How hard should you exercise?

When attending your pulmonary rehabilitation program the staff will assess your exercise tolerance at the start of the program. From this assessment, you will be prescribed a program at the right level for you. If being a prescribed a home-based program, similar assessments will be made before determining the best intensity of exercise for you.

There are a number of ways to measure exercise intensity. The fitness industry often uses heart rate measures. This is not recommended for people with chronic lung conditions, heart failure or other cardiac conditions because some medicines can affect heart rate, making this method unreliable.

The best method for measuring exercise intensity for people with chronic lung conditions is rating your breathlessness:

  1. Your level of breathlessness can be measured during an activity and rated against the Borg or modified Borg scale (see the following diagram). The highlighted section is the target training intensity. Please note that for those with chronic heart failure, pulmonary hypertension or other conditions involving the heart or blood pressures, the target training intensity may be lower. You can discuss this with the person developing your home-based exercise program.
  2. Exercising according to heart rate is not recommended for lung disease, heart failure or other cardiac conditions as medicines can affect heart rate and people who have these conditions may be limited by their breathlessness. Check with your doctor if your medications affect your heart rate.

These scales can be used to guide training intensity and to set personal goals for exercise. You should aim to exercise to a level where your breathlessness is at a moderate to somewhat severe level. This level is where you can still talk (but are huffing and puffing a bit), but cannot sing or laugh, and are not gasping for breath.

This is highlighted below:

Adapted from: Borg G. Perceived exertion as an indicator of somatic stress. Scand J Rehab Med. 1970;2:92-9; Borg G. Psychophysical bases of perceived exertion. Med Sci Sports Exer. 1982:14:377-81; Mahler D. The measurement of dyspnoea during exercise in patients with lung disease. Chest. 1992;101:242-7.