Hello and welcome to the Canadian Lung Association's BREATHE Better, Stay STRONG virtual pulmonary rehabilitation program. I'm very happy that you decided to join us today.

If you have COPD, which includes emphysema and chronic bronchitis, if you have asthma, bronchiectasis, or cystic fibrosis, this program is for you.

If you have interstitial lung disease, which includes sarcoidosis and many types of pulmonary fibrosis, this program is for you, too.

But if you have pulmonary hypertension or waiting for lung transplant or volume reduction surgery, talk to your provider about a supervised pulmonary rehabilitation program.

This program is intended for Canadians living with moderate to severe chronic lung disease who've had a lung function test and whose healthcare provider has recommended or prescribed pulmonary rehab.

You might wonder how exercise helps your breathing, especially since it makes you feel short of breath.

Lung disease causes a cycle where you begin to feel more breathless doing activities that you enjoy, so you tend to do less. This causes your muscles to get weaker and deconditioned. When this happens, the muscles require more oxygen to function, which makes you feel more breathless.

As your fitness level declines, it becomes more difficult to perform the same daily functions. As a result, less is done and the decline continues.

To reverse this cycle, performing exercises through live or virtual lung health and rehabilitation programs helps you to increase your fitness level. Exercise also allows your heart and your lungs to work more effectively together so that you can circulate oxygen throughout your body.

As your muscles get stronger, you're able to accomplish more and suffer less from breathlessness.

Finally, exercise not only helps you physically but also emotionally.  As you gain confidence in your physical ability and feel less restricted by symptoms of your disease, your level of  anxiety is likely to decrease and your sense of joy and optimism is likely to increase.

BREATHE Better, Stay STRONG is an eight-week program that offers education, exercise and resources.

For you to benefit most from this program,  be sure to follow this program sequence from beginning to end, participating three times per week.

This might seem challenging at first, but if you start small you're sure to finish strong.

The education portion of this program will cover important health topics that focus on understanding your disease, managing your symptoms, conserving energy, understanding your medications and oxygen therapy. The education topics will also cover breathing techniques, airway clearance, nutrition mood, advanced directives and, of course, smoking cessation.

The exercise portion of this program will focus on retraining your respiratory muscles, stretching upper and lower body strength and aerobic exercise. These exercises will help improve your stability and flexibility, strength and endurance, making it easier and safer for you to perform activities of daily living.

After completing the BREATHE Better, Stay STRONG program, you might have fewer symptoms of cough, fatigue and shortness of breath.

You may find that your energy level is higher, your stress level is lower and your quality of life is improved.

You will feel better able to make healthy choices that manage how well you live with your lung disease.

The BREATHE Better, Stay STRONG mission is to help you live happier and more confidently so that you can do the things that you enjoy with the ones that you love, 
living with fewer symptoms of chronic lung disease and fewer hospitalizations.

Please note: if you are having increasing symptoms of a flare-up or an exacerbation, start your action plan if you have one, or contact your healthcare provider.

When this is the case, wait for your symptoms to settle down completely before starting or restarting the program. It's okay to take a break, just come back when you're well enough.

So now, if you're ready let's get started, click below to learn how this program works.

Before we begin exercising, let me say that your safety comes first. I want to make sure that your provider says that it's safe for you to exercise. I also want to make sure that you exercise safely.

• Keep your workspace clutter free to avoid accidents.
• Wear shoes with traction to avoid slipping.
• Wear comfortable clothes that are not restrictive around the waist to make it easier to breathe.
• If you use oxygen, make sure that your oxygen is set correctly for exercise.
• If you have a pulse oximeter, periodically check your oxygen saturation level. You want to keep it over 90%.
• Feel free to pause the video do some recovery breathing or pursed-lip breathing and join us again when you're ready.

If you have hand weights or ankle weights at home, that's great, but there's no need for special equipment. Household items can be used instead of weights. You can use water bottles, soup cans, shampoo or detergent bottles. You can use fruits if you have them handy.

As your fitness level increases, the number of repetitions that you will perform will increase as well. We will start with eight repetitions and increase to 15.

If you can perform 15 repetitions at a specific weight, then it's time to increase your weight by half a kilo or a kilogram and return to eight repetitions of the new weight.

