#TBDay: Exercise essential, but with care

According to Dr Lloyd Leach of the department of sport recreation, and exercise science at the University of the Western Cape and director of academia at the Biokinetics Association of South Africa (BASA), exercise and fitness can greatly reduce the detrimental effects of TB.

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Supervision is the key

However, he warns that while exercise is important for the fully recovery of the TB patient, the introduction of an exercise programme should always be cleared by the patient’s physician, and if indicated, must be engaged gradually and, where possible, under the supervision of an experienced biokineticist who fully understands the disease and its associated risks.

Biokineticsts who are experienced in cardiac and pulmonary rehabilitation are trained to design an exercise programme that is tailored for the individual patient, taking account of his or her disease features and symptoms.

During the fever stage of the disease, absolute bed-rest is essential. Even deep breathing exercises should be avoided, while the disease is active, as there is a danger of adhesions in the lungs tearing loose and again setting up the disease.

“As the individual gets better and no longer runs a temperature, exercise - if taken within proper limits - is of value, and under proper direction can be instrumental in promoting full recovery,” he added.

Lengthy process

Dr Leach advised that in order to obtain the maximum benefits and full restoration of normal pulmonary stamina, the exercise rehabilitation programme can be a lengthy process involving judicious planning of the patient’s training programme and persistent adherence to the exercise programme.

Initially, the focus of the exercise programme will be on improving the patient’s breathing. Once breathing becomes easier, low-intensity aerobic-type activity, such as brisk walking or low-resistance cycling will usually be introduced to improve strength and endurance. Any activities that could increase intrathoracic pressure, such as high-intensity interval training or weightlifting without controlled breathing, should be avoided as they could precipitate circulatory collapse, which could be fatal.

Exercise guidelines

According to Dr Leach, the optimal exercise programme for TB sufferers has not been clearly defined, as yet, but there are useful guidelines that can be followed.

“It is recommended that individuals recovering from TB perform at least three to five days of supervised exercise sessions per week, although two supervised sessions in combination with one or more unsupervised sessions at home may also be acceptable,” he said. “With such a programme, training adaptations can occur within just a few weeks, but longer training programmes will be required to produce larger and more sustained benefits.”

The positive effects of specific exercise therapy in individuals with TB include:

• improved pulmonary ventilation and gas exchange

• restored correct breathing biomechanics

• enhanced immune mechanisms

• improved tissue metabolism and autonomic nervous system functioning

• improved psychological well-being (anxiety, depression, mood and self-esteem) and mental capacity (cognitive functioning)

• improved quality of life

• increased functional status

• increased participation in everyday activities

• reduced healthcare costs