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[The role of physical rehabilitation in the treatment of exudative pleurisy].

INTRODUCTION: Exudates are due to a variety of diseases, the major and most common ones being tuberculosis, nonspecific inflammation and malignancy. They are usually treated conservatively, sometimes combined with surgery and physical treatment. Physical therapy includes positional exercises, breathing exercises and biostimulation. AIM OF THE STUDY: The study was aimed to find out the following: 1) Is lung function improved by physical therapy; 2) Can adhesions be diminished and mobility of the affected hemidiaphragm improved by physical treatment; 3) Is there a direct positive correlation between physical treatment and obtained improvement, or the same can be achieved in patients receiving medicamentous treatment only; 4) What are the effects of some factors we cannot influence (sex, age, effusion level, position of adhesions) on lung function and diaphragm mobility improvement, that is on the efficiency of physical treatment; 5) How do the factors we can influence (the time interval before initiating the treatment and its duration) affect improvement of the same lung function parameters, that is treatment efficacy? MATERIAL AND METHODS: Physical treatment of patients with exudative pleurisy was accomplished at the Department of Rehabilitation in our Institute and it consisted of directed breathing exercises and laser biostimulation. Its effects were examined in a group of 175 patients, who received both conservative and physical treatment, and results were compared with the control group patients, treated only conservatively (with antibiotics, antituberculotics, corticosteroids). RESULTS: Comparative analysis confirmed a significant improvement of lung function parameters (VC, FEV1, PEF) as well as of hemidiaphragm mobility on the affected side of the thorax in favour of the examined group. The severity of the lung function and diaphragm mobility impairments have been found to be in correlation with the localization of adhesions, whereas the degree of improvement correlated with the time interval before the treatment initiation, as well as with its duration. DISCUSSION AND CONCLUSION: The applied physical therapy resulted in: 1) significant improvement of all examined lung function parameters in the examined group, which was not registered in the control group; 2) significant improvement of the diaphragm mobility in general; 3) factors such as sex, age and effusion level have no effects on the physical treatment results; 4) treatment results are affected by the time interval passed before the treatment initiation and its duration, as well as the localization of adhesions; anterior adhesions affected lung function and diaphragm mobility least, posterior ones more, while the influence of lateral adhesions was most significant. It is finally concluded that physical treatment should necessarily be included in the treatment of exudative pleurisy.

Adult↗

PubMed1990

[Respiration physical therapy?].

This review assesses the role of physical modalities - chest physical therapy, breathing exercises, breathing training, and physical exercises - in the treatment of patients with pulmonary diseases. Controlled studies suggest that "routine" exercises yield a disappointing effort-benefit ratio, but that individually adapted programs may improve the well-being and functional ability of selected patients.

Breathing Exercises↗

PubMed1989

Effects of continuous positive- and negative-pressure breathing on the pattern of breathing in man during exercise.

Breathing pattern and static lung volumes were studied in 10 subjects at rest and during incremental-load cycle ergometry under three different conditions, viz. with normal pressure in the airways (control) and during continuous positive- and negative-pressure breathing (CPPB, CNPB) of +15 and -15 cmH2O. End-expiratory, end-inspiratory and mid-expiratory volumes were increased by CPPB and decreased by CNPB; these effects were especially pronounced at rest and during mild exercise. Both at rest and during exercise mean inspiratory flow (VT/TI) was exaggerated by CPPB and attenuated by CNPB. At rest these changes were due mainly to concomitant changes in tidal volume (VT) which was increased by CPPB and decreased by CNPB, while inspiratory time duration (TI) was relatively unaffected by pressure breathing. The transition from rest to loadless pedalling induced an increase in VT but no change in TI in the control condition, whereas in the CPPB and CNPB conditions TI decreased and VT remained unaltered. This CPPB- and CNPB-induced change in the volume-time threshold relationship at the onset of pedalling is attributed to increased stretch receptor activity in the extrathoracic portion of the trachea as a result of the increments in transmural pressure. During the course of exercise there was an inverse relationship between the slope of the VT-TI curve and the mid-expiratory volume in that the slope was greater in the control than in the CPPB condition and greatest during CNPB, suggesting that in exercise hyperpnoea the VT-TI relationship is also determined by pulmonary and/or thoracic wall stretch receptors capable of sensing the absolute lung volume.

Adult↗

PubMed1980

[Principles and techniques of physiotherapy for arterial claudication of the limbs (author's transl)].

