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hello, i am dr. ken chapman, director of theasthma & airway centre of the university health network and director of our pulmonary rehabprogram at toronto western site. i am delighted to be able to introduce thisdvd of basic pulmonary rehab exercises. how are you going to use this dvd? first,you consult with your physician and make sure that you can do the exercises described. youwant to be sure there is no other medical problem: a heart problem, a joint problemthat would prevent from doing some of the things we describe.when you are given that green light you want to begin these exercises gradually until youbuild up to the maximum which is your maximum. once you’ve achieved this level of fitness,you want to remember to keep on exercising

to maintain that fitness.is this a complete program of exercises? no, but we hope that once you have developed thatexercise habit, you’ll be able to consult with professionals and perhaps find otherexercises that are helpful to you. this is gonna be a basic guide, somethingthat will keep you exercising using correct technique and a bit of a companion along theway. what can you expect of all this effort? ifyour breathing is a bit limited, it will probably not going to change these numbers very much,but we do know that we can make those exercising muscles more efficient, stronger. it willimprove your balance, and as a result, you will be able to do more day to day.patients tell us, that once they’ve been

through the program, they enjoy life more,because they can do more. so by all means start your exercise program. at least thirty minutes of endurance exercisedaily is ideal. sometimes, thirty minutes is difficult to do so it is important to paceyourself and start slow. great examples of endurance exercise include walking, cycling,swimming or simply repeated leg walking exercise while seated. other exercises that focus onbalance, strength and flexibility are equally important. never do strength training on thesame muscle groups two days in a row. your muscles need a day of rest in between in orderto rest and recover and also to minimize the risk of injury. always take care and listento your body.

hi , my name is meeran manji and i work atthe pulmonary rehabilitation clinic at the toronto western hospital,, part of the universityhealth network. join us as we take you through a program that includes warm up, breathingexercises, arm exercises, abdominal strengthening work, upper body strength training, lowerextremities based balance and flexibility exercises and finally a brief cool down.let’s first start by reviewing proper pursed lip breathing technique. breath in throughyour nose and simply exhale softly through your mouth through pursed lips as if you arewhistling through soft exhalation. let’s try it.( demo) remember to breathe out slowlyand not to be forceful as you exhale. exhaling slightly longer than the time you took toinhale is also important. it is important

to incorporate pursed lip breathing techniquein your daily activities remember to always exhale on effort. this technique will helpyou decrease the work of breathing, some what reduce your shortness of and also help withoverall relaxation. let’s begin. let’s start the warm up exercises. sit upin your chair, nice and tall. place your hands at your mid abdomen. inhale through your noseand try to feel some movement at your diaphragm. breathing out through pursed lips, just likeyou’re whistling the air out softly. as you inhale, feel the abdomen rise with eachinhalation, exhale through pursed lip. place one hand at your chest and the other at yourabdomen. you should feel more movement at your abdomen than your chest.inhale deeply….andexhale. good, let’s switch to the other

side, inhale exhale…place your hands are at the lower half of the rib cage and inhale deeply through thenose… lift up that rib cage as you inhale. exhale leaning forward pursed lip breathing.once again inhale… and exhale. last one… inhale… exhale, pursed lip. sit forward in your chair, clasp your handsbehind your back if you can. inhale lifting those arms up get a good stretch in your armas well as across the rib cage. hold … now exhale pursed lip, leaning forward. once againinhale… hold that stretch, don’t give into it… exhale as you lean forward. andthis is the last one; inhale lift those arms up get a good stretch and exhale pursed lip.sit up tall try not to lean into the chair.

bring that arm up and face your hand up tothe ceiling and feel the stretch right through your arms to the finger tips… and switch.switch sides…and last stretch. good. ok once againyou’re sitting up nice and tall with the chin tucked in and i want you to look down…and gently look up… and look down …and look up look down… look straight ahead,turn to the side… and gently turn to face the other direction. face the side once again.and now look straight ahead bring your arms up at chest level over to the side i wantyou to inhale through your nose…exhale through your mouth, pursed lip. once again inhaleand exhale… inhale and exhale …last one inhale…and exhale as you turn.bring those shoulders up as high as you can…

and drop. once again. inhale bring the shouldersup hold… drop. last one …and drop i want you to bring your arms up, level ofthe chest elbows together, hands together, inhale… and exhale as you close your arms.inhale …exhale. last one …and exhale. extend your arms out and we’re going armcircles, the movement is small and anticlockwise inhale as you reach your arms up and exhale as you bend forward to touch yourtoes. bring your hands out in front of you and openand close your hands. move your hand in a circular motion, oppositedirection take your hand a tap your shoulderslets reach up and alternate side to side, 1,2,3,4 reach out at centre, 1,2,3,4, reachdown 1,2,3,4 deep breath, pursed lip breathing

