Respiratory diseases are among the most common diseases in humans. Everyone experiences respiratory diseases in their lifetime, among which chronic bronchitis, emphysema, asthma, tuberculosis and other diseases tend to recur, thus leading to respiratory dysfunction, affecting people’s ability to exercise and daily life, as well as combining with functional abnormalities of other systems, leading to disability in severe cases. Exercise therapy is a very effective method for the rehabilitation of respiratory diseases. In this paper, we explain the basic principles and methods of exercise therapy from the anatomy and physiology of the respiratory system, as well as specific plans for the treatment of various respiratory diseases, so as to help patients with respiratory diseases to carry out simple and easy self-exercise and rehabilitation.
I. Basic knowledge of respiration
1.What is breathing? Most people know that “breathing” refers to the expulsion of gas from the lungs, mainly to expel carbon dioxide; “inhaling” refers to the process of inhaling fresh air into the lungs, mainly to take in oxygen from the air. The process of respiration is the basis of life activities.
On the surface, the main organ of respiration is the lung. But the oxygen inhaled and the carbon dioxide exhaled are not primarily produced or consumed by the lungs. Oxygen is directly involved in the “combustion” of energy materials, and the important product of “combustion” is carbon dioxide, which is a physiological process called gas metabolism. The energy metabolism of the body is like the burning of coal, the coal fire is not strong when there is a lack of oxygen, without oxygen the fire will be extinguished, while the coal can be fully burned when there is enough oxygen to produce the maximum heat. The body’s metabolic energy material is not coal, but glycogen, sugar, fat, etc.. Their “burning” must have the participation of oxygen. Breathing stops, oxygen can not be inhaled, carbon dioxide can not be expelled, and life will stop. People can survive for several days without food, but without oxygen, they can only survive for a few minutes. Since oxygen consumption is related to the level of energy metabolism, the body’s ability to absorb oxygen is directly related to the level of energy metabolism. Respiratory, circulatory and motor functions can be assessed medically by determining the amount of oxygen absorbed by the body through the measurement of respiratory gases.
The body maintains a balance between the “imported” oxygen and the “exported” carbon dioxide from the outside world. If the “imported” oxygen is insufficient, the body will experience symptoms of hypoxia, such as chest tightness, difficulty breathing, dizziness, and a blue face. The control of imported oxygen is very strict. Oxygen cannot be stored in the body, if the body is not hypoxic, the “imported” oxygen cannot be increased, even if oxygen is inhaled, it will not help. Therefore, in the absence of oxygen deficiency, oxygen is of no value to the organism. Normal people and patients with mild respiratory diseases do not suffer from hypoxia in a quiet state, so oxygen inhalation at this time is not beneficial, but may increase the likelihood of other problems. On the other hand, if the “outlet” carbon dioxide is insufficient, the body’s acid accumulates and can lead to respiratory acidosis. Excessive “exit” carbon dioxide can be seen in cases of hyperventilation, stress, hypochondriac attacks, etc., which can lead to respiratory alkalosis, manifested as tingling of limbs, dizziness, etc. It is better to have a balanced breathing, too much or not enough is not good for the organism.
2.Relationship between exercise capacity and breathing: Exercise needs to consume energy, which also needs to consume oxygen. The amount of oxygen intake during exercise represents the energy consumed during exercise, and can be used as an indicator of the level of human exercise. The higher the maximum oxygen intake during human exercise, the stronger the exercise capacity. Athletes have a significantly higher maximum oxygen uptake than the average person. And when not exercising for a long time, the muscle metabolism is impaired and the oxygen uptake decreases significantly. Oxygen uptake decreases in patients with both respiratory and circulatory diseases, as well as in those who lack physical exercise. Power exercise training of large muscle groups is an exercise method to improve the aerobic metabolic capacity of the body. The ultimate goal of respiratory rehabilitation is to improve the body’s metabolism and enhance the body’s exercise capacity. Therefore, the positive effect of aerobic training on respiratory rehabilitation should not be ignored.
