Constitutional, Developmental, and Corrective or Therapeutic.
They strengthen vital organs and increase their activity. They are not strenuous. Can be done by people of all ages and of all occupations. They include –
Free hand exercise
To develop muscles of the body to improve strength and specially for the young and not essential for every body. They include-Exercises with an apparatus
Corrective or Therapeutic
They are taken in the case of diseases like those of the heart, chest, arthritis, vascular diseases, flat feet, spinal curvatures, pigeon chest, knock knees etc.
We will discuss exercise to be done in the case of :
The use of physical exercises by physicians in caring for patients with heart diseases has greatly increased in recent years. There are two types of exercises – Isotonic and Isometric Isotonic exercises are those involving movement with muscle exertion like walking, jogging, running, cycling and swimming. These lead to a rise in the pulse rate rather than blood pressure.
Isometric exercises exert muscle force but no movement takes place. They evoke an increase in the blood pressure and smaller increase in the heart rate during exercises of hand grip, climbing steps, resistance wheel, rowing machine etc. They are more useful for cardiac patients. They produce cardio vascular distress which is physiologic and rapidly reversible.
The blood pushed out with every heart beat called stroke volume, increases 4-5 times in a normal person when he progresses form rest to maximum exercises. The oxygen consumption increases form 10-12 times in a normal human being during maximum exercises.
We will deal with two diseases of the heart
In angina pectoris, the arterial supply to heart muscles called coronary arteries are either narrowed blocked. The heart muscles will become ischaemic as external physical load increases during exercises.
In both cases the medical management in almost the same. Of course, in myocardial infarction initially 8-12 weeks of complete rest is given so that infarction may heal up, then gradual activity is started.
For cardiac rehabilitation the known factors should be decreased
Elevated blood cholesterol
Regular physical exercises will prevent further progression of coronary atherosclerosis (narrowing due to fat deposit in the coronary wall). It has been found that the incidence of heart diseases is much lower among bus conductors than the less active bus drivers.
There have been research studies that have been conducted to more active during work or leisure time is less compared to among those doing a similar activity but in a sedentary sort of way. The first step in the conditioning programme for heart patients is to do an exercise test. It will determine the intensity and duration of the prescribed exercise. The usual procedure is for the patient to maintain the highest conditioning heart rate at 80-85% of the measured maximum of symptomatic heart rate. This gives measurable benefit in 10-12 weeks. Exercise testing should be done every 3 months. Later on every six months. The exercise prescription is updated after the new test. Following points should be remembered:
It should be safe
It should be supervised by a physician
Each patient must be guided individually
The patients must tame their won pulse rate and report any excessive rate or unusual symptoms.
At least five or six mechanical devices should be available for the tests like stair steps, bicycle, rowing machine, resistance for 4 minutes, at the end of which the heart rate should be taken as the target heart rate level. After two minute’s rest, the patient can repeat the same exercise or move on to other exercise. Two minutes rest. Then each of the group rotates to other station or device. This pattern should continue five or six times. Over exercising can cause harm.
Chest or Pulmonary Diseases
The value of breathing and general exercises, as an adjunct particularly in treating of asthma, bronchitis, emphysema, etc. has been recognised . Patients are consistent and generous in their praise for the relief provided. Physicians with long experience put their faith in stressing the benefit provided by theses exercises.
Before we make an attempt to do the exercises, we should be made aware of the elastic property of the lungs and the thoracic wall (chest wall). The lungs resist change in their shape because of their elastic property. In the normal state the inclination of the lungs to empty is opposed by inclination of thoracic wall to fill. A stiffer lung will empty to a smaller volume and the rigid chest wall will hold the lung at bigger volume.
The lung volume established passively by the elastic properties is the functional residual volume of lung, normally varying around 3000ml. It is important to note that this is the volume to which lung will return passively. A change of lung volume away from functional residual volume requires active muscular effort. The contraction of the diaphragm decreases thoracic pressure and thus increases the lung volume, Simultaneously by compressing the abdomen it increases abdominal pressure.
