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PubMed1997

Pulmonary rehabilitation and surgery for end-stage lung disease.

Pulmonary rehabilitation is a multidisciplinary approach to the comprehensive management of patients with end-stage lung disease. Components of the pulmonary rehabilitation program include education, exercise, nutrition, and psychosocial support. Most of the information published on pulmonary rehabilitation has been from patients with COPD. There are some data on patients with cystic fibrosis but, unfortunately, there is a lack of information on other causes of end-stage lung disease. Published data almost invariably show improvements in functional capacity (i.e., walk distance) and quality of life. There are no objective physiologic changes in lung function. Because patients who attend programs regularly are a carefully selected subpopulation, conclusions from published reports may not apply to all patients with end-stage lung disease. The recommendation for pulmonary rehabilitation prior to lung volume reduction surgery or lung transplantation is based on assumptions that may not necessarily be true. No data exist that conclusively show that preoperative rehabilitation alters outcome. Nevertheless, given the relatively benign nature of pulmonary rehabilitation and the documented benefits, it is reasonable to recommend such a program to patients who are awaiting surgical intervention. Further research is required to define the role, nature, duration, intensity, and frequency of exercise training in the management of patients who are to undergo surgical treatment for advanced lung disease.

Activities of Daily Living↗
PubMed1999

Cycle ergometer and inspiratory muscle training in chronic obstructive pulmonary disease.

In patients with chronic obstructive pulmonary disease (COPD) the intensity of aerobic training is limited by dyspnea. Improving strength of the inspiratory muscles could enhance aerobic exercise training by reducing exercise-related dyspnea. We examined effects of home-based inspiratory muscle training (IMT) and cycle ergometry training (CET) in 53 patients with moderate to severe COPD (FEV(1)% pred, 50 +/- 17 [mean +/- SD]). Patients were randomly assigned to 4 mo of training in one of four groups: IMT, CET, CET + IMT, or health education (ED). Patients were encouraged to train to the limits of their dyspnea. Inspiratory muscle strength and endurance increased in IMT and CET + IMT groups compared with CET and ED groups (p < 0. 01). Peak oxygen uptake increased and heart rate, minute ventilation, dyspnea, and leg fatigue decreased at submaximal work rates in the CET and CET + IMT groups compared with the IMT and ED groups (p < 0. 01). There were no differences between the CET and CET + IMT groups. Home-based CET produced a physiological training effect and reduced exercise-related symptoms while IMT increased respiratory muscle strength and endurance. The combination of CET and IMT did not produce additional benefits in exercise performance and exercise-related symptoms. This is the first study to demonstrate a physiological training effect with home-based exercise training.

Aged↗
PubMed2004

Transient attenuation of CO2 sensitivity after neurotoxic lesions in the medullary raphe area of awake goats.

The major objective of this study was to gain insight into whether under physiological conditions medullary raphe area neurons influence breathing through CO(2)/H(+) chemoreceptors and/or through a postulated, nonchemoreceptor modulatory influence. Microtubules were chronically implanted into the raphe of adult goats (n = 13), and breathing at rest (awake and asleep), breathing during exercise, as well as CO(2) sensitivity were assessed repeatedly before and after sequential injections of the neurotoxins saporin conjugated to substance P [SP-SAP; neurokinin-1 receptor (NK1R) specific] and ibotenic acid (IA; nonspecific glutamate receptor excitotoxin). In all goats, microtubule implantation alone resulted in altered breathing periods, manifested as central or obstructive apneas, and fractionated breathing. The frequency and characteristics of the altered breathing periods were not subsequently affected by injections of the neurotoxins (P > 0.05). Three to seven days after SP-SAP or subsequent IA injection, CO(2) sensitivity was reduced (P < 0.05) by 23.8 and 26.8%, respectively, but CO(2) sensitivity returned to preinjection control values >7 days postinjection. However, there was no hypoventilation at rest (awake, non-rapid eye movement sleep, or rapid eye movement sleep) or during exercise after these injections (P > 0.05). The neurotoxin injections resulted in neuronal death greater than three times that with microtubule implantation alone and reduced (P < 0.05) both tryptophan hydroxylase-expressing (36%) and NK1R-expressing (35%) neurons at the site of injection. We conclude that both NK1R- and glutamate receptor-expressing neurons in the medullary raphe nuclei influence CO(2) sensitivity apparently through CO(2)/H-expressing chemoreception, but the altered breathing periods appear unrelated to CO(2) chemoreception and thus are likely due to non-chemoreceptor-related neuromodulation of ventilatory control mechanisms.

