Pulmonary concerns and the exercise prescription.

When writing an exercise prescription, the contributions of the pulmonary system are commonly forgotten. The lung has a tremendous potential to improve its work output, and its contributions are only realized when pulmonary disease or environmental stresses of altitude limit pulmonary performance. At altitudes of 5000 feet above sea level, hypoxia is significant in limiting aerobic capacity, and the exercise prescription should follow relative percentages of VO2max guided by the training heart rate rather than actual work output. Training at altitude will improve performance at altitude, but training at altitude does not always improve sea level performance. Suggestions of using longer recovery intervals, sojourns back and forth from sea level to altitude, and shorter-duration, high-intensity exercise sessions may help improve sea level performance, but more research is needed. The limitations of reactive airway disease and exercise-induced asthma can be minimized with proper attention to training techniques, environmental modifications, and pharmacologic treatment. In the 1984 Olympics, 41 medals were won by athletes with the diagnosis of reactive airway disease. Finally, the crippling limitations of chronic obstructive bronchopulmonary disease can be improved by a proper exercise rehabilitation program that uses an accurate and thorough assessment procedure prior to beginning an exercise program. Also, careful follow-up and continual monitoring of cardiac rhythm, oximetry, and exercise intensity of the pulmonary impaired patient will result in optimal improvement in the patient's sense of well-being, tolerance to dyspnea, and increased ability to do aerobic work, as well as an enhanced quality of life.