Think Beyond Medicine – Exercise is also Treatment

A flash-back to Liverpool, 2011

I was pacing the corridor of the Liverpool Heart and Chest Hospital, stethoscope flapping like a tail-wind, when my bleep shrieked: “Ward 14, patient desaturating on 20 m walk test—come quick!”
That pager, the clunky British bleep, still rings in my ears.
I sprinted, not because the patient was crashing, but because I knew exactly what was happening: another COPD patient had hit the invisible wall of exercise-induced hypoxia.
That moment kicked off the study that would later travel with me to the British Thoracic Society meeting in London and, more importantly, travel with my patients back to their daily lives.

Why this matters more than ever

COPD is the quiet tsunami in India: we inhale pollution, exhale disability.
The numbers are climbing faster than the elevators in my hospital.
We doctors keep adding inhalers, but we forget the lungs are also muscles that need training.
That’s where pulmonary rehabilitation (PR) comes in—an evidence-based, low-cost boot-camp for lungs and legs.
Yet, when I moved back to India in 2014, the only “rehab” most patients knew was a cardiac one.
Pulmonary rehab? Blank stares.

The oxygen “bicycle seat”

Picture learning to ride a bike.
The first few pedals are wobbly; you need training wheels.
Once you find balance, off come the wheels and you’re flying.
Ambulatory oxygen is exactly those training wheels for COPD patients during rehab.
We used lightweight cylinders and portable concentrators; patients clipped them on only while exercising.
No politics, no lifetime tether—just a temporary crutch.

What we actually did (the simple version)

1. Took 52 COPD patients who couldn’t finish a 6-minute walk without oxygen saturation dipping below 88%.
2. Split them: half got ambulatory O₂ during the 8-week PR, half got room air.
3. Everyone did the same exercise prescription: walking, cycling, upper-limb weights, and the “talk while you walk” drills I borrowed from my theatre-sports days.
4. Measured walk distance, Saint George’s score, and—my favourite—“how many times can you get up from the sofa without puffing?”

The magical bit

At graduation, 71% of the oxygen group left the programme without needing oxygen and walked farther than their room-air peers.
Imagine that: the group that started on oxygen finished freer.
One chap, Mr. O’Leary, told me, “Doc, I’ve swapped my cylinder for my grandson’s cricket bat!”
That’s when the nerd in me did a little victory dance in the physio gym.

So what makes pulmonary rehab tick?

• Exercise: Legs, arms, diaphragm—no bench-press records, just rhythmic, progressive effort.
• Education: Why inhalers are like Wi-Fi routers—useless unless switched on and positioned right.
• Nutrition tricks: “Eat little, eat often, eat protein”—my three-line sermon.
• Mood: Depression and anxiety are the evil twins of COPD; group sessions beat both.
• Ambulatory oxygen: The secret sauce for the desaturators.

The Indian reality check

Back home, a patient travels 200 km wheezing in a bus, spends 10 minutes with me, gets “increase Seretide” scribbled, and travels back.
No physio, no diet chart, no counselling.
We spend crores on stents and transplants but pennies on prevention and rehab.
It’s like buying a Ferrari and forgetting to service it.

How to start a programme without a NASA budget

1. Space: A hospital corridor, a temple hall, or even a shaded park—patients just need 30 m to walk.
2. Staff: One trained physio plus volunteers; nurses can double as educators with a simple slide-deck.
3. Equipment: Step-up boxes, light dumbbells, and a couple of fingertip pulse-oximeters (₹1500 each).
4. Oxygen: Rent or loan portable cylinders for the session only—no long-term contracts.
5. Smartphone app: WhatsApp group for daily step counts; motivation via emojis, not expensive gadgets.

My challenge to policy makers

If we can roll out dialysis centres in every district, we can fund 100 PR programmes for the cost of one dialysis machine.
COPD is the only disease where a ₹0.50 tablet and a ₹0.00 walk can trump a ₹50,000 hospital stay.
Let’s stop waiting for patients to turn blue before we act.

Practical takeaway for patients and families today

Ask your chest doctor for a “6-minute walk test with oximetry.”
If saturations drop, insist on a trial of ambulatory oxygen during exercise.
Join or form a local COPD support group; start with five people and two water bottles.
Remember: “Out of breath, not out of hope.”

My closing confession

Every time I see a patient sell their cow to pay for yet another nebuliser, my heart sinks.
We can’t change air quality overnight, but we can gift them stronger legs and clearer minds while the policymakers wake up.
Ambulatory oxygen during pulmonary rehab isn’t fancy; it’s fair.
Let’s make it as common as the humble stethoscope around our necks.

See you on the walking track—no bleep, just beats of healthier lungs.