Exercise should not hurt. Only you know the limits of your range of motion. If you cannot raise your arm over your head due to shoulder pain, only do what is comfortable.

Exercising at a moderate level will cause some muscle fatigue, some shortness of breath and some perspiration. This Scale of Perceived Exertion is your guide to the intensity of your workout. You should exercise between a three and a five on the scale.

Another quick reference to know that you're exercising at the right level is that you should be able to speak your phone number in one breath. If you develop dizziness, chest pain or extreme shortness of breath at any time, stop exercising. If it does not resolve, get medical attention.

Many of the exercises that have been selected are to help maintain or improve your daily functions. The goal is to be able to exercise with us two to three times per week.

Alex will lead you through most of the exercises and I will join him to show modifications or progressions for different ability levels.

Another goal is to stretch and do 30 minutes of cardio five to seven days per week.

The exercise program has been set up so that you can access the warm-up and the cool down stretches separately.

A home walking program chart has also been added to help you increase your cardio to 30 minutes over the eight-week program.

If you're ready, let's begin!

Pursed-lip breathing

This technique can be used to avoid shortness of breath while performing activities such as lifting, walking or climbing stairs. You can also use this technique to recover from breathlessness associated with activity, anxiety or baseline shortness of breath.

Practice this when feeling well so that it comes more naturally when you are exercising or feeling short of breath.

Relax your neck and shoulders.

Inhale normally through the nose with the lips closed for a count of two.

Pucker or purse your lips as if blowing out a candle.

Exhale gently through your pursed lips for a count of four.

Through your nose, inhale for a count of two. Through pursed lips, exhale for a count of four. Through your nose, inhale for a count of two. Through pursed lips, exhale for a count of four.

This can be done until the breathlessness has resolved. Stop if you feel any dizziness.

Exhaling should take twice as long as inhaling. You may have to adjust for your breathing pattern. For example, with more severe COPD, inhale for three, purse and exhale for six. For pulmonary fibrosis, inhale for one, purse and exhale for two.

Diaphragmatic breathing

This breathing technique helps strengthen your diaphragm, a major muscle of breathing. It also allows your chest and shoulder muscles to relax, which uses less energy to breathe.

Diaphragmatic breathing allows you to use much more of your lung capacity. It promotes relaxation, reduces respiratory muscle fatigue, reduces heart rate and blood pressure.

This technique can be used for chronic lung disease and for anxiety and stress release. Practice this when feeling well so that it comes more naturally when you are short of breath.

From a seated position or from a lying position with your knees bent, one hand on the center of your chest the other on your stomach, inhale through your nose for two to three seconds. Feel your abdomen balloon out. Exhale slowly and steadily for four to six seconds. Feel your abdomen tighten and shrink in. Note that the hand on your chest should not move.

Huff coughing

This technique allows mucus to separate from the lung wall and move to the central airways where it can be coughed out more easily. Doing this helps you to conserve energy when clearing mucus. You should have a tissue handy.

Practice this technique while you are well and make it part of your airway clearance regimen.

Sit up straight in a chair, tilt chin slightly up to open your mouth and airway. Take a slow deep, breath in to fill your lungs three quarters full. Hold your breath for two to five seconds. Exhale forcefully but slowly like fogging up a mirror.

As you exhale you will hear (exhale noise). This allows mucus to move to your central airways, making it easier to cough.

Follow this with one or two strong coughs to clear the mucus from your lungs. Cough the mucus into a tissue and dispose of it.

Recovery breathing

This technique can be used when you have trouble catching your breath during exercise if you suffer from obstructive lung diseases like COPD. It relaxes the chest muscles, widens the chest by lifting the rib cage and expels the carbon dioxide that has become trapped in your lungs. This allows more oxygenated air to fill your lungs.

Practice this technique when you feel good so that it feels more natural when you feel out of breath from the exercise.

From a seated position, lean forward. Place your elbows or hands on your knees.

Breathe in through your nose. Breathe out more forcefully and more prolonged through your mouth. Repeat this cycle for five breaths.

Stop if you feel light-headed.

This can also be performed leaning on a wall, leaning on a chair or leaning on a table.