Endurance Training – Lower Limb
Lower limb aerobic exercises (uses large muscle mass):
- Walking training for all patients (over-ground or treadmill).
- Stationary cycling training if possible.
For patients with severe dyspnoea, fixing the shoulder girdle by using a wheeled walker (rollator) for walking training or when using a stationary cycle for cycle training allows:
- The accessory respiratory muscles to work more efficiently.
- This lean forward position may help to dome the diaphragm, improving its length/tension relationship.
Note: These two strategies may result in a slight reduction in ventilatory constraints to exercise, allowing a greater work level to be achieved by the lower limb muscles e.g quadriceps, gastrocnemius and gluteal muscles.
For patients who experience oxygen desaturation during exercise, the level of oxygen desaturation is often less during cycling, compared to walking.
However, it should be remembered that to achieve the greatest changes in a functional activity such as walking, it may be better to train in walking.
Downhill walking is associated with less symptoms of dyspnoea and fatigue than level walking2, and may be better tolerated by patients with severe dyspnoea.
Lower limb aerobic exercises performed in the water are an alternative option for patients with physical co-morbid conditions, such as orthopaedic or musculoskeletal conditions, which limit their ability to perform lower limb exercise training on land.3