Animals↗
PubMed2004

[Exercise effort training for COPD: physiological basis and results].

INTRODUCTION: In the last decade pulmonary rehabilitation has become a well accepted treatment for patients with chronic obstructive pulmonary disease (COPD) suffering from persistent dyspnea and fatigue, despite appropriate medical treatment. STATE OF ART: Patients with COPD frequently have muscular dysfunction that can be corrected by appropriate exercise training programmes. Muscle function as measured by strength and endurance tests exercise capacity and also the health status and quality of life are improved by exercise and endurance training. However, integration of exercise training in a multidisciplinary management programme is necessary to take account of all aspects of the illness. PERSPECTIVES: Methods of exercise training need to be adapted for patients with severe COPD who are unable to undertake endurance training and for patients who obtain little benefit. CONCLUSIONS: Pulmonary rehabilitation, thanks to its multidisciplinary nature, seems to be an effective modality of management for patients with COPD. However, the improvements in physical ability, quality of life and general health require an exercise training programme that is adapted for the individual patient.

Breathing Exercises↗
PubMed1997

[Changes in body equilibrium response caused by breathing. A posturographic study with visual feedback].

BACKGROUND: Therapeutical methods involving holistic medicine are of increasing interest. The present study deals with the psychophysical breath work by Middendorf and examines whether it has an effect on reactions of the body's equilibrium system. METHODS: Different optical patterns were projected on a video screen to the test subject standing on a modified posturographic platform. Subjects were instructed to shift their center of gravity according to the patterns projected on the video screen. The patterns consisted of a line that had to be followed in the anterior-posterior and in the lateral plane, and of a circle which had to be followed clockwise and counterclockwise. PATIENTS: Three groups each consisting of 17 healthy persons were tested; group 1: advanced in breath training, group 2: beginners in breath training, group 3: no experience in breath work at all. RESULTS: Group 1 und 2 show significantly better results in the posturographic test with visual feedback than subjects without experience in breast work (group 3). Furthermore, posturographic results immediately after one hour of breath work reveal clear improvements in the body equilibrium. CONCLUSIONS: Psychophysical breath work by Middendorf leads to a general improvement of the body equilibrium which is stable over time. The positive results of this study lead to the assumption that breath work by Middendorf is a valuable method for treatment and rehabilitation of balance disorders.

Adult↗
PubMed1986

The effect of inspiratory resistive training on exercise capacity in optimally treated patients with severe chronic airflow limitation.

This study was designed to determine whether inspiratory resistive training could improve the exercise performance of patients with severe chronic airflow limitation who had already received optimum conventional therapy with bronchodilators and physiotherapy. Eighteen patients were studied. Ten patients were trained with an inspiratory resistance device for six weeks and eight patients used a placebo device. Psychological factors, likely to influence exercise capacity, were taken into account. Although there was no significant increase in maximum inspiratory pressure in the ten trained subjects, inspiratory muscle endurance was improved. Exercise performance, as assessed by progressive cycle exercise, stair climbing, 12 minute walking distance and treadmill walking did not change significantly in either group. It was concluded that inspiratory muscle training, using a currently available technique, produced no additional improvement in exercise capacity beyond that achieved by conventional bronchodilator and rehabilitation therapy.

Aged↗
PubMed2001

Intracerebral haemorrhage and Qigong.

