Improvement in ejection fraction by hydrotherapy as rehabilitation in patients with chronic pulmonary emphysema

BACKGROUND AND PURPOSE

It has been reported that breathing exercise by immersion in combination with expiring into water improved pulmonary function and blood-gas exchange in patients with chronic obstructive pulmonary disease (COPD). This effect may result from respiratory muscle exercise against hydraulic pressure and decreased dead space by increased sub-abdominal pressure. Increased cardiac function by bathing is suggested to contribute to the effect. To clarify the effect of the breathing exercise by immersion on cardiac function, a study was made of cardiac function during the exercise in patients with emphysema.

METHOD

Echocardiography, respiratory function test and arterial blood gas analysis were performed during a two-month breathing exercise programme in a pool filled with 38 degrees C water for 12 patients (aged 70.9 +/- 9.1 years) with stable chronic pulmonary emphysema who were treated at our hospital between 1993 and 1996. The patients breathed in whilst standing in a pool and breathed out through the mouth while sinking the nose under water. This exercise was repeated for 30 min per day and continued for six days a week for two months.

RESULTS

The ejection fraction increased significantly after each 30-minute exercise (N = 12; p < 0.01) as well as after the two-month exercise programme (N = 12, p < 0.05). Left ventricular end-diastolic and systolic dimensions at rest decreased significantly after the two-month exercise programme (N = 12, p < 0.01). The ratio of forced expired volume in one second to forced vital capacity (FEV1:FVC) increased and PaCO2 decreased following this programme (N = 12, p < 0.05).

CONCLUSIONS

These results suggest that the breathing exercise by immersion is useful not only in treating emphysema but also in improving cardiac function.

Effective physical therapy for chronic obstructive pulmonary disease. Pilot study of exercise in hot spring water

Respiratory function and arterial blood gas were examined before and after a two-month exercise program performed in a pool filled with hot spring water in 22 patients (70.9 +/- 9.1 years of age) with stable chronic obstructive pulmonary disease (12 cases of bronchial asthma and 10 cases of pulmonary emphysema) treated at our hospital between 1991 and 1994. The ratio of forced expired volume in one second to forced vital capacity (FEV1%) was significantly increased after the exercise program (P < 0.05), whereas the ratio of forced vital capacity to predicted normal value (%FVC) did not change. In addition, a tendency toward an increase in peak flow without an increase in maximum expiratory flow at 25 and 50% (V25 and V50) was observed. Although PaO2 was not increased, PaCO2 was selectively decreased by the exercise program (P < 0.05). The changes in respiratory function and arterial blood gas were considered attributable to respiratory muscle training and small airway clearance. Exercise in a pool filled with hot spring water may be useful in treating chronic obstructive pulmonary disease.