Exercise training of stage II arteriopathy is set in accordance with the localisation of the lesions the walking distance and the cardio respiratory state. It must procure an improvement of the respiratory function, a stimulation of the muscles and vessels situated downstream of the lesion and a re-training of the patient to a more economical way of walking. The passive technics use warmth, massages, postures. The active methods, when they can be applied, are more efficient and include exercise under load or no load, abdominal exercises, breathing exercises, analytical exercises against a resistance, global exercises on a cycle ergometer or walking on a path or a trad mill.

Exercise Therapy↗

PubMed1992

Individuality of breathing patterns during hypoxia and exercise.

Breathing was recorded via a pulsed ultrasonic flowmeter in 11 healthy subjects, at rest and during steady-state exercise (at 50% of their maximal O2 consumption) at both sea level (200 m) and simulated altitude (4,500 m in a hypobaric chamber). The pattern of breathing was quantified breath by breath in terms of classical respiratory variables (tidal volume and inspiratory and expiratory times), and the shape of the entire airflow profile was quantified by harmonic analysis. Statistical tests were used to compare the within-individual with the between-individual variations. In comparing the sea level vs. altitude rest (16% increase in ventilation) and sea level vs. altitude exercise (40% increase in ventilation) airflow profiles, we found a significantly greater resemblance within the individual than between individuals. Comparisons of sea level rest and exercise (295% increase in ventilation) and altitude rest and exercise (375% increase in ventilation) revealed no similarity within individuals. Despite airflow profile changes between rest and exercise, it is still possible to attest to a diversity of flow profile between individuals during exercise. Hypoxia at rest or during exercise does not alter the phenomenon of the individuality of breathing patterns.

Adult↗

PubMed1997

The components of a respiratory rehabilitation program: a systematic overview.

OBJECTIVE: To determine the contribution of the various components of a rehabilitation program to the improvement of exercise capacity and health-related quality of life (HRQL) in patients with COPD. DATA SOURCES: MEDLINE (1966 to April 1996) was searched. Abstracts presented at international conferences were also hand searched for additional relevant trials. Bibliographies of the retrieved articles were reviewed. Experts in rehabilitation were consulted to uncover unpublished trials. STUDY SELECTION: Randomized controlled trials (RCTs) of exercise training, breathing exercises, education, and psychosocial support in patients with COPD were primarily included if (1) the treatment effect of a specific component of a rehabilitation program could be isolated, and (2) exercise capacity, HRQL, compliance with medical therapy, and/or knowledge about the disease were measured. DATA SYNTHESIS: A best-evidence synthesis was conducted; 22 RCTs contributed to the analysis. We found the following: (1) the patients exposed to interventions that included exercise training improved their functional exercise capacity and HRQL; (2) exercise training was muscle specific; (3) the evidence to support inspiratory muscle training and other breathing exercises as an adjunct to exercise training in COPD remains equivocal; (4) the contribution of education has not been well addressed; and (5) psychosocial support reduced dyspnea acutely and, when used as an adjunct to rehabilitation, promoted compliance with an exercise regimen and improved HRQL. CONCLUSION: Respiratory rehabilitation is likely to improve functional exercise capacity and HRQL if it includes exercise training and psychosocial support. Further research is required to better define the types and intensity of exercise as well as the influence of respiratory muscle training and patient education.

Breathing Exercises↗

PubMed1992

Effects of anticipation, prior-exercise, and breathing frequency to ventilatory response during step exercise: a preliminary study.

We examined the effects of anticipation, prior-exercise, and restricted breathing frequency on the ventilatory transient response to bicycle step exercise (75 W, 4 min, 50 rpm), i.e., 1) whether the increase of work rate was anticipated by the subject or not, 2) whether the exercise was preceded by light exercise (25 W), or rest, and 3) whether the exercise entrained the breathing frequency (f: 12.5/min, or 25/min) or not (voluntary). The corresponding step-on exercise was randomly performed at least two to five times by one adult male subject. As a result, a) the initial rapid ventilatory component, phase 1, was not observed when initiated from light exercise, whereas the overshot phase 1 was observed from rest in anticipation and voluntary breathing frequency condition due to the rapid increase of tidal volume; b) compared with the anticipation condition, the phase 1 response of VE in the non-anticipation condition was slower with prior-rest, and not with prior-light exercise; and c) the restriction of the breathing frequency for entraining the exercise rhythm did not affect the initial rapid response, but decreased the fluctuation of VE in the steady state, compared to the condition of voluntary breathing frequency.

Adult↗

PubMed1969

The effect of CO2 on ventilation and breath-holding during exercise and while breathing through an added resistance.