We report on a 65-year-old woman who presented with acute right-sided weakness because of an intracerebral (thalamic) haemorrhage. As a Qigong enthusiast with a long-standing history of hypertension, she developed a stroke syndrome soon after practising Qigong one morning. Following neurological recovery, the patient exhibited erratic blood pressure responses while practising Qigong, despite the fact that resting blood pressure was normal. The haemodynamic responses to exercise are discussed and a review of the therapeutic implications of practising Qigong is presented.

Aged↗
PubMedDate not supplied

Muscle retraining in ICU patients.

The general aim of an ICU respiratory rehabilitation programme is to improve the patient's measured quality of life. It can be done by applying advanced therapeutic modalities in order to improve the remaining functions and to decrease the patient's dependency as well as the risks associated with an ICU admission. A number of physiological changes involve all the body systems as a consequence of a bed-rest period and play an important role in the weaning failure of ventilated patients. Inactivity muscle mass declines from the first week of ICU admission, as well as the muscle's ability to perform aerobic exercise. The respiratory muscles strength and endurance decreases, also the ventilatory pump and the cardiovascular response to exercise may be alterated. Disorientation, and disfunction of the Central Nervous System may occur. The aim of this review is to analyse the usefulness of skeletal and respiratory muscle training in improving strength, endurance and decreasing dyspnea at rest and during exercise and the role of rehabilitation in obtaining maximal functional capacity of ICU patients.

Breathing Exercises↗
PubMed1990

[Effect of qigong exercise on the blood level of monoamine neuro-transmitters in patients with chronic diseases].

In this study, the authors, by means of fluorescence spectrophotometry, observed the variations of blood contents of monoamine neuro-transmitters (5-hydroxytamine 5-HT; norepinephrine NE; dopamine DA) in 68 subjects before and after adoption of Qigong exercises. A comparison of pre- and post-exercise showed a general reduction in 5-HT, varying from 0.43 +/- 0.21 to 0.21 +/- 0.13 microgram/ml (P less than 0.001). Variations in NE and DA tended to go up, NE being from 0.27 +/- 0.13 to 0.35 +/- 0.27 microgram/ml, DA from 0.86 +/- 0.69 to 1.19 +/- 0.81 micrograms/ml (P less than 0.02). Effects of Qigong exercises on different diseases: Subjects in each group showed reduction in blood 5-HT content after they had practised Qigong exercise. (1) Cardiovascular disease: 0.47 +/- 0.34 to 0.16 +/- 0.11 microgram/ml (n = 13); (2) gastric diseases: 0.37 +/- 0.19 to 0.22 +/- 0.13 microgram/ml (n = 20); (3) joint system diseases: 0.44 +/- 0.21 to 0.18 +/- 0.13 microgram/ml (n = 10); (4) respiratory system diseases: 0.40 +/- 0.22 to 0.22 +/- 0.12 microgram/ml (n = 8); (5) other diseases (neuroasthenia, neurosis, etc.): 0.46 +/- 0.22 to 0.25 +/- 0.14 microgram/ml (n = 13). In all these groups except the fourth group, variations in 5-HT content in comparison with the pre-exercise values were respectively P less than 0.01, less than 0.01, less than 0.05, less than 0.05. The difference was obvious. The post-exercise blood content of DA in various groups rose up remarkably.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Effects of "he xiang zhuang gongfu" on respiratory function in healthy adults].

Eleven healthy adults who practised He Xiang Zhuang Gongfu (HGF) were followed for 6 months; 15 pulmonary function tests were determined before HGF practice, 2 months and 6 months after HGF practice. All 11 subjects took the HGF exercise every day for 30 minutes. Samplings were taken before subjects had ever practised HGF as control value, immediately and 30 minutes after HGF exercise. In the 2nd month and 6th month of HGF practice. The results indicated that VO2 decreased after 2 and 6 months HGF practice, and the effect even persisted to 30 minutes after HGF exercise, indicating that HGF may reduce metabolic rate and decrease the oxygen consumption of body. The possible mechanism was discussed. MVV had an up tendency after HGF practice, which suggested the possibility of strengthening respiratory muscle by HGF. HGF may be a good physical exercise and can induce a wakeful hypometabolic physiologic state.

Adult↗
PubMedDate not supplied

Qigong practice: a pathway to health and healing.

Qigong is a therapeutic Chinese practice that has been used for thousands of years to optimize and restore energy (Qi) to the body, mind, and spirit. Elements of Taoist and Buddhist philosophies form the foundation of Qigong, which promotes health and vitality through gentle exercises for the breath, body, mind, and the voice. One component of Qigong is T'ai Chi, an exercise modality that uses gentle movements. Research has demonstrated that Qigong and T'ai Chi have beneficial effects on the body and that these are becoming popular holistic modalities in the United States. Nurses should understand the philosophy, concepts, and elements of Qigong and T'ai Chi so that they can guide patients to the benefits of this ancient art and science.

Breathing Exercises↗
PubMed1998

Effect of continuous negative-pressure breathing on skin blood flow during exercise in a hot environment.

To assess the impact of continuous negative-pressure breathing (CNPB) on the regulation of skin blood flow, we measured forearm blood flow (FBF) by venous-occlusion plethysmography and laser-Doppler flow (LDF) at the anterior chest during exercise in a hot environment (ambient temperature = 30 degreesC, relative humidity = approximately 30%). Seven male subjects exercised in the upright position at an intensity of 60% peak oxygen consumption rate for 40 min with and without CNPB after 20 min of exercise. The esophageal temperature (Tes) in both conditions increased to 38.1 degreesC by the end of exercise, without any significant differences between the two trials. Mean arterial pressure (MAP) increased by approximately 15 mmHg by 8 min of exercise, without any significant difference between the two trials before CNPB. However, CNPB reduced MAP by approximately 10 mmHg after 24 min of exercise (P < 0.05). The increase in FBF and LDF in the control condition leveled off after 18 min of exercise above a Tes of 37.7 degreesC, whereas in the CNPB trial the increase continued, with a rise in Tes despite the decrease in MAP. These results suggest that CNPB enhances vasodilation of skin above a Tes of approximately 38 degrees C by stretching intrathoracic baroreceptors such as cardiopulmonary baroreceptors.

Adult↗
PubMed1997

Comparison of invasive and noninvasive saturation monitoring in prescribing oxygen during exercise in COPD patients.

The aim of this study was to determine whether it is possible using ear-oximetry to prescribe the correct oxygen flow rates during exercise in chronic obstructive pulmonary disease (COPD) patients on long-term oxygen therapy (LTOT). Twenty COPD patients on LTOT, with exercise desaturation breathing oxygen at resting flow rates, performed a series of 6-min treadmill walking tests, with a progressive increase in oxygen flows until oxygen saturation measured by ear- or pulse-oximetry (Sp,O2) was above 90%. The exercise studies were repeated the next day, saturation being measured both noninvasively by ear-oximetry (Sp,O2) and invasively by CO-oximeter (Sa,O2). The exercise studies continued until both Sa,O2 and Sp,O2 were above 90%. Reproducibility and agreement of the results were analysed according to Bland and Altman. Sp,O2 was significantly lower than Sa,O2 by, on average, 0.7% (p < 0.004). Sp,O2 reproducibility between the two days was good. The invasive and noninvasive oxygen flow prescriptions agreed in only 10 subjects; in six subjects ear-oximetry over-estimated the oxygen supply (p < 0.0005), whilst in four subjects it underestimated (p < 0.01). Contingency table analysis with coded raw data for the values of the sixth minute (that of the deepest desaturation) showed poor agreement between CO- and pulse-oximetry (Chi-squared p < 0.003). However, theoretically, if the Sp,O2 target had been raised to 93%, there would have been hardly any underestimations of Sa,O2 p = NS). We concluded that noninvasive measurement of oxygen saturation is not adequate for estimating arterial saturation in chronic obstructive pulmonary disease. We suggest, as a working solution, that a new cut-off limit of 93% oxygen saturation measured by pulse oximetry should be used as the value below which exercise-induced desaturation should be corrected in order to allow oxygen to be properly prescribed during activities of daily life.

