Chronic obstructive pulmonary disease (COPD).
COPD is a lung disease characterized by airflow limitation that is not fully reversible and progresses progressively. COPD is the 4th leading cause of death worldwide at present and its morbidity and mortality are expected to increase further in the coming decades. The main symptoms of COPD are cough, sputum and dyspnea, and its treatment is not only pharmacological, but also pulmonary rehabilitation has been considered by the American Thoracic Society and the European Respiratory Society as an important method of non-pharmacological treatment for COPD since 2012. pulmonary rehabilitation therapy for COPD patients mainly includes: exercise rehabilitation (including respiratory muscle exercise, upper and lower limb muscle exercises), effective cough and sputum excretion guidance, nutritional support, psychological rehabilitation and health education for their families, etc., among which exercise rehabilitation for patients is the core of pulmonary rehabilitation. Methods of exercise rehabilitation
Training methods of active exercise rehabilitation
Bed exercise, sitting, turning, standing on the bed, stepping in place at the bedside, upper and lower limb activities, activities under oxygen inhalation, activities under non-invasive ventilation, walking, running, stair climbing, flat exercise, power bicycle, etc. can be adopted.
Training methods of passive motion rehabilitation
Passive traction-assisted exercise, neuromuscular electrical stimulation, massage, acupuncture, etc. can be used.
There are 3 types of motor exercise according to the part of the exercise as follows.
Muscle training
The strength and endurance of auxiliary respiratory muscles can be enhanced, including fist making, weight lifting, ball throwing, etc.
Lower limb muscle exercise
Including walking, running, stair climbing, planking, power cycling, etc.
Whole body exercise
Autonomous turning in bed, sitting up, qigong, taijiquan, etc.
Timing of exercise rehabilitation
From the perspective of rehabilitation, chronic obstructive pulmonary disease (COPD) is divided into.
Stable phase, acute exacerbation phase, and acute exacerbation recovery phase. During the stable phase of COPD, although exercise cannot improve the lung function of patients, it can improve the exercise capacity (including exercise endurance and maximum exercise capacity) of COPD patients. Dyspnea and quality of life also improve after exercise rehabilitation. the benefits obtained from 8-12 weeks of exercise rehabilitation can last up to 2 years.
Treatment guidelines therefore recommend that
Treatment of patients with moderate or severe COPD should routinely include exercise rehabilitation. Patients should be rehabilitated as early as possible in the recovery from an acute exacerbation, i.e., the effects of pulmonary rehabilitation early in the recovery from an acute exacerbation (6 weeks starting on the day of discharge) have shown significant improvements in exercise tolerance, quality of life, and dyspnea symptoms in patients with AECOPD. Acute exacerbations are a cause of hospitalization in COPD patients and an important cause of reduced lung function and quality of life, even death. Without pulmonary rehabilitation, even with aggressive pharmacological treatment during hospitalization, deterioration in pulmonary function and quality of life can still exist in patients with AECOPD, and it can take weeks or even months to return to pre-exacerbation baseline levels, with some patients not fully recovering.
In patients with acute exacerbations due to infection, exercise rehabilitation can be started once the infection is controlled; in those with non-infectious factors, the intensity of pulmonary rehabilitation can be reduced, but need not be stopped, which helps to shorten the length of hospital stay. In patients with tracheal intubation and mechanical ventilation, pulmonary rehabilitation after infection control is beneficial to the recovery of coughing and coughing ability after deconditioning and deconditioning.
Exercise rehabilitation considerations
COPD patients with hypoxemia and chronic respiratory failure need to monitor oxygen saturation and heart rate during exercise. Exercise under oxygenation as much as possible, with the oxygen flow rate adjustable to 3-5L/min; for exercise under non-invasive ventilation, the ventilator parameters must be adjusted until the patient feels comfortable.