3.How the inhaled oxygen reaches the tissues: the lungs and bronchi are the first link: the air is inhaled to the lungs through the trachea, and then the gas exchange with the pulmonary vessels. The blood before the gas exchange is dark red venous blood, while the blood after the gas exchange becomes bright red arterial blood. The circulatory system is the second link: the blood acts as a gas carrier, and the heart is the blood pump, driving the blood to the arteries and transmitting it to the tissues; after the tissues have exchanged gases, they return to the heart through the veins. And so on and so forth. Therefore, cardiovascular and blood functions also directly affect the process of gas metabolism. The energy consumption and oxygen uptake capacity of the body’s tissues is the third link. If the level of energy consumption of body tissues is low, or if the ability to take in oxygen is low, then respiration is going to be affected. Obviously respiration is not a simple function of the lungs. Physiology categorizes respiration into two processes: internal and external respiration. The process of external respiration is the entry of outside air into the body. Internal respiration is the process by which gases enter the body and are exchanged, transported and metabolized within the body. The two are interrelated and together affect the respiratory process of the body. From the perspective of physiological function, the internal respiratory process is equally important as the external respiratory process, but is often overlooked.
4, the door of respiration: external respiratory “door” is the nasal cavity, oral cavity, epiglottis and larynx, the main function of these structures is to exclude as much as possible factors unfavorable to the respiratory tract. The nasal cavity and the oral cavity are connected to each other at the back, and finally they can reach the trachea through the pharynx. The role of the nose is not only olfactory. The nasal passage is rather curved, with the nasal septum in the middle and three folds in the outer nasal cavity wall, called the turbinates, which divide the nasal tract into upper, middle and lower tracts. The cavity wall of the nasal cavity is rich in blood vessels and well-developed mucus glands, as well as short thick nasal hairs. The blood vessels are like many heaters, so that the cold air inhaled quickly raise the temperature; mucus glands are like sprayers, helping to make the inhaled air moist, while the nasal hairs play the role of a filter, blocking out the dust and foreign matter in the air, reducing lung pollution. Therefore, breathing through the nose can ensure that the inhaled air is in a relatively constant state of temperature and humidity, reducing the stimulation of the respiratory tract by external climate change. Obviously we should encourage breathing through the nose in general. However, the nasal turbinates are very rich in blood vessels, and because they are often exposed to external bacteria and dust, they are prone to infection and enlargement. The first symptoms of the nose when you have a cold include runny nose and nasal congestion, reflecting enlarged turbinates and increased mucus production. At this time, the respiratory channel becomes very narrow, and in addition, the nasal channel will also appear relatively narrow during strenuous exercise, when the organism must choose other respiratory channels to compensate, and the most effective additional channel is the oral cavity.
The oral cavity is much more spacious than the nasal cavity, so it is more fluid when breathing. However, the oral cavity does not have the function of filtration; at the same time, because the airflow is too fast, the warming and moistening of the air is not significant, so there is a risk of inhaling undesirable gases into the lungs when breathing. The role of the oral cavity can be likened to that of a “peace door”, used as an emergency entrance and exit. For respiratory exercise and rehabilitation, the special role of the oral cavity is that the lips can be adjusted to any size, thus controlling the respiratory resistance, which is of great value for the training of patients with chronic emphysema.
The pharynx is the connection between the oral cavity, the nasal cavity and the larynx, as well as the enlargement and intersection of the upper end of the alimentary canal and the trachea. The surface of the pharynx is rich in blood vessels and mucous membrane containing mucus glands and lymphatic tissue, which has a certain protective function for the respiratory system. The tonsils and the lymphatic system of the pharynx can defend to a certain extent against the invasion of bacteria from outside. However, in case of chronic infections in these areas, they may again become a source of chronic bacterial infections of the respiratory tract.
Below the pharynx are the larynx and the vocal cords. The larynx is not only an articulatory organ that produces a beautiful sound, but also serves as an “off-ramp” for the respiratory and digestive tracts. The larynx has a very delicate device called the epiglottis, which is composed of cartilage and mucous membrane. The muscle that controls the epiglottis is the transverse muscle, so it can be subjectively controlled by the person. When inhaling, the epiglottis is set up above the larynx, closing the esophagus and preventing gas from entering the digestive tract. When eating, the epiglottis lies upside down, tightly blocking the tracheal opening to ensure that food does not enter the trachea. If the epiglottis malfunctions, such as nerve paralysis or inflammation, the patient will inhale food into the trachea when eating, leading to inflammation and even blockage of the trachea. The elderly have reduced neural regulation and are prone to impaired control of the epiglottis; a sudden distraction while we are eating may also cause loss of control of the function of the epiglottis, leading to choking and coughing. For patients with chronic emphysema, extra care should be taken to avoid choking and coughing to reduce the possibility of triggering disease attacks. Control of the epiglottis is also one of the keys to the coughing process. If the epiglottis is not controlled properly, coughing abnormalities will follow.
The second door below the epiglottis is the vocal cords. The glottis is the true articulatory organ, controlled by the left and right vocal cords, and has little direct influence on breathing. Below the vocal cords is the trachea.
