I. The purpose of rehabilitation exercise
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 impact left by the disease, to carry out active respiratory and exercise training, and to explore the respiratory function potential. Wu Zhigang, Department of Rehabilitation Therapy, Sichuan Bayi Rehabilitation Center
4.Educate patients on 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, COPD rehabilitation exercise specific methods
1.Lip contraction breathing
(1) Purpose: To increase the airway pressure during expiration 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, which is the 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 increase, while the respiratory rate and minute ventilation volume decrease.
(2) Methods
①Position: Patients can be in the prone, semi-prone, sitting, forward sitting (20°~45°) and other positions;
②Position: one hand on the abdomen and the other hand on the upper chest.
③Movement essentials: when inhaling, the patient consciously puffs up the abdomen and tries to use the abdominal muscles to push the hand placed on the abdomen to move forward; when exhaling, the hand placed on the abdomen is pushed slightly to help the abdomen recover. The hand placed on the upper chest is used to monitor whether there is a significant rise and fall of the chest.
④Rhythm and frequency of breathing: Breathing must be done in rhythm, and the ratio of inhalation to exhalation is 1:2 or 1:3 is appropriate. 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 breathing muscles
(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 movement intensity increases.
② Use respiratory training apparatus to enhance respiratory muscles: Use inspiratory training apparatus to increase resistance during inspiration.
4. Postural sputum evacuation
(1) Applicable to the following cases: ① Sputum is too much to cough up; ② Avoid 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. Each site is 5~10min; if multiple sites need to be drained, it should not exceed 45min.
(4) Attention.
①Patients who are old and frail, suffering from severe heart disease and/or hypertension, heart failure and obvious respiratory distress, cyanosis, and hyperthermia 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 back to expel sputum
(1)Method: Slightly flexing the palm of the hand (hand flexed into a cup shape, also called “hollow palm”) or mechanical tapping on the chest wall to produce vibration, so that the secretions on the bronchial wall of the affected area move to the larger bronchus. In general, the order of percussion should be “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) Attention: ① For the elderly and post-surgical patients, the strength of percussion should not be excessive; ② The timing of percussion should be rapid and repeated during exhalation, avoiding percussion 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.
①Patient in sitting or standing position with upper body slightly leaning forward (preferably holding onto 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 for 3 times, and press the abdomen with your hand to promote gas discharge;
④Stop coughing, contract your lips to exhale the remaining air as much as possible.
⑤ Do it 2~3 times in a row, rest and breathe normally for a few minutes and then start again.
⑥If deep inhalation induces coughing, try intermittent split inhalation.
7.Aerobic exercise
(1) Significance and purpose: COPD patients, often accompanied by difficulty in action, 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; further will lead to a decline in exercise, muscle strength, endurance followed by a decline, causing disuse syndrome. In the long run, a vicious circle will be formed. The purpose of aerobic exercise is to improve the endurance of the patient’s whole body, improve cardiopulmonary function, and prevent the occurrence of the above vicious circle.
(2) Determination of exercise intensity: The exercise intensity of aerobic exercise is mainly determined by the patient’s self-conscious symptoms, heart rate, heart rhythm, blood pressure, oxygen saturation, oxygen uptake, anaerobic threshold and other indicators; it is best to perform cardiopulmonary exercise test (CPET) to decide.