Flexibility and Balance


These flexibility and stretching exercises are suggestions only. Patients should only spend about 5 minutes within each class performing flexibility and stretching exercises as the emphasis within the class should be on endurance and strength training. The flexibility and stretching exercises could be incorporated into the additional home training program. Health professionals should prescribe and modify appropriate flexibility and stretching exercises according to individual needs.

Patients with ILD at risk at falls can also benefit from the inclusion of balance exercises.

Flexibility of the joints in the spine (particularly the thoracic spine) is important for people with respiratory disorders to enable thoracic mobility when breathing.

The exercises in the table below are designed to move the joints through their range in order to improve or maintain flexibility.

When prescribing flexibility exercises, the following points should be considered:

  • Patients should perform two or three repetitions of each exercise using slow, smooth movements.
  • Patients should only perform each exercise as far as they can without causing pain/discomfort.


Flexibility Exercises

Trunk rotation
  • Gently rotate the trunk side to side.
Shoulder rotation
  • Slowly make circles with elbows.

The pectoral muscles may become shortened as a result of the forward lean position adopted by many patients with chronic lung disease when breathless, and therefore it is important to include stretches that aim to maintain the length of the pectoral muscles and in doing so this may improve posture.

When prescribing stretching exercises, the following points should be considered:

  • Ask the patient to hold each stretch for five to ten seconds
  • Ask the patient to perform two or three repetitions of each stretch.
  • Patients should gradually lengthen the muscle to the point that feels as if they are stretching or pulling the muscle, but no pain is experienced.
  • After this point is reached, the patient should be asked to “hold it there”.
  • Encourage the patient to gradually stretch a little further if they feel able to do so.
  • Encourage patients to breathe while stretching, some patients hold their breath and others are unable to hold stretches for as long as 5 seconds due to breathlessness.
  • The exercises in the table below have been designed to help patients stretch muscles in their upper and lower limbs


Stretching Exercises

Exercise #1
Pectoralis stretch
  • Stand in the corner or in a doorway with your hands at shoulder level and your feet away from the corner or doorway.
  • Lean forward until a comfortable stretch is felt across the chest.
  • Take extra precaution if patient has shoulder pain.
Exercise #2
Triceps stretch
  • Lift your arm so that your elbow is next to your ear.
  • Place your hand between your shoulder blades.
  • Gently push your elbow back with your other hand until you feel a stretch.
Exercise #3
Hamstring stretch
  • Sit on edge of chair
  • Bend one leg and straighten the other with toes pointed up
  • Lean forward slowly until you feel a stretch at the back of the thigh
Exercise #4
Shoulder stretch
  • Place one arm across your body
  • Gently pull on your elbow with your opposite hand until a stretch is felt in the shoulder
Exercise #5
Calf stretch
  • Place hands on a wall or bench
  • Keep your body upright and bend your front knee
  • Straighten your back leg and keep your heel on the ground, with toes facing forward
  • Slowly lean forward until you feel a stretch in the back of your calf

Although there is no direct comparison of fall rate between people with COPD and age-matched healthy population, previous studies suggested that people with COPD have a higher prevalence of falls (44 to 51%)111213compared with community-dwelling older populations (29 to 33%).141516 The level of balance impairment and fall rate increase further after hospitalisation in people with COPD.17 Falls can be caused by a number of risk factors such as reduced lower limb muscle strength, decreased daily physical activity and reduced standing balance capacity and these risk factors are also associated with COPD.1819As a result, maintaining and enhancing balance is important especially for patients with a balance deficit or those with an increased risk of falls.

The following exercises can help improve balance:

  • Static and dynamic stance exercises (such as stand with eyes closed, tandem stance, one-legged stance and throw and catch ball or bat a balloon), lower limb muscle strength training (such as sit to stand exercises and stepping up and down on a block or step) and gait exercises (tandem, sideway and backward walk)
  • Tai Chi (with or without additional weights such as a backpack or wrist cuff weights)

The Toolkit

Getting Started
Getting Started
Patient Assessment
Patient Assessment
Exercise Training
Exercise Training
Patient Education
Patient Education
Patient Re-assessment
Patient Re-Assessment
Additional Resources
Additional Resources

Endorsed by the following organisations according to their respective approved criteria: