Science and Health Promotion, is a 30+ year veteran in the fitness industry educating other health/fitness professionals to increase their expertise and brand influence.  She is on the MedFit Education Advisory Board and the head health/fitness educator for FiTOUR.  She is currently the Head Instructor at Club Pilates in Athens, GA.

Suggested Reading

  1. Cancelliero-Gaiad, K. M., Ike, D., Pantoni, C. B., Borghi-Silva, A., & Costa, D. (2014). Respiratory pattern of diaphragmatic breathing and pilates breathing in COPD subjects. Brazilian journal of physical therapy, 18(4), 291– https://doi.org/10.1590/bjpt-rbf.2014.0042
  2. de Jesus, L.T., Baltieri, L., de Oliveira, L.G., Angeli, L.R., Antonio, S.P., Pazzianotto-Fort, E.M. (2015) Effects of the Pilates method on lung function, thoracoabdominal mobility and respiratory muscle strength: non-randomized placebo-controlled clinical trial. Pesqui. vol.22 no.3. http://www.scielo.br/scielo.php?pid=S1809-29502015000300213&script=sci_arttext&tlng=en
  3. Hagag, A.A., Salem, E.Y. (2019) Pilates Exercises Improve Postural Stability, Ventilatory Functions and Functional Capacity in Patients with Chronic Obstructive Pulmonary Disease. IOSR Journal of Nursing and Health Science (IOSR-JNHS), vol. 8, Issue 4 Ser. VI., PP 86-91 http://iosrjournals.org/iosr-jnhs/papers/vol8-issue4/Series-6/M0804068691.pdf
  4. Baglan Yentur S, Saraç DC, Sarİ F, et al. (2020). Fri0613-hpr the effects of pilates training on respiratory muscle strenght in patients with ankylosing spondylitis. Annals of the Rheumatic Diseases;79:912. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2129


  1. Pilates, J., William, J. M., Gallagher, S., Kryzanowska, R. (2000). The Complete Writings of Joseph H. Pilates: Return to Life Through Contrology and Your Health. BainBridge Books, Philadelphia, PA. (Originally written 1945)

Expand Your Career! Become a Multiple Sclerosis Fitness Specialist

The health/fitness industry is constantly evolving with new scientific research and education released on a regular basis. Currently, the medical fitness track is on the precipice of explosion and expansion. Therefore, obtaining your personal training or group exercise instructor certification is only the beginning for launching your professional health and fitness career. One area of health/fitness specialization that is gaining attention is with the multiple sclerosis (MS) community. There is a huge need and demand for qualified health/fitness professionals to provide proper programming for those with MS. The National MS Society states that the MS population is more than double what was previously recorded with over one million people diagnosed in the United States alone. Health/fitness professionals can effectively work with those who have MS, providing them with a better quality of life, hope for the future and continued improvement. Education and specialization on the part of the professional is key to the success of the professional and the client through proper exercise programs, nutritional guidance and mindset training specifically for those with MS.