Home-Based Prescribed Pulmonary Exercise in Patients with Stable Chronic Obstructive Pulmonary Disease

Presented here is a protocol to investigate the effects of home-based prescribed pulmonary exercise in stable chronic obstructive pulmonary disease (COPD) patients, which is modified based on traditional Chinese exercises according to dyspnea and limited exercise capacity observed in COPD patients.

This protocol can be applied as a convenient alternative and effective community based exercise program for stable COPD patients. The prescribed pulmonary exercise have been developed from the theory of traditional Chinese medicine and are aimed at the rehabilitation of COPD dyspnea and the exercise capacity. This method can also be used the geriatric method to improve the cardiovascular and musculoskeletal fitness and to delay the progressively declined fitness of elderly patients.

The skill operating in coordination with movement may be the most challenging part of the technique for a novice. Demonstrating the testing procedure will be Peijun Li a graduate student from my laboratory. Before the formal training session, give introductory training sessions three times within two weeks to the prescribed pulmonary exercise participants.

Ask the participants to study the complete action and breathing requirements of each intervention after each training session. At the formal training session, give the prescribed pulmonary exercises video and the exercise record brochure to the participants in prescribed pulmonary exercises groups. Instruct the prescribed pulmonary exercise participants to perform the prescribed pulmonary exercises in accordance with the intervention program.

Instruct the prescribed pulmonary exercise participants to perform a warmup exercise for 10 minutes mainly focusing on the dynamic flexibility exercises of the involved muscle groups and stretching of the muscles. At the end of the warmup, have the participants perform the prescribed pulmonary exercises of hu and si sounds in liuzijue, pushing up the sky to regulate the triple warmer, and drawing a bow to shoot a vulture in baduanjin, the crane actions in wuqinxi, and cross-armed iron staff in yijinjing over a period of 40 minutes. When all of the exercises have been completed, instruct the prescribed pulmonary exercise participants to perform a cool down exercise for 10 minutes mainly focusing on stretching and relaxing the muscles.

Instruct the participants to record details after each exercise session in the exercise record brochure including information about the exercise method, time, duration, intensity, and site. At the end of the exercise treatment period, explain the six minute walking test to the participants and inform the participants that temporary rest is available when discomfort or exhaustion arises. Prior to the beginning of the test, use the Borg CR10 to assess each participant for their level of dyspnea.

Then have the participants walk back and forth as quickly as possible in a marked 30 meter straight line using standardized phrases of encouragement for each minute. After six minutes, ask the participants to stand still and record their distance in meters and levels of dyspnea. After a 30 minute rest, have the participants perform the test a second time.

Before beginning the 30 second arm curl test, explain and demonstrate the test procedure. Have the participants sit on a 43 centimeter tall, straight back, armless chair in an upright position and with their feet flat on the ground. With the participants arm in the down position of the arm curl position, have the participant perform the arm curl motion one to two times without moving the wrist to familiarize themselves with the movement.

When each participant is ready, have them hold an appropriately weighted dumbbell in the dominant hand and on the go signal, have the participant curl the weight through a full range of motion as quickly and as many times as possible in 30 seconds while standing to the side to time and record the results. To preform a 30 second stand to sit test, first place a chair with the backrest leaning against a wall and explain and demonstrate the test procedure. Next, have the participant sit in the middle of the chair with a straight back, arms crossed on the chest, hands placed on the opposite shoulders, with the feet separated and the knees flexed at about 90 degrees.

Have the participants perform the standing up motion one to two times to familiarize themselves with the movement. Then on go, have the participant stand up and sit down as quickly and as many times as possible in 30 seconds while standing to the side to time and record the results. In this representative study, data from 37 participants was analyzed with no significant differences observed in the basic participant characteristics between the control and prescribed pulmonary exercise groups.

After three months of intervention, the number of repetitions of the 30 second arm curl and 30 second sit to stand tests increased in the prescribed pulmonary exercise group. In addition, the activity score showed a significant increase in the control group, while the total and item scores of St.George's Respiratory Questionnaire was significantly decreased in the prescribed pulmonary exercise group. The prescribed pulmonary exercise video, exercise record brochure registered by the participants themselves and their encouragement and instruction from staff praise played an irreplaceable role in the success of this protocol.

Tests to evaluate the function of pulmonary and skeletal muscle can be performed and the results can provide further understanding into the effects of the prescribed pulmonary exercise. These procedures can also be applied to other chronic noncommunicable diseases to determine the efficacy of prescribed pulmonary exercise.