Exercise therapy for diseases of the respiratory system

The healing effect of exercise respiratory diseases is based on a person’s ability to regulate and control the depth and speed of breathing, the duration of breathing phases and respiratory pauses, restore the most physiological full type of breathing at rest and during active strength muscle activity. A competent combination of general strengthening physical training with special breathing techniques and various phases of breathing increases blood and lymph circulation in the lungs, helps accelerate and completely resolve infiltrative and exudative processes, prevent adhesions and other complications.

In case of chronic lung diseases, physical training can improve impaired respiratory function. Specific exercises make it possible to strengthen the respiratory muscles, increase the excursion of the chest and diaphragm, and help stretch the pleural adhesions. Performance breathing exercises in certain initial positions (the so-called drainage gymnastics) makes it possible to enhance the outflow and removal of pathological secretions during purulent processes in the lungs. The so-called expiratory gymnastics, which uses breathing exercises with specially difficult exhalation, is used to prevent oxygen collapse of the bronchi and increase the strength and endurance of the respiratory muscles. For lung diseases with an asthmatic component and for bronchial asthma, relaxation-respiratory gymnastics is very effective, the essence of which is a combination of static and dynamic breathing exercises with special training for relaxing the muscles of the torso and limbs, supplemented with elements of autogenic training (self-hypnosis).

Contraindications for exercise therapy for diseases of the respiratory system are: respiratory failure of the 3rd degree, lung abscess before it breaks into the bronchus or encystation, bleeding (hemoptysis) and its threat, asthmatic status, a large amount of exudate in the pleural cavity or its rapid accumulation, complete pulmonary atelectasis, high body temperature.

1. Pneumonia
2. Pleurisy
3. Chronic obstructive pulmonary diseases
4. Emphysema
5. Bronchial asthma

Pneumonia

In acute pneumonia, exercise therapy is prescribed taking into account the patient’s motor mode after establishing a typical or persistent low-grade fever and the presence of clinical, radiological and laboratory data indicating a reverse development of the inflammatory process.

For patients on bed rest, static and dynamic breathing exercises are recommended, as well as elementary light-intensity gymnastic exercises for the upper and lower extremities in the initial lying and sitting position. Core exercises are performed with a limited, incomplete range of motion at a leisurely pace. The duration of LG classes is 10-15 minutes. In patients on a ward basis, therapeutic exercises are carried out for 20-25 minutes in the initial position lying, sitting and standing. In addition to special breathing exercises, general developmental exercises are used in a ratio of 1:1 - 1:2. For patients who are on a free regimen, PH training is carried out according to a general strengthening method using exercises with apparatus, on a gymnastic wall, games, and dosed walking. The total time spent practicing various forms of exercise therapy in this group of patients can reach 1.5-2.5 hours per day. At the same time, the proportion of breathing and general strengthening exercises is 1:3 - 1:4, and the heart rate is up to 100 beats per minute. After discharge from the hospital, aerobic exercise (running, swimming, training on exercise machines) and hardening procedures are recommended.

For pleurisy, exercise therapy is prescribed on the 2-3rd day after the temperature drops, with a significant decrease in the amount of exudate, and the patient’s general satisfactory condition. The LH technique for pleurisy is based on the localization of the process and the motor mode of the patients. Special exercises for pleurisy are breathing exercises with a maximum tilt to the healthy side while exhaling. The range of motion can be

increased by raising the arm, using objects and equipment (balls, dumbbells, etc.). To prevent adhesions, it is necessary to periodically change the position of the body. When forming adhesions in the costophrenic sinus, specialized training is recommended - a deep (or rather, even a full) breath at the moment of the maximum possible (deep) squat with the upper limbs fixed, using your hands to grab the crossbar of the gymnastic wall at approximately chest level. Breathing exercises for a healthy lung and general strengthening exercises for various muscle groups are also used. The duration of LH is 5-10 minutes, repeated hourly at the beginning of the course of treatment and up to 1/3 hour 3-4 times a day in a ward setting. The forms of exercise therapy in patients on a general regimen are similar to those in acute pneumonia.