(I)
Respiratory diseases are one of the most common human diseases. Everyone experiences respiratory diseases in their lifetime, among which chronic bronchitis, emphysema, asthma, tuberculosis and other diseases tend to recur, thus leading to respiratory dysfunction, which affects people’s ability to exercise and daily life, and also combines with functional abnormalities of other systems, leading to disability in serious cases.
Exercise therapy is a very effective method for the rehabilitation of respiratory diseases. In this paper, we explain the basic principles and methods of exercise therapy from the anatomy and physiology of the respiratory system, as well as specific plans for the treatment of various respiratory diseases, so as to help patients with respiratory diseases to carry out simple and easy self-exercise and rehabilitation.
I. Basic knowledge of respiration
1.What is breathing? Most people know that “breathing” refers to the expulsion of gas from the lungs, mainly to expel carbon dioxide; “inhaling” refers to the process of inhaling fresh air into the lungs, mainly to take in oxygen from the air. The process of respiration is the basis of life activities.
On the surface, the main organ of respiration is the lung. But the oxygen inhaled and the carbon dioxide exhaled are not primarily produced or consumed by the lungs. Oxygen is directly involved in the “combustion” of energy materials, and the important product of “combustion” is carbon dioxide, which is a physiological process called gas metabolism. The energy metabolism of the body is like the burning of coal, the coal fire is not strong when there is a lack of oxygen, without oxygen the fire will be extinguished, while the coal can be fully burned when there is enough oxygen to produce the maximum heat. The body’s metabolic energy material is not coal, but glycogen, sugar, fat, etc.. Their “burning” must have the participation of oxygen. Breathing stops, oxygen can not be inhaled, carbon dioxide can not be expelled, and life will stop. People can survive for several days without food, but without oxygen, they can only survive for a few minutes. Since oxygen consumption is related to the level of energy metabolism, the body’s ability to absorb oxygen is directly related to the level of energy metabolism. Respiratory, circulatory and motor functions can be assessed medically by determining the amount of oxygen absorbed by the body through the measurement of respiratory gases.
The body maintains a balance between the “imported” oxygen and the “exported” carbon dioxide from the outside world. If the “imported” oxygen is insufficient, the body will experience symptoms of hypoxia, such as chest tightness, difficulty breathing, dizziness, and a blue face. The control of imported oxygen is very strict. Oxygen cannot be stored in the body, if the body is not hypoxic, the “imported” oxygen cannot be increased, even if oxygen is inhaled, it will not help. Therefore, in the absence of oxygen deficiency, oxygen is of no value to the organism. Normal people and patients with mild respiratory diseases do not suffer from hypoxia in a quiet state, so oxygen inhalation at this time is not beneficial, but may increase the likelihood of other problems. On the other hand, if the “outlet” carbon dioxide is insufficient, the body’s acid accumulates and can lead to respiratory acidosis. Excessive “exit” carbon dioxide can be seen in cases of hyperventilation, stress, hypochondriac attacks, etc., which can lead to respiratory alkalosis, manifested as tingling of limbs, dizziness, etc. It is better to have a balanced breathing, too much or not enough is not good for the organism.
2.Relationship between exercise capacity and breathing: Exercise needs to consume energy, which also needs to consume oxygen. The amount of oxygen intake during exercise represents the energy consumed during exercise, and can be used as an indicator of the level of human exercise. The higher the maximum oxygen intake during human exercise, the stronger the exercise capacity. Athletes have a significantly higher maximum oxygen uptake than the average person. And when not exercising for a long time, the muscle metabolism is impaired and the oxygen uptake decreases significantly. Oxygen uptake decreases in patients with both respiratory and circulatory diseases, as well as in those who lack physical exercise. Power exercise training of large muscle groups is an exercise method to improve the aerobic metabolic capacity of the body. The ultimate goal of respiratory rehabilitation is to improve the body’s metabolism and enhance the body’s exercise capacity. Therefore, the positive effect of aerobic training on respiratory rehabilitation should not be ignored.
