How to Exercise with an O2 Concentrator

Many people with breathing difficulties learn about the benefits of exercise after seeing their doctor or beginning pulmonary rehabilitation. Exercise gets your heart pumping and increases your breathing rate, which means increased circulation of oxygenated blood throughout the body. This can help your body with oxygenation of the tissues and, the better shape your muscles are in, the better they are at using oxygen effectively. With regular exercise, your muscles will require less oxygen and produce less carbon dioxide, reducing how quickly you need to breathe and how quickly you feel out of breath. Regular exercise also strengthens your heart and improves circulation, which continues to help improve your body’s oxygenation. In short: Regular exercise can help improve lung function, symptoms of lung conditions and overall heart health and circulation. All of these combine to create better oxygenation in the body and improved overall health, even for people with lung conditions and breathing difficulties.^[1]

So, if you struggle with your breath while exercising, should you consider EWOT?

What Is EWOT?

Exercise with Oxygen Therapy (EWOT) is a method of training your body to re-establish oxygen pathways in the capillaries for better blood-flow and oxygen absorption. By wearing a mask that supplies a constant flow of oxygen while engaging in a workout, you can improve your health, enhance your performance, and achieve better fitness results. While this technique was originally developed by a physicist named Dr. Manfred von Ardenne to treat cancer patients, it has since been adapted for use with athletes and certain other medical conditions.^[2]

Exercise with oxygen therapy treatments are delivered in two main ways. Nasal cannulas deliver a lower percentage of oxygen due to the air escaping out of your mouth; this method is less expensive. Oxygen masks provide a tighter seal for more optimal oxygen delivery. The mask or nasal tubes are connected to a longer tube which plugs into an oxygen tank or a concentrator. A concentrator pulls oxygen out of the surrounding air, purifying it. You exercise on a piece of cardio equipment, such as an exercise bike, treadmill, elliptical, or stepper for 10 to 15 minutes while using the device.^[2]

Proponents of EWOT say that it can offer a number of different health benefits because of the combination of oxygenation and regular aerobic exercise. They suggest these benefits could include:[2] 

• Decrease in systemic inflammation.
• Increase in energy.
• Boosting the immune system.
• De-acidifying the body and improving alkalinity.
• Protect the body from cancer and also as an adjuvant treatment to cancer, helping to decrease the toxic effects of chemo and radiation and increase the body’s energy.
• Boost metabolism to improve weight loss and help the body to burn fat.
• Improvement in symptoms of COPD
• Management of chronic conditions such as cancer, heart disease and brain injury

These are significant claims, so could EWOT benefit people with COPD and other lung or breathing conditions? 

How EWOT Could Benefit Oxygen Users

It might seem odd that exercising when you are short of breath actually improves it—but it works! Exercise helps your blood circulate and helps your heart send oxygen to your body. It also strengthens your respiratory muscles. This can make it easier to breathe.^[3] If you already use oxygen therapy, EWOT may be right for you. The use of oxygen therapy during exercise has already been proven to improve exercise tolerance and stamina for COPD patients.^[4]

If you use supplemental oxygen, you should exercise with it. Your doctor may adjust your flow rate for physical activity, which will be different than your flow rate when you are resting.^[4] Be aware, however, the EWOT uses continuous flow oxygen, [2] so if you have been using an oxygen concentrator that provides pulse dosing, you may require new equipment to participate in EWOT. Work with your doctor to adjust your oxygen for physical activity. Some gyms and physical therapy centers may offer EWOT, so that could be an option, but it is essential that before you start exercising, talk to your doctor and healthcare team about what types and amounts of exercise are right for you.

Are There Risks to EWOT? 

Just like any situation in which medical grade supplemental oxygen is in use, there are some risks to be aware of and consider. Using more oxygen than is medically necessary can be hazardous to your health and raises the potential for complications like oxygen toxicity or the suppression of the drive to breathe. Additional side effects could include dry nasal passages, sinuses or throat. By and large, these risks can be diminished or avoided altogether by keeping EWOT sessions to 15 minutes or less, keeping the oxygen delivery to four liters per minute or less and maintaining 90-95% oxygen purity.^[2] Discuss all possible side effects and complications of EWOT with your doctor before considering or beginning the training regimen.

