I. The purpose of rehabilitation exercises.
1.Improve the ventilation function of the lungs and improve the efficiency of breathing.
2.To relieve or control the acute symptoms and complications of COPD.
3.To eliminate the dysfunction and psychological effects left by the disease, to carry out active respiratory and exercise training, and to explore the respiratory function potential.
4.Educate patients how to strive for and maximize their activities in daily life and improve their endurance for exercise and activities, increase their ability to take care of themselves in daily life, and reduce the need for hospitalization.
Second, several methods commonly used in COPD rehabilitation exercises.
1.Lip contraction and exhalation.
2, abdominal breathing.
3.Strengthening respiratory muscles.
4.Postural drainage.
5.Back patting for sputum removal.
6.Effective coughing.
7.Aerobic exercise.
Three, COPD rehabilitation exercise specific methods.
1.Lip contraction breathing.
(1) purpose: to raise the airway pressure during exhalation to prevent airway collapse and gas trapping.
(2) Method: Inhale with the nose, exhale with the mouth into a shrunken lip to exert some resistance, slowly exhale. The ratio of inhalation and exhalation is 1:2, and the ratio of slow inhalation and exhalation can reach 1:4.
2, abdominal breathing.
(1) Purpose: to re-establish the physiological breathing pattern.
Patients with COPD are prone to dyspnea when they are active, and in the long run they gradually become accustomed to thoracic breathing. However, chest breathing as a basic type of breathing can cause inefficient breathing and increase dyspnea, triggering a vicious circle. It is then necessary for the patient to adopt an efficient breathing method.
Abdominal breathing can make the activity of diaphragm bigger and the activity of auxiliary respiratory muscles such as sternocleidomastoid muscle decrease, thus making the tidal volume, respiratory efficiency and arterial oxygen partial pressure rise, while the respiratory rate and minute ventilation volume decrease.
(2) Methods.
① Position: Patients can be in various positions such as lying, semi-recumbent, sitting, and forward sitting (20° to 45°).
②Position: one hand on the abdomen and the other hand on the upper chest.
③Movement essentials: when inhaling the patient consciously bulge the abdomen, try to use the abdominal muscles to push the hand placed on the abdomen to move forward; when exhaling the hand placed on the abdomen with slight force to help the abdomen recover. The hand placed on the upper chest is used to monitor whether there is a significant heaving of the chest.
④Rhythm and frequency of breathing: Breathing should be done in rhythm, and the ratio of inhalation to exhalation should be 1:2 or 1:3. Try to breathe about 7-8 times per minute, 3 times a day, 10-15 minutes each time.
Lip reduction and abdominal breathing is best applied jointly; persistently, try to do “habit into nature”, and finally become an unconscious breathing pattern.
3, strengthen the respiratory muscle.
(1) purpose: to increase the strength of the respiratory muscle to improve the ventilation function, improve the state of shortness of breath, improve the ability to exercise.
(2) Methods.
① abdominal weight loading method: when performing abdominal breathing exercises (especially during inhalation), weight in the abdomen to counteract abdominal expansion, so that the abdominal auxiliary respiratory muscles and diaphragm increase the intensity of movement.
② Use respiratory training apparatus to enhance respiratory muscles: Use inspiratory training apparatus to increase resistance during inspiration.
4. Postural drainage: It can also be called “postural sputum evacuation”.
(1) Applicable to the following cases.
(1) When sputum is too much to be coughed up.
(2) Avoiding excessive physical exertion.
(3) Need to completely eliminate sputum as much as possible.
(2) Principle: Place the lesion in a high position so that the opening of the draining bronchus is downward.
(3) Time: The duration of sputum removal should not be too long. Two times a day is appropriate when there is little secretion, and 3~4 times a day when there is much secretion. 5~10min for each site; if multiple sites need to be drained, it should not exceed 45min.
(4) Attention.
①Patients who are old and weak, suffering from severe heart disease and/or hypertension, heart failure and obvious respiratory distress, cyanosis, and high fever should be prohibited.
②Patients with bronchospasm may inhale bronchodilator first.
③It is advisable to do it before meals.
④Patients with recent spinal injury or instability of the spine, recent rib fracture and severe osteoporosis are prohibited.
5. Patting the back to expel sputum.
(1) Method: The vibration is generated by tapping the chest wall with a slightly flexed palm (hand flexed into a cup shape, also called “hollow palm”) or mechanical tapping device to move the secretions on the bronchial wall of the affected area to the larger bronchus. The overall percussion should follow the order of “from outside to inside and from bottom to top”.
(2) Time: 3 times a day, 2-3 minutes each time; percussion and vibration should be performed 2 hours after meals; the number of percussions can be increased as appropriate when the patient coughs.
(3) Caution: ① For the elderly and post-surgical patients, the percussion should not be too strong; ② The timing of percussion should be rapid and multiple percussions during exhalation, avoiding percussions during inhalation as much as possible.
(4) Contraindications: It is contraindicated for people with suspected pulmonary embolism, bleeding, severe pain, tumors and other disorders.
6. Effective coughing.
Methods and steps.
(1) Sit or stand the patient in a sitting or standing position with the upper body slightly tilted forward (preferably grasping a sturdy support).
② Inhale slowly and deeply, hold your breath for a few seconds and then contract your abdominal muscles with force.
③Open the mouth and cough 3 times in a row, and press the abdomen with your hand to promote gas expulsion while coughing.
④Stop coughing, contract your lips and exhale the remaining air as far as possible.
⑤ Do it 2~3 times in a row, rest and breathe normally for a few minutes before starting again.
⑥If deep inhalation induces coughing, try intermittent split inhalation.
7.Aerobic exercise.
(1) Significance and purpose: COPD patients, often accompanied by difficulty in movement and increased oxygen consumption; if at the same time due to pathological changes in the lungs lead to insufficient oxygen uptake, it will easily lead to respiratory distress; furthermore, it will lead to a decrease in exercise, muscle strength and endurance subsequently, causing disuse syndrome. In the long run, a vicious circle will be formed. The purpose of aerobic exercise is to improve the patient’s whole body endurance, improve cardiopulmonary function, and prevent the occurrence of the above vicious cycle.
(2) Determination of exercise intensity: The exercise intensity of aerobic exercise is mainly determined by the patient’s conscious symptoms, heart rate, heart rhythm, blood pressure, oxygen saturation, oxygen uptake, anaerobic threshold and other indicators; the most also conducts cardiopulmonary exercise test (CPET) to determine.