3.How the inhaled oxygen reaches the tissues: the lungs and bronchi are the first link: the air is inhaled to the lungs through the trachea, and then the gas exchange with the pulmonary vessels. The blood before the gas exchange is dark red venous blood, while the blood after the gas exchange becomes bright red arterial blood. The circulatory system is the second link: the blood acts as a gas carrier, and the heart is the blood pump, driving the blood to the arteries and transmitting it to the tissues; after the tissues have exchanged gases, they return to the heart through the veins. And so on and so forth. Therefore, cardiovascular and blood functions also directly affect the process of gas metabolism. The energy consumption and oxygen uptake capacity of the body’s tissues is the third link. If the level of energy consumption of body tissues is low, or if the ability to take in oxygen is low, then respiration is going to be affected. Obviously respiration is not a simple function of the lungs. Physiology categorizes respiration into two processes: internal and external respiration. The process of external respiration is the entry of outside air into the body. Internal respiration is the process by which gases enter the body and are exchanged, transported and metabolized within the body. The two are interrelated and together affect the respiratory process of the body. From the perspective of physiological function, the internal respiratory process is equally important as the external respiratory process, but is often overlooked.
4, the door of respiration: external respiratory “door” is the nasal cavity, oral cavity, epiglottis and larynx, the main function of these structures is to exclude as much as possible factors unfavorable to the respiratory tract. The nasal cavity and the oral cavity are connected to each other at the back, and finally they can reach the trachea through the pharynx. The role of the nose is not only olfactory. The nasal passage is rather curved, with the nasal septum in the middle and three folds in the outer nasal cavity wall, called the turbinates, which divide the nasal tract into upper, middle and lower tracts. The cavity wall of the nasal cavity is rich in blood vessels and well-developed mucus glands, as well as short thick nasal hairs. The blood vessels are like many heaters, so that the cold air inhaled quickly raise the temperature; mucus glands are like sprayers, helping to make the inhaled air moist, while the nasal hairs play the role of a filter, blocking out the dust and foreign matter in the air, reducing lung pollution. Therefore, breathing through the nose can ensure that the inhaled air is in a relatively constant state of temperature and humidity, reducing the stimulation of the respiratory tract by external climate change. Obviously we should encourage breathing through the nose in general. However, the nasal turbinates are very rich in blood vessels, and because they are often exposed to external bacteria and dust, they are prone to infection and enlargement. The first symptoms of the nose when you have a cold include runny nose and nasal congestion, reflecting enlarged turbinates and increased mucus production. At this time, the respiratory channel becomes very narrow, and in addition, the nasal channel will also appear relatively narrow during strenuous exercise, when the organism must choose other respiratory channels to compensate, and the most effective additional channel is the oral cavity.
The oral cavity is much more spacious than the nasal cavity, so it is more fluid when breathing. However, the oral cavity does not have the function of filtration; at the same time, because the airflow is too fast, the warming and moistening of the air is not significant, so there is a risk of inhaling undesirable gases into the lungs when breathing. The role of the oral cavity can be likened to that of a “peace door”, used as an emergency entrance and exit. For respiratory exercise and rehabilitation, the special role of the oral cavity is that the lips can be adjusted to any size, thus controlling the respiratory resistance, which is of great value for the training of patients with chronic emphysema.
The pharynx is the connection between the oral cavity, the nasal cavity and the larynx, as well as the enlargement and intersection of the upper end of the alimentary canal and the trachea. The surface of the pharynx is rich in blood vessels and mucous membrane containing mucus glands and lymphatic tissue, which has a certain protective function for the respiratory system. The tonsils and the lymphatic system of the pharynx can defend to a certain extent against the invasion of bacteria from outside. However, in case of chronic infections in these areas, they may again become a source of chronic bacterial infections of the respiratory tract.
Below the pharynx are the larynx and the vocal cords. The larynx is not only an articulatory organ that produces a beautiful sound, but also serves as an “off-ramp” for the respiratory and digestive tracts. The larynx has a very delicate device called the epiglottis, which is composed of cartilage and mucous membrane. The muscle that controls the epiglottis is the transverse muscle, so it can be subjectively controlled by the person. When inhaling, the epiglottis is set up above the larynx, closing the esophagus and preventing gas from entering the digestive tract. When eating, the epiglottis lies upside down, tightly blocking the tracheal opening to ensure that food does not enter the trachea. If the epiglottis malfunctions, such as nerve paralysis or inflammation, the patient will inhale food into the trachea when eating, leading to inflammation and even blockage of the trachea. The elderly have reduced neural regulation and are prone to impaired control of the epiglottis; a sudden distraction while we are eating may also cause loss of control of the function of the epiglottis, leading to choking and coughing. For patients with chronic emphysema, extra care should be taken to avoid choking and coughing to reduce the possibility of triggering disease attacks. Control of the epiglottis is also one of the keys to the coughing process. If the epiglottis is not controlled properly, coughing abnormalities will follow.
The second door below the epiglottis is the vocal cords. The glottis is the true articulatory organ, controlled by the left and right vocal cords, and has little direct influence on breathing. Below the vocal cords is the trachea.