The action of the diaphragm is to produce inspiration which means drawing in of breath. It is also active while vomiting and in defecation. The external intercostal muscles help in inspiration. The internal intercostal muscles help in the expiration. In the quiet tidal breathing, the diaphragm moves approximately 1.5 cm in the standing position and little more in the supine position. The rib cage increases 1 cm. while standing and 6cm in supine posture. Anteroposterior displacement is greater than lateral. While breathing to the maximum volume (deep breath) the rib circumference increases by 8cm. The anteroposterior diameter by 3cm, lateral diameter by 1.5 cm. The maximum diaphragmatic execution is 10cm. The linear displacement of diaphragm accounts for approximately two third of changes in the lung volume.
The drawing in of breath or inspiration, is achieved by the development of intrapleural pressure varying from 6-10 cms of H2O below the atmospheric pressure in quiet breathing, 50-60 cms of H2O in deep breathing. The intra pulmonary pressure is also below atmospheric pressure by about 3-4 cms of H2O in quiet respiration and more in deep breathing. Two forces oppose the changes in the lung volume. First the elastic property which determines the distensibility of lung and thorax.
The second is the resistance of the airways developed in common pulmonary diseases due to bronchial muscle constriction, with muscle congestion and hypersecretion. In the presence of bronchial disease, the increased resistance of distal airways lowers the pressure in proximal airways, so they are more easily compressed.
Thus an increased airway resistance, even closure, is readily produced by overactive expiratory efforts. Less forceful expiration may force more air. The oxygen consumption of respiratory muscles increases over ten times in respiratory diseases due to extra put in by the muscle. Any exercises with attempts to produce higher minute volume is jeopardised. This is because the extra oxygen (O2) absorbed might, at least theoretically, be consumed by expiratory muscles in their increased effort.
Tissue destruction reduces the elastic property of the lung tissue. The tendency of the chest wall to distend leads to hyper-ventilation of the lungs. The mechanical or microbial threat to airways are dealt with in part by the secretion of the muscle and by cough reflex mediated by vagus nerve.
Lung Function Test
A simple test may be indicated. The lung function test enables the physician to know whether there is an obstruction to the air flow, but not whether the patient has lung cancer. It helps:
To give a measurable assessment of the patient’s disability.
To follow the progress of the disease.
To try to differentiate the possible causes of breathlessness.
This is the amount of air expelled by maximum voluntary effort. In a normal person about 3/4 of air in the lungs is expelled in the first second and within 3 seconds all of it is expelled out. In a diseases lung there may be obstruction in the air passage. Therefore, the amount of air expelled in the first second will be much less. If the air expelled in one second is as much as 70% of the tidal volume, the lung under scrutiny will be normal. If it is less than this, it will be due to obstruction in the airway passage.
This test should be repeated after a few weeks to measure if there is noticeable improvement. The maximum expiratory flow can be measured by a peak flow meter. This portable instrument directly measures the peak flow rate which is otherwise reduced when there is obstruction of the airways.
In asthma as the lungs usually remain quite normal, a minority patients ultimately develop emphysema. In bronchitis there is hypertrophy of mucous glands in the trachea and bronchi with high proportion of goblet cell which produce excessive mucus which obstructs the passage. In bronchial diseases there may be obstruction with or without infection leading to more severe consequences or abscess formation.
The sufferers of asthma and bronchitis should be given a simple programme of exercises. They should walk1/2 to 1km. initially and increase the distance gradually as the health permits. This can be combined with simple free hand exercises or exercises with steps, cycle with a meter or a tread mill. They should preferably walk instead of moving in a car if the distance is short.
Patients respond to these exercises favourably. Their confidence increases. Their tolerance for exercises goes higher. With this improvement, they will experience a fall in the heart rat during exercise. Even those who have severe form of disease can increase their exercise levels and oxygen uptake by twenty percent.