let’s repeat once againextend one leg up, point the toe and now flex point your toes and let’s do toe circlesin one direction and now let’s switch to the opposite directionplace your feet flat on the floor and we’ll have you lift your toes up and then your heels.once again the toes come up and then the heels. nice little rocking motion that allows thebottom of your feet to feel a nice stretch. reach forward and tap your foot , switch tothe other add box step , take left foot and tap at fourcorners now switch to the other foot. let’s start walking and pace your selves,include arm movement if you are able to

hold on to the chair, place right foot forward,ensure that you have a bend at your knees at the right leg, lean in to this stretch,your left leg should be straight. now switch to the other side, etcplace your feet shoulder width apart, lean on to one side and now switch to the other,etc place your feet together, hold on to the chair,lift your heels up and release last stretch inhale bring you arms all theway up. exhale leaning forward just going as far as you can keep a slight bend in yourknee, this isn’t about toe touching this is about getting a good stretch. ok inhaleexhale as you lean forward. inhale…and exhale. great.

forward and punch.(counting… seven…eight…nine…and10. arm jog now. two…three four…five…six…seven…eight…nine…ten.reach up for marching soldier bring those arms up as high as you can and switch. five…six…seven…eight...nine...andten. lean over and your going bring those armsback up for this is called pump the tire ok. three…four…five…six…seven…eight...nine…andten. bring your arms up and swing them over yourhead side to side 5, 4, 3, 2,1 and now take a break, pursedlip breathing, deep breath.., let the tension go from your shoulders.ready to climb the mountain? reach up your arms up and alternate…3…2..1bring the arms up into criss-cross at chest

level…4, 3, 2,1bring the arms up at chest level and push forward and release. this is a modified taichi move. coordinate your breathing as you reach the arms forward exhale, as you bring them backtowards you inhale.. 4,3,2,1, lean forward and pull the weeds… 4, 3, 2,1bring those arms up into position and row the boat, 4,3,2,1let’s do upper cuts, punch…4,3,2,1 let’s play the piano as we move to cool downstir the soup, it’s a big pot… five in one direction and now lets switch to the otherdirection… great place your hand on the chair, lift your kneesup and exhale. you should feel this action

working your lower abdomen, 3,2,1lift your right knee up and bring your left elbow to your right knee and alternate. makesure to exhale pursed lip as you bring your knee up.we’re going to start with the weight training segment. so, uncross your legs, feet flaton the floor. coordinate your breathing with your movements, so inhale initially…andexhale as you lift your free weights. weights are down by yoursides and start with shoulder shrugs lift your shoulders up to your ears, exhale whilelifting up inhale, now lift arms up and exhale, inhaleas you bring the weight down 4,3,2,1, loosen your shouldersinhale, now lift your right arm up

to the level of your chest and inhale as youbring the weight down, now switch to the other side,4,3,2,1lift weights to level of chest, inhale on the way up and exhale as you bring the weightsback down sit tall with chin tucked in, lift your weightsabove your head with free weights facing front bring your weights to your shoulder level.lift the weights up exhale, now inhale,4,3,2,1the weights are facing front parallel, lift up,exhale, bring weight down, inhale , exhale,4,3,2,1 bring your arms up, elbows together, handstogether, inhale, extend your arms apart, exhale, inhale as you bring your arms togetherstart by inhaling, bring the weight up, bend at

elbows and exhale as you lift up tuck your elbow by your waist, inhale, nowexhale while you push the weight down, 4,3,2,1. let’s switch to the other sidenow , we will do triceps extension with both arms working, exhale pursed lip as we push the weight downsit back in your chair, legs uncrossed, feet flat on the floor. cross your arms over yourchest, inhale, reach forward to stand while you exhalestand beside the chair and hold on to the chair if you have weak balance,inhale, lift your knee up and exhale. it is

important to maintain proper posture. nowswitch to the other side inhale, bend your legs back as you exhaleand switch to the other side hold on to the chair, extend your arms, leanforward and lift your leg straight back within the frame of your body, exhale, now switchto the other side. hold on to the chair and lift your leg to the side now switch to the other sidehold on to the chair if you wish, inhale, reachup on your toes and exhale as you come down let’s begin by sitting tall, tuck in yourchin look down for a count of three and then

up. let’s repeat, now look straight aheadturn your head to one side and now to face the other, once again.loosen your shoulder, bring your arms up to chest level, turn to one side, now let’sface the other, once again. clasp your hands in front of you, turn themaround, inhale as you lift up and exhale pursed lip as you bring them down to the sides, onceagain, inhale, now exhale. sit forward in your chair, straighten theleg as much as you can and lean forward , try and reach forward as much as you can, youshould feel a gentle tug at the back of your leg, now let’s try the other side, extendyour leg out reach forward and hold. let’s repeat once more.now finally sit back in your chair, breath

in deeply, exhale pursed lip. give your selfa hug, hold, and now a pat on the back in you can.this concludes your session for today. have a great day and remember to keep up with yourexercise routine.