1. Ventilation was measured while subjects were made to rebreathe from a bag containing CO(2) and O(2) in order to expose them to a steadily rising CO(2) tension (P(CO2)). The object of the experiments was to determine the effect of a variety of stimuli upon the increase in ventilation and fall in breath-holding time which occurs in response to the rising P(CO2).2. Steady-state exercise at 200 kg.m/min resulted in a small fall in the slope of the ventilation-CO(2) response curve (S(V)) and a small, though not statistically significant, fall in the P(CO2) at which ventilation would be zero by extrapolation (B(V)). There was a marked fall in the slope of the breath-holding-CO(2) response curve (S(BH)) and an increase in the P(CO2) at which breath-holding time became zero by extrapolation (B(BH)).3. These results have been interpreted with the aid of a model of the control of breath-holding and it is suggested that there is no change in CO(2) sensitivity on exercise, either during rebreathing or breath-holding.4. An increase in the resistance to breathing caused a marked reduction in S(V) and B(V), but no change in the breath-holding-CO(2) response curve. These findings suggest that the flattening of the ventilation-CO(2) response curve is mechanical in origin and acute airway obstruction produces no change in CO(2) sensitivity.5. On the basis of these results, we suggest that more information about CO(2) sensitivity can be obtained by a combination of ventilation and breath-holding-CO(2) response curves.

Apnea↗

PubMed1992

[Control of breathing during exercise].

Although the control of breathing during exercise has been studied extensively that both neural and humoral factors may play a role in mediating the exercise hyperpnea, it remains unresolved whether the response is due solely to neural or humoral mechanisms and how the pulmonary gas exchange matches to the tissue exchange rates. At just onset of exercise ventilation can increase abruptly within 1 to 2 breathes (Phase I). Such a rapid increment of ventilation is not attributed to the humoral factor(s) due to the circulation delay from muscle metabolites. More rapid mechanism(s) such as irradiation from brain stream, afferent neurogenic control, blood flow increment as cardiodynamic theory might be considered. During moderate exercise intensity with a step function, ventilation increased exponentially to the steady state (phase II) after an abrupt increase at just onset of exercise. In this phase II, the breathing is controlled as to exchange the oxygen and carbon dioxide at rates appropriate for the acid-base homeostasis regulation. As a result, arterial blood gases and acid-base status must maintain within a narrow range despite of extremely enlarged metabolic rates by exercise. Some humoral factor(s) might be mediated for the control of breathing such as mean steady state error theory, arterial blood gases oscillation theory, feedback system by CO2, or optimization theory. At the heavy exercise intensity, anaerobic metabolism was supplemented to product for the enhanced energy requirement, so that ventilation increased non-linearly with oxygen uptake due to the lactoacidosis and its buffering activity. There has been a debate concerning cause and effect relationship between blood lactate increment and hyperpnea during exercise. Recently, arterial potassium concentration resulted from depolarization due to muscle contraction during exercise might stimulate to carotid bodies for increasing ventilation.

Animals↗

PubMed1992

Breathing pattern and subjective responses to small inspiratory resistance during submaximal exercise.

Breathing patterns and subjective responses to small resistances were investigated in seven subjects during moderate exercise. Inspiratory resistances of 0.15 (R1), 0.25 (R2) and 0.30 (R3) kPa.l-1.s were tested against control of 0.06 kPa.l-1.s with no added resistance. Subjective responses to small inspiratory resistances were evaluated through whole experiments including periods before and after exercise, herein called SNS. Average SNS significantly increased above the R2 condition. Above the R2 condition, significant changes in the breathing components of volume, flow and timing were also observed during exercise. SNS grew as a power function of peak inspiratory pressure (P(imax)) measured during exercise within such small range of stimulation less than the R3 condition and individual differences in the relationship between SNS and P(imax) were observed. All subjects felt at least some discomfort below the resistance of R3 and two subjects felt it below around R1 condition. It was suggested that breathing pattern was selected to limit peak pressure at the R3 condition by further increasing inspiratory work for a breath and this tendency was reinforced in load-sensitive subjects with longer inspiratory time and lower peak flow rate. We concluded that breathing patterns depend mainly on peak work, especially in load-sensitive individuals, which is likely to be one of the primary determinants of a worker's tolerance to respirators.

Adult↗

PubMed1999

Nasal dilator strips delay the onset of oral route breathing during exercise.