Chronic obstructive pulmonary diseases

In chronic obstructive pulmonary diseases, physical therapy is used differentially depending on the clinical form of the disease. When proliferative processes predominate with a probable outcome in pneumosclerosis, combinations of various breathing exercises with general strengthening exercises for large and medium muscle groups are used. When abscess formation occurs, positional drainage (postural) is used periodically (2-3 times a day) as an effective means of removing purulent sputum and reducing intoxication in the patient’s body. To perform it, it is necessary that the purulent focus is located above the outflow tract. For example, if the lesion is localized in the middle or lower lobes of the lungs, the patient is placed on a couch with the leg element raised by 40-45° or on a specialized drainage couch. The duration of postural drainage is 10-30 minutes. To increase the drainage effect, the use of drainage gymnastics is recommended, which is a combination of drainage positions with various exercises for the body and limbs with strict cough pushes that help remove sputum. To increase the flow of exhaled air and increase the separation of sputum, deep unforced exhalation, periodic change of starting positions, and vibration massage of the chest over the site of the lesion are often used. Exercises are used in a cycle 6-8 times a day for 10-15 minutes.

For pulmonary emphysema, it is necessary to perform expiratory gymnastics, in which, together with general strengthening exercises for most muscle groups, static and dynamic breathing exercises are intensively used with exhalation through tightly compressed lips. In order to control the smoothness and duration of exhalation, the pronunciation of voiced consonants and individual vowels (“z”, “zh”, “r”, “e”, “i” and others) is used when exhaling. Exercises are performed at a slow and medium rhythm with the maximum available range of motion. Often they use a lesson density of 60-70%. Breathing exercises should be performed 2-3 times a day for 20-40 minutes. During remission, aerobic exercises with a power of 60-75% of the threshold load are indicated.

Bronchial asthma

The objectives of exercise therapy for bronchial asthma are: teaching the patient proper breathing, increasing chest mobility, strengthening and developing respiratory muscles, preventing emphysema, increasing adaptation to environmental influences, psychological stability and tolerance to physical activity.

A course of physical therapy for bronchial asthma is prescribed as early as possible (in the intensive care unit) and consists of preparatory and training periods. The preparatory period lasts about 2 weeks and is aimed at teaching breathing control techniques, correct behavior during an attack, and the ability to prevent, alleviate or stop an attack without medications. The duration of exercise therapy sessions during this period is from 10 to 30 minutes; Independent training is mandatory 2-3 times a day with an interval of 4-5 hours. The training period lasts almost the entire life of the patient, since special breathing exercises do not have a long-term effect. The duration of exercise therapy classes during the day is up to 1.5 hours, including independent studies and physical training.

The main means of exercise therapy for bronchial asthma are: LH (diaphragmatic-relaxation breathing exercises, static and dynamic breathing exercises with an extended exhalation phase, exercises for all muscles of the trunk and limbs, exercises with apparatus), post-isometric relaxation (PIR) for the muscles of the neck, shoulder belts, torso rotators, dosed walking (30-60 minutes at a speed of 100-120 steps per minute), walks (up to 2 hours per day), cycling (15-20 minutes), exercise equipment, swimming, skiing, etc. Hardening with air baths and water procedures is carried out during and after PH classes. Special systems of breathing exercises, the K-P method, have also become widespread. Buteyko (method of volitional elimination of deep breathing), method of A.N. Strelnikova (method of countering inhalation), method of V.V. Gneushev (method of voluntary reduction of MOP), sound gymnastics, etc. To improve the quality of pulmonary ventilation, special devices are also used - mouthpieces for passive exhalation, breathing simulators, breathing through a thin tube, breathing into a vessel filled with water, inflating rubber toys.

Contraindications to exercise therapy: pulmonary heart failure of the III degree, chronic pulmonary heart disease in the stage of decompensation, exacerbation of the inflammatory process in the lungs, febrility, glaucoma, epilepsy, tuberculosis and tumor process in the lungs, severe diabetes mellitus. Exercises with hyperventilation, a sharp increase in intrathoracic pressure (straining), or holding your breath for more than 5-7 seconds are contraindicated.