Tips for Improving Your Exercise Experience on Oxygen Therapy

Exercising on oxygen therapy, as well as EWOT can take some getting used to at first. However, by following a few tips, you can help improve your overall oxygenation and your exercise experience, particularly if you experience increased shortness of breath or discomfort during exercise. 

• Practice your breathing technique. Believe it or not, there is a right way and a wrong way to breathe. If you have ever done pulmonary rehab you already know this, but many people get into bad breathing habits—particularly when you frequently struggle with shortness of breath. Practice breathing techniques like pursed lip breathing and diaphragmatic breathing to reteach your body how to breathe as effectively and efficiently as possible, with minimal exertion.^[4]
• Talk to your doctor about timing medication use. If you are using medications other than supplemental oxygen to help you breathe better, talk to your doctor about whether you should adjust when you use the medication to better support your exercise routine. For example, if you use a bronchodilator to open your airways or mucolytics to thin your mucus, using these before exercise could be helpful.^[2]
• Start slow. Building up your exercise tolerance and stamina can take a while whether you are on oxygen or not, but particularly when you already have breathing difficulties. Take your time building up to your total exercise time and listen to your body. You may need to take breaks when you first get started, and that is perfectly okay. Work with your health care team to ensure you do not overdo it.^[1]
• Do a warm-up and a cool-down. It is never a good idea to just jump into a workout cold, as it puts you at greater risk of injury. For people with breathing and lung conditions, jumping in too quickly can cause breathlessness and anxiety, too. Do some stretching to warm up your muscles before beginning your exercise routine, and take the time after exercising to cool down properly with more stretching. This will help prevent soreness and stiffness, but may also help with breath control as well. Talk to your doctor about whether to continue your oxygen therapy use during the warm-up and cool-down to maximize your oxygen absorption and muscle health.^[1]

Deciding Whether EWOT Is Right for You

Ultimately, deciding whether EWOT is right for you is a decision you should make with your doctor. If you have not yet incorporated oxygen therapy into your exercise routine, or you are new to exercising with breathing difficulties altogether, you may need to do some oxygen level tests to find out whether EWOT would benefit you. If you do decide to try EWOT, stay in communication with your health care team and pay close attention to how it makes your body feel. You and your doctor may need to make adjustments to your routine to find the correct therapeutic fit for you.

If you already use an oxygen concentrator, talk to your doctor about using it during exercise. If you do not currently use an oxygen concentrator, but require oxygen therapy, talk to your doctor about incorporating an oxygen concentrator so you can experience peace of mind when outside your home and away from your stationary concentrator. Remember: Exercise can bring many benefits and be enjoyable, even with a long-term health problem. Even if a task seems difficult at first, if you tackle one thing at a time at your own pace, you will quickly notice an improvement in your symptoms. Find out more today by contacting Inogen to learn how an Inogen One oxygen concentrator can benefit you.

Sources Cited:

1. “Your Lungs and Exercise.” Breathe , European Respiratory Society, Mar. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4818249/.
2. Santiago, Nadia. “Benefits and Risks of Exercise With Oxygen Therapy.” LoveToKnow, LoveToKnow Corp, Accessed 16 Aug. 2020, exercise.lovetoknow.com/types-exercise/exercise-oxygen-therapy.
3. “Breathing Exercises.” American Lung Association, American Lung Association , 27 May 2020, https://www.lung.org/lung-health-diseases/wellness/breathing-exercises.
4. Emtner, Margareta, et al. “Benefits of Supplemental Oxygen in Exercise Training in Nonhypoxemic Chronic Obstructive Pulmonary Disease Patients.” ATS Journals, American Journal of Respiratory and Critical Care Medicine, 14 July 2003, www.atsjournals.org/doi/full/10.1164/rccm.200212-1525OC.

Additional Resources:

• https://chunchiro.com/services/medical-services/ewot/83-header/1161-oxygen-multistep-therapy-history-of-ewot
• “Oxygen Multistep Therapy (EWOT).” Healthways Medical Group, Healthways Medical Group, 16 Aug. 2020, www.healthways1.com/services/medical-services/ewot.