The external nasal dilator strip (ENDS) device (Breathe Right, CNS Inc., Chanhassen, MN, USA) has been adopted by athletes to promote nasal route breathing during exercise. We studied the influence of ENDS on the switching point from nasal-only to oro-nasal breathing during exercise in 4 healthy men (age 25 +/- 2 yrs, mean +/- SEM) and 5 women (age 30 +/- 5 yrs). Resting inspiratory nasal airflow resistance decreased from 0.33 +/- 0.02 kPa/L/s without ENDS to 0.22 +/- 0.01 kPa/L/s with ENDS (p < 0.01). ENDS delayed the onset of oro-nasal breathing such that the time from commencement of exercise to switching increased by 15.2%, and maximum levels of inspiratory nasal airflow and ventilation achieved prior to switching increased by 14.9% and 14.3%, respectively (all p < 0.05). We conclude that, in normal healthy subjects, ENDS does promote nasal route breathing during exercise, but any delay in the onset of oral route breathing during a progressive exercise task appears relatively small.

Adult↗

PubMed2004

Nonpharmacologic treatment of hypertension by respiratory exercise in the home setting.

BACKGROUND: Device-guided breathing exercises at home have a potential to become a nonpharmacologic treatment of high blood pressure (BP). The aim of this study was to evaluate the impact of device-guided breathing exercises on both office and home BP. METHODS: A total of 79 mild hypertensive individuals, either medicated or unmedicated, with BP > 140/90 mm Hg were enrolled. After a 2-week run-in phase, in both the control and treatment groups daily home blood pressure was monitored for 8 weeks. The treatment group also engaged in 15-min daily sessions with device-guided breathing exercises. RESULTS: A total of 47 treatment patients and 26 control subjects completed the study. In the control group both office and home BP showed small nonsignificant reductions. Device-guided breathing exercises reduced mean office BP (systolic/diastolic) by 5.5/3.6 mm Hg (P < .05 for diastolic) and mean home BP by 5.4/3.2 mm Hg (P < .001 for both). Home BP response reached a plateau after 3 weeks. CONCLUSION: Our data show that device-guided breathing exercises have an antihypertensive effect that can be seen in conditions closer to daily life than the setting of the physician's office.

Adult↗

PubMed1995

Breathing-coordinated exercise improves the quality of life in hemodialysis patients.

Breathing-coordinated exercise is a traditional Chinese exercise. These exercise maneuvers consist of slow diaphragmatic breathing, end-inspiratory pause, and Kegel's exercise. A total of 30 patients were enrolled in this study, with 12 patients as controls, to evaluate its effect on hemodialysis patients. Exercise was performed for 25 to 30 min twice a day for at least 3 months. Results from the exercise group showed a subjective improvement in appetite and physical strength, and an increase in the frequency of bowel movements, in addition to enhanced sexual activity and a significant increase in Karnofsky scores. Six patients in the exercise group underwent bicycle ergometry and demonstrated a stable maximal oxygen consumption, whereas the control group revealed a decline in maximal oxygen consumption. Photoelectric plethysmography and laser-Doppler flowmetry demonstrated a pulsatile enhancement of the peripheral microcirculation. Abdominal sonography revealed an oscillatory change in the diameter of the inferior vena cava. It was concluded that these gentle exercise maneuvers may improve the quality of life in hemodialysis patients, especially weak dialysis patients. The mechanism may be partly related to an improvement in microcirculation.

Adult↗

PubMed2004

Proportional assist ventilation reduces the work of breathing during exercise at moderate altitude.

Reducing the work of breathing (WOB) during exercise and thus the oxygen required solely for ventilation may be an option to increase the oxygen available for nonventilatory physiological tasks at altitude. This study evaluated whether pressure support ventilation (PSV) and proportional assist ventilation (PAV) may partially reduce WOB during exercise at altitude. Seven volunteers breathing with either PSV or PAV or without support (control) were examined for WOB, inspiratory pressure time product (iPTP), and (O(2)) before and during pedaling at 160 W for 4 min on an ergometer at an altitude of 2860 m, where barometric pressure and oxygen partial pressure are approximately 30% less than at sea level. PSV and PAV reduced WOB from 4.5 +/- 0.9 J/L(-1)/min(-1) during unsupported breathing to 3.7 +/- 0.4 (p < 0.05) and 3.2 +/- 0.7 (p < 0.01), respectively. iPTP was reduced during PAV (570 +/- 151 cm H(2)O/sec/min(-1), p < 0.01), but not during PSV (727 +/- 116, p = 0.58) compared with unsupported ventilation during exercise (763 +/- 90). During PSV and PAV breathing, higher arterial oxygen saturations (84 +/- 2%, p < 0.05, and 86 +/- 1%, p < 0.01, respectively) were observed compared with control (80 +/- 3%), indicating that PSV and PAV attenuated hypoxemia during exercise at altitude. Total body (O(2)), however, was not reduced during PSV or PAV. In conclusion, both PSV and PAV reduced the WOB during exercise at altitude, but only PAV reduces iPTP. Both modes reduce hypoxemia, which may be due to higher alveolar ventilation or decreased ventilation-perfusion heterogeneity compared to unsupported breathing.

