Breathing exercises are a great help in ‘retraining’ in breathing. We should be realistic in assessing the effect of these exercises:
Breathing should be relaxed. This way the opening of the airways is increased.
Clearing of the airways can be enhanced.
A patient will become confident that he can withstand breathlessness. He can also participate in normal day-to-day activities.
Stress should not be given after strengthening the respiratory muscles, as their excessive use will compress the airways and increase breathlessness.
A proper and efficient use of the respiratory muscles and accessory muscles is indicated so that the oxygen used is much less.
By increased expiration the hyperinflation of the lungs can be reduced, so that during inspiration lungs are not fully stretched.
An increased diaphragmatic exertion with reduced thoracic movement will reduce the sensation of breathlessness.
An altered pattern of respiration changes the distribution of inspired air, so that the gas exchange is better. We use same exercises for asthma, bronchitis and emphysema. They are few with certain variations adopted in several parts of the world. We have tried to include all the good points from these many exercises.
Air of treatment
Physical and mental relaxation.
Acquiring good posture
Lower rib respiration
Increase of diaphragmatic respiration.
Patients should have confidence in the therapist. They should be taught individually and later he may join a group. When he does these exercises in a group, he will be encouraged by others and will feel more confident and put in better effort.
It is most important for a patient with asthma and emphysema to relax. These patients are always tense, nervous and exhausted because they are all the time making a continuous effort to avoid suffocation.
If you watch these patients carefully you will find many signs of tension. They may have tremors in the hand, their eyes may twitch when closed, they may have a short movement pattern in their chest region as they are all the while conscious of their breathing. They may show more movement in the upper chest, shoulders, neck and spine especially when they are being seen. This tension and these wasteful movements unfortunately use up a lot of energy.
For these patients relaxation is very important. If they are relaxed, then only can they learn to breathe more efficiently and in the right sort of way. A patient should be told about these wasteful movements and also be taught the intricacies of abdominal breathing. He should be told that proper breathing will be less taxing and will reduce the attacks of breathlessness. These new methods are not short term methods, but should be used permanently.
At the time of an attack he should give more attention to these new methods and he will be benefited by the new knowledge. These patients should be provided with a happy and congenial atmosphere at home. They should also adopt a happy-go-lucky attitude. When patient is taught to have relaxation, an atmosphere of silence must prevail. He should be made to lie down comfortably with his head and knee supported an a pillow and the arm resting comfortably.
He should be taught the difference between tense and relaxed muscles. Tense them for a short period and relax them for a linger period. This should continue till he knows how to relax them completely. This should be done in the muscles of the arm, shoulder, neck, face, chest and abdomen. These tensions in the muscles can be measured, and we can know about their success. The patient can also take the help of a machines called biofeed back, and the patient can watch himself how much relaxed he is and it helps him in further relaxation. When the patient has learnt this of relaxation, he is ready for exercises. He starts with stretching and relaxing short muscles of shoulder and upper chest. Various rhythmic and swinging exercises designed for the purpose are carried out along with respiration.
Do breathing exercise in the morning or evening when the stomach is empty. You can do them just before your morning exercises. Deep breathing is important. It can be done standing, sitting or lying down. Standing position gives advantage of freedom for muscle movements.
Stand erect, arms on your side, exhale slowly and deeply, bend your neck, bring your shoulders forward and contract the abdomen. You will find that you can further exhale more air. This is called forced exhalation.
Now start breathing in slowly, expand the chest, abdomen and straighten the neck. Do not hold the abdomen. To inhale a little more, lift your chest further, retract the abdomen a little and extend the neck. You will able to draw in a little more air. This is called forced inhalation. Stop for few moments at the end of exhalation and inhalation.Do it 4 times and go up 10 or more. To make it more effective and interesting, add arm movements.
Stand erect, bring the arms in front and at shoulder level. This is the starting position. Start breathing in slowly and deeply and simultaneously bring the arms back and extend you neck. Pull out the chest and abdomen. This will help you to draw in more air than you usually do. Hold the breath for a movement and then start exhaling slowly, bring down your arm to your side and straighten your neck. Exhale as much air as you can, pause for a moment and start again.
You can move your arms in a different direction. Stand erect, arms on your side. Keep the back straight. Start slowly breathing in, raising the arms and heels. Do not forget to expand the chest and bulge out abdomen. Hold the breath for few moments and start breathing out slowly and reverse the journey of the arms and heels. Hold the breath for few movements and start it again.