To have a source of living water - a brief discussion on simple and easy breathing function exercises

This is the 3779th article of Da Yi Xiao Hu

Chronic respiratory diseases (CRDs) include chronic obstructive pulmonary disease, bronchial asthma, bronchiectasis, interstitial lung disease, obstructive sleep apnea syndrome, lung cancer, lung transplantation, lung volume reduction surgery, etc. The prevalence, disability and mortality of chronic respiratory diseases in my country are high, and the disease burden is heavy. These diseases usually require additional treatment during acute exacerbations, and severe conditions require hospitalization. In outpatient and emergency departments or wards, we are often asked by patients or their families: "Doctor, in addition to quitting smoking, breathing oxygen, using non-invasive ventilators, and eating nutritiously at home, what other ways can we use to reduce the onset of this disease?" The answer is: "Pulmonary rehabilitation management." Broadly speaking, pulmonary rehabilitation management includes: smoking cessation guidance, nebulizer inhalation technology, prevention and treatment of aspiration, airway clearance technology, respiratory function training, exercise prescription, oxygen therapy, non-invasive ventilation technology, nutritional prescription, psychological care, health education and follow-up. Current studies have shown that, compared with standard strategies, maintenance pulmonary rehabilitation therapy can have a positive impact on patients' 6-minute walking distance and health-related quality of life for 3 years in patients with chronic obstructive pulmonary disease. This article focuses on simple and easy-to-operate respiratory function exercises at home. It mainly includes respiratory function exercise techniques to improve lung ventilation, pulmonary rehabilitation techniques to promote lung cleaning, and exercise training to improve respiratory function.

1. Breathing function training techniques to improve lung ventilation

1.1

Breathing exercise techniques to improve lung ventilation

Pursed lip breathing patients take a deep breath through their nose slowly, then purse their lips and exhale easily like a flute, with an inhalation to exhalation time ratio of 1:2 or 1:3, 10 minutes each time, 3 to 4 times a day. Pursed lip breathing increases the pressure of the small airways accordingly, moves the isobaric point toward the large airways, prevents the small airways from collapsing and occluding prematurely, facilitates the discharge of alveolar residual gas, and improves ventilation. Patients with severe to extremely severe COPD can improve their dyspnea and respiratory muscle function to varying degrees through pursed lip breathing exercise training.

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1.2

Abdominal breathing

The patient lies or sits, relaxes the whole body, inhales through the nose, exhales through the mouth, puts one hand on the abdomen, and the other hand on the chest. When inhaling, try to straighten the abdomen, or press the abdomen with your hands. When exhaling, the abdomen collapses, and the air is exhaled as much as possible; generally inhale for 2 seconds, exhale for 4 to 6 seconds, the ratio of inhalation to exhalation time is 1:2 or 1:3, and breathe 7 to 8 times per minute; start twice a day, 5 minutes each time, and gradually increase to 10 to 15 minutes/time, 2 to 3 times a day after becoming proficient. COPD patients use the diaphragm to take deep and slow breaths, change the unreasonable shallow and fast breathing method involving auxiliary respiratory muscles, prolong the exhalation time to increase tidal volume, reduce ineffective dead space, increase alveolar ventilation, reduce respiratory power consumption, and relieve shortness of breath symptoms.

Image source: https://cn.bing.com/images/

1.3

Chest expansion exercise training

The patient lies in a supine or sitting position, and the attendant places both hands on the thorax corresponding to the lung lobe that the patient wants to expand. The patient is asked to exhale and feel the ribs moving downward and inward. At the same time, the attendant's palms test downward pressure. A moment before the patient inhales, the thorax is quickly pulled downward and inward to induce contraction of the external intercostal muscles. The patient is asked to inhale and resist the resistance of the attendant's hands; this improves the restricted lung lobe, expands the chest wall again, and increases lung ventilation.

1.4

Inspiratory resistance training

The patient inhales through the resistance trainer in the mouth, which is provided by tubes or springs of various diameters. The training time is gradually increased to 20-30 minutes each time to increase the endurance of the inspiratory muscles, 2-3 times a day. When the patient's inspiratory muscle strength and endurance improve, the diameter of the trainer is gradually reduced or the spring resistance is increased. The trainer can be used (as shown below)

Image source: Baidu Gallery

2. Pulmonary rehabilitation techniques to promote lung cleansing

2.1

Cough training

Sit down with your upper body slightly leaning forward and your shoulders relaxed; take a slow, deep breath to fully inflate the alveoli; hold your breath for 2 to 3 seconds, open your mouth and cough 3 times in a row, contracting your abdominal muscles while coughing; stop coughing, purse your lips and slowly exhale the remaining gas; take a slow, deep breath, and repeat the above movements. You can repeat 2 to 3 or more movements in each training session.

2.2

Postural drainage

With the help of appropriate body position, the purulent lesions in the lungs are placed in a high position, so that the purulent necrotic materials accumulated in the bronchi and lungs can be drained to the large airways and then coughed out through the mouth, thereby improving the patient's respiratory function; turn over every 0.5 to 1 hour, keep the drainage position for 10 to 20 minutes, 1 to 2 times a day, preferably in the early morning or before going to bed.

Image source: https://cn.bing.com/images/

3. Exercise training to improve respiratory function

Exercise training should follow the principles of gradual, moderate and appropriate amount. Instruct patients to follow the recommended plan; exercise frequency should be at least 3 times a week, exercise intensity should be 40%~85% of maximum oxygen uptake, and each exercise should last 20-60 minutes; mainly including upper limb training, lower limb training and whole body training.

3.1

Upper body training – arm lifts

The patient lies in supine or sitting position, stretches both arms and slowly lifts them forward alternately to the end of a comfortable position, then slowly lowers them, 5 times per set, 3 sets/day; for arm curls, hold dumbbells or sandbags, place arms on both sides of the body, slowly bend arms to lift the weight and then slowly lower them.

3.2

Lower limb training - ankle pump exercise

The patient lies on his back or sits, stretches his lower limbs, relaxes his thighs, slowly curls his toes, tries his best to point his toes toward himself to the maximum, holds for 5 seconds, then slowly presses his toes down to the maximum, holds for 5 seconds. Then relax, 10 per set, 2-3 sets/day; simulate squats, hold the back of a chair with your hands, stand with your feet shoulder-width apart, then slowly squat, keep your knees straight without turning outward or inward, then slowly stand up, 10 per set, 2-3 sets/day.

3.3

Full body training

Walking, breathing gymnastics, going up and down stairs, Tai Chi, Ba Duan Jin, square dancing, etc.; patients who are asymptomatic at rest and only experience breathing difficulties when walking or doing strenuous exercise can do jogging, brisk walking, shuttlecock kicking, badminton, cycling, square dancing, etc.; patients who experience shortness of breath after a little activity can choose to walk slowly, do Tai Chi, etc.

The above-mentioned respiratory function exercises are simple and highly practical. On the one hand, they can improve respiratory muscle function, promote lung cleaning and gas exchange, and reduce sputum retention; on the other hand, they can effectively reduce symptoms of dyspnea, improve exercise endurance, improve patients' quality of life, and reduce readmissions.

Author: Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine

Chen LiyunDeputy Chief Physician