Rehabilitation exercises for patients with chronic respiratory diseases

Respiratory rehabilitation is a very effective treatment for CRD patients, aiming to improve the physical and mental status of CRD patients and promote their long-term adherence to health-promoting behaviors. Respiratory rehabilitation can improve exercise capacity, reduce dyspnea symptoms, improve health-related quality of life, and reduce hospitalization rates.

The following methods of rehabilitation exercise and improving nutritional status are recommended

▶► Cardio training

Aerobic training is the cornerstone of respiratory rehabilitation and aims to improve aerobic exercise capacity, strengthen the muscles involved in walking, and improve ability to perform daily activities. A useful supplement to resistance training, the main purpose of which is to improve muscle mass and strength.

Patients with chronic respiratory diseases should monitor fingertip blood oxygen during exercise. SpO2 should always be ≥88%. If the patient's SpO2 is less than 88% or drops by more than 4% during exercise, training should be stopped and oxygen therapy should be supplemented.

▶►Recommended postural drainage for CRD patients

Postural drainage uses gravity to help drain bronchial secretions from the airways by placing the patient in a specific position. At the same time, improve the ventilation of the specific area where the secretions are located, and use the increase in ventilation in this area to help the removal of secretions.

▶►Using HFNC (High Flow Nasal Humidified Oxygen Therapy)

It is recommended that chronic respiratory failure (CRF) patients with severe hypoxemia use HFNC (high-flow humidified nasal oxygen therapy) in the stable phase to reduce arterial blood carbon dioxide partial pressure.

The presence of PaO2≤55mmHg or SaO2<88%, with or without hypercapnia or 55mmHg<PaO2≤60mmHg, but combined with PAH, cor pulmonale or hematocrit>0.55, or the application of HFNC during exercise can increase the number of patients Respiratory rehabilitation exercise intensity while reducing the incidence of complications.

▶►Use a non-invasive ventilator

Long-term home use of non-invasive ventilator therapy is recommended for the following patients:

(1) Long-term home NIPPV is recommended for stable patients with persistent hypercapnia (PaCO2>50mmHg); patients with chronic obstructive pulmonary disease, especially those with obstructive sleep apnea and hypopnea.

(2) For patients with acute exacerbation of severe COPD with acute type II respiratory failure, it is recommended to sequentially apply long-term home NIPPV during the recovery period.

For COPD patients who cannot tolerate respiratory rehabilitation training, NIPPV adjuvant therapy is recommended to relieve dyspnea symptoms, improve exercise tolerance, and improve quality of life.

In addition to rehabilitation exercises, patients with chronic respiratory diseases should also pay attention to nutritional management. The suggestions are as follows:

▶►It is recommended that malnourished CRD patients achieve the nutritional intervention goals of 30kcal/kg energy and 1.2g/kg protein per day; The energy required to gain weight may need to reach 45kcal · kg -1 · d -1.

▶► It is recommended to use supplements containing essential amino acids or branched-chain amino acids and their metabolites necessary for building body proteins; oral leucine or active leucine metabolite β-hydroxy-β-methylbutyrate β- Hydroxy‑β‑methylbutyric acid, HMB) at a dose of 1-3g/d;

▶►Add n‑3 PUFAs to the diet

n-3 polyunsaturated fatty acids mainly include docosahexaenoic acid (DHA), docosapentaenoic acid (DPA), eicosapentaenoic acid (EPA), α-linolenic acid, γ-linolenic acid, etc.; Supplementation of n-3 polyunsaturated fatty acids can be achieved by increasing the intake of fish.

▶► It is recommended to add antioxidants to the diet

(1) There are complex antioxidant systems in animals and plants, such as glutathione, vitamin C, vitamin A, vitamin E and various antioxidant enzymes;

(2) It is recommended that patients consume at least 1500g of fruits and vegetables per day;

▶► It is recommended to supplement nutritional supplements containing vitamin D

(1) If the patient has vitamin D deficiency (<25nmol/L) during the acute exacerbation of COPD, vitamin D can be supplemented by oral vitamin D800~1000mg/d, or increased sunlight exposure;

(2) Patients with PAH with vitamin D deficiency should supplement cholecalciferol (vitamin D3) or vitamin D as appropriate.


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