Exercise Test↗
PubMed1983

Control of breathing at the start of exercise as influenced by posture.

It has been suggested that the initial phase of the ventilatory response to exercise is governed by a mechanism which responds to the increase in pulmonary blood flow (Q)--cardiodynamic hyperpnea. Because the initial change in stroke volume and Q is less in the supine (S) than in the upright (U) position at the start of exercise, we hypothesized that the increase in ventilation would also be less in the first 20 s (phase I) of S exercise. Ten normal subjects performed cycle ergometry in the U and S positions. Inspired ventilation (VI), O2 uptake (VO2), CO2 output (VCO2), corrected for changes in lung gas stores, and end-tidal O2 and CO2 tensions were measured breath by breath. Heart rate (HR) was determined beat by beat. The phase I ventilatory response was markedly different in the two positions. In the U position, VI increased abruptly by 81 +/- 8% (mean +/- SE) above base line. In the S position, the phase I response was significantly attenuated (P less than 0.001), the increase in VI being 50 +/- 6%. Similarly, the phase I VO2 and VO2/HR responses reflecting the initial increase in Q and stroke volume, were attenuated (P less than 0.001) in the S posture, compared with that for U; VO2 increased 49 +/- 5.3 and 113 +/- 14.7% in S and U, respectively, and VO2/HR increased 16 +/- 3.0 and 76 +/- 7.1% in the S and U, respectively. The increase in VI correlated well with the increase in VO2, (r = 0.80, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2002

Pulmonary hemodynamic and tidal volume changes during exercise in heart failure.

BACKGROUND: Impairment of lung mechanics, increase of pulmonary artery pressure and limitation of exercise capacity are common findings in chronic heart failure. The objective of the present study was to evaluate whether pulmonary mechanics are correlated with pulmonary hemodynamics, whether both are correlated with the functional capacity and whether the time course of their changes during exercise correlates with the exercise capacity. METHODS: We performed a cardiopulmonary exercise test (breath by breath analysis of ventilation and gas exchange, cycloergometer, 25 W increments every 3 min) with pulmonary hemodynamic monitoring in 38 heart failure patients. The parameters were analyzed at rest, 1 min after the work rate increase and at peak exercise. RESULTS: A significant linear correlation with peak oxygen consumption was found at rest for: mean pulmonary artery pressure (mPAP, r = -0.56), right atrial pressure (RAP, r = -0.42), pulmonary wedge pressure (PWP, r = -0.53), and total pulmonary (TPR, r = -0.53) and pulmonary vascular resistances (PVR, r = -0.45); after 1 min of exercise for: cardiac index (CI, r = 0.49), mPAP (r = -0.57), RAP (r = -0.60), PWP (r = -0.45), and TPR (r = -0.67) and PVR (r = -0.38); at peak exercise for: tidal volume (r = 0.63), CI (r = 0.63), RAP (r = -0.43), TPR (r = -0.65) and PVR (r = -0.43). A significant linear correlation with peak oxygen consumption was found, for the increment between rest and 1 min of exercise, for RAP (r = -0.58) and CI (r = 0.42) and, for the increments between rest and peak exercise, for tidal volume (r = 0.79) and CI (r = 0.61) and, for the ratio between the increment between rest and 1 min of exercise/increment between rest and peak exercise, for mPAP (r = -0.42), RAP (r = 0.51) and CI (r = -0.54). The same ratio of increment of mPAP (r = 0.39) and CI (r = 0.36) correlated with that of tidal volume. CONCLUSIONS: This study provides evidence of a strong correlation between the respiratory function and pulmonary vascular pressure changes during exercise in heart failure.

Adult↗