Flexibility and Stretching

Note: 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 home program. Trainers should prescribe and modify appropriate flexibility and stretching exercises according to individual needs.

Flexibility

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.

Stretching

The pectoral muscles may become shortened as a result of the forward lean position adopted by many patients with COPD 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 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 _____		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