Adult↗

PubMed1980

Low-density gas breathing during exercise in chronic obstructive lung disease.

Because breathing low-density helium-oxygen gas mixture has been reported as improving ventilatory mechanics in chronic obstructive pulmonary disease (COPD) patients and reducing the oxygen cost of ventilation in exercising normal subjects, it might prove useful in COPD physical conditioning programs. 7 COPD patients performed incremental exercise to tolerance while breathing either air on 79% helium-21% oxygen mixture. There was a tendency for low-density gas breathing to stimulate a higher ventilation at any given work load. As a result there was a tendency to greater tolerance with air breathing. Throughout exercise there was no statistically significant difference in endurance, oxygen consumption, heart rate, or ventilatory parameters suggesting that the helium-oxygen mixture was not beneficial to exercise performance.

Aged↗

PubMed2006

Use of a simple relaxation technique in burn care: literature review.

AIM: This paper presents a literature review examining the implications of previous research in order to make evidence-based decisions about the possible use of breathing exercises with adult patients with burns for pain management during wound care. BACKGROUND: Adult patients with burns experience pain during wound care despite pharmacological interventions. Additional interventions are needed to improve the effectiveness of pain management. Relaxation techniques can be considered, for example breathing exercises, music and distraction. A simple breathing relaxation technique is especially relevant because it involves no risk, is easy and quick to learn, equipment does not need to be purchased and it can be employed immediately by the often exhausted and ill patient. However, the effect of breathing exercises on procedural pain during burn wound care has not been investigated. METHOD: The CINAHL, PubMed and Cochrane databases were searched in 2004 in order to answer two questions: are breathing exercises effective in the management of procedural pain in adult burn patients, and what are the implications of previous investigations for future research concerning pain reduction in adult patients with burns during wound care? Eleven papers were included in the review. FINDINGS: The effect of breathing exercises for pain management in patients with burns has not been investigated. Prior to undertaking an effect study, additional basic research is needed. The number of sessions necessary to learn to use the technique should be clarified. A valid and reliable instrument to assess relaxation must be developed. The adequacy of the proposed data collection procedure needs to be assessed. CONCLUSION: It is not possible at this time to base decisions about the use of breathing exercises during wound care in adult patients with burns on research specific to the procedure and patient group. The most suitable relaxation technique for future investigation is concentration on breathing, in combination with jaw relaxation.

Adult↗

PubMed1992

Deep diaphragmatic breathing: rehabilitation exercises for the asthmatic patient.

A new diaphragmatic breathing technique practiced without the aid of a physical corset is outlined, and the findings from a study of its application in the respiratory rehabilitation of asthmatic patients are presented. Sixty-seven asthmatic adults randomly assigned to either deep diaphragmatic breathing training, physical exercise training, or a waiting list control group participated in a 16-week program. Deep diaphragmatic training resulted in significant reductions in medication use and in the intensity of asthmatic symptoms. Importantly, a nearly 300% increase in time spent in physical activities also resulted from deep diaphragmatic training. A follow-up at two months found many patients had returned to earlier medication levels and sedentary habits. A strengthened musculature can replace the need for a physical aid in this respiratory habilitation; adherence to its use may require individually-tailored encouragement.

Adult↗

PubMed2005

The Buteyko breathing technique for asthma: a review.

Breathing exercises and breathing retraining are often used in the management of asthma. One specific form of breathing therapy, known as the Buteyko breathing technique (BBT) has received considerable attention, but there is a paucity of rigorous research evidence to support its recommendation for asthma patients. There are only four published clinical trials and two conference abstracts evaluating BBT. Although all have reported improvements in one or more outcome measures, results have not been consistent. This article provides the background to the BBT, reviews the available evidence for its use and examines the physiological hypothesis claimed to underpin it. In common with other therapies, BBT is not a standardised treatment modality. The BBT 'package' is complex, as it also includes advice and education about medication use, nutrition and exercise, and general relaxation. This makes it difficult, and possibly inappropriate, to attempt to tease out a single mechanism. Buteyko's theory relating to carbon dioxide levels and airway calibre is an attractive one, and has some basis in evidence from experimental studies. However, it is not known whether altering breathing patterns can raise carbon dioxide levels significantly, and there is currently insufficient evidence to confirm that this is the mechanism behind any effect that BBT may exert. Further research is necessary to establish unequivocally whether BBT is effective, and if so, how it may work.

Adult↗