G u est Editorial E X E R C I S E PROGRAMM ES AND CHRONIC OBSTRUCTIVE DECEMBER 1980 P H Y S I O T H E R A P Y 91 AIRWAYS A re c e n t e d ito ria l in th e L a n c e t (1980) p o in te d o u t th a t th e re h a v e b e e n m a n y s tu d ie s o f th e p o ssib le b e n e ­ fit o f p h y sic a l ex erc ises in c h ro n ic b ro n c h itis a n d e m ­ p h y se m a , a n d t h a t th e s e h a v e a ll p ro v id e d e v id e n c e th a t so m e fo rm o f e x erc ise tra in in g c a n in c re a s e th e c a p a c ity fo r p h y sic a l e x erc ise. I t a lso p o in te d o u t t h a t tra in in g is m o s t effe c tiv e w h e n it is d ire c te d to specific a n d sim p le ta s k s su c h as w a lk in g , o n th e lev e l o r c lim b ­ in g sta irs. T w o re c e n t B ritis h stu d ie s , o n e fro m D u n d e e (S in­ c la ir a n d In g ra m , 1980) a n d o n e fro m L ee d s (M u n - g all a n d H a in s w o rth , 1980) h a v e o n c e m o re c o n firm ed th e tr u th o f th e a b o v e s ta te m e n t a n d a d d e d fre s h in fo r- S n a tio n . I n b o th s tu d ie s th e p a tie n ts w ere f a ir ly se v e re ly ►'affected c h ro n ic b ro n c h itic s f r o m w h o m n o g re a t im ­ p ro v e m e n t c o u ld b e e x p e c te d a n d in w h o m th e n a tu r a l h isto ry w o u ld le a d u s to e x p e c t ste a d y d e te rio ra tio n . W h e th e r e a rlie r in te r v e n tio n w o u ld p ro d u c e g re a te r b e n efit re m a in s u n a n s w e re d in s p ite o f th e im p o rta n c e o f a tte m p tin g to p re v e n t c h ro n ic d is a b ility in a fa irly w id e sp rea d d iso rd e r. M c G a v in e t al. (1977) sh o w e d in a n e a rlie r B ritish stu d y t h a t th e y c o u ld o b ta in , e v en in u n s u p e rv is e d se v e re ly d isa b le d c h ro n ic b ro n c h itic s e x e rc isin g a t h o m e, a m e a n im p ro v e m e n t o f 6,3 p e r c e n t in th e 12 m in u te w a lk in g d ista n c e . T h e m o re r e c e n t s tu d y b y S in ­ c la ir a n d I n g ra m (1980) g a v e e v e n b e tte r re su lts . T h e y u se d 33 su b je c ts, a ll sm o k e rs w ith c h ro n ic b ro n c h itis b u t fre e o f c a rd io v a s c u la r, n e u ro lo g ic a l o r m u s c u lo ­ sk e le ta l dise ase, re c e n tly re c o v e re d fro m a n a c u te e x a c ­ e rb a tio n , a n d d iv id e d th e m in to tw o g ro u p s, o n e u n d e rta k in g a d a ily 12 m in u te su p e rv ise d w a lk to g e th e r w ith s ta ir clim b in g , a n d th e o th e r se rv in g as a c o n tro l. A f te r d isc h a rg e f r o m h o s p ita l th e e x e rc is e g ro u p w e re fo llo w ed u p w e ek ly b y a n u rs e a n d re a sse sse d b y a d o c to r e v ery 2 m o n th s . A f t e r 8 m o n th s th e e x erc ise g ro u p h a d im p ro v e d th e i r 12 m in u te w a lk in g d is ta n c e by a m e a n o f 2 3 ,4 p e r c e n t (185 m etres). T h e c o n tro l g ro u p d id n o t im p ro v e . A s in o th e r stu d ie s , th e e x e r­ cise g ro u p sh o w e d n o o b je c tiv e im p ro v e m e n t in c a rd io ­ re s p ira to ry fu n c tio n e x c e p t f o r a h ig h ly sig n ific a n t in ­ c r e a s e in fo rc e d v ita l c a p a c ity . T h e e x erc ise g ro u p fe lt B e tte r a n d m o re o f th e m g a v e u p sm o k in g (b u t th e r e w as still a sig n ific a n t d iffe re n c e b e tw e e n th e tw o g ro u p s o f sm okers). In th e L e e d s in v e s tig a tio n , M u n g a ll a n d H a in s w o rth (1980) h a d o n ly te n s u b je c ts b u t assessed th e m in g re a t d e ta il, u sin g e ac h p e rs o n a s h is o w n c o n tro l. T h e y a lso Contents E x e rc is e P ro g ra m m e s and C h ro n ic O b s tru c tiv e A irw a y s D is e a s e — E d ito ria l .............................. 91 C h e s t A s s e s s m e n t and S im p le L u n g F u n c tio n Tests — C. P. R o dseth ....................................... 93 A irw a y P re s s u re C h a n g es D u rin g "B a g S q u e e z in g ” — I. H ack, A. Katz, C. Eales ... 97 The M a n a g e m e n t o f V e ry Y o u n g C h ild re n w ith P u lm o n a ry D is o rd e rs — S. H. M. B la c k w o o d ... 100 DISEASE w o rk e d w ith se v e re ly h a n d ic a p p e d m a le b ro n c h itic s an d also u sed th e 12 m in u te w a lk in g te st. B e ca u se th e r e a re la rg e v a ria tio n s w ith tim e in c a rd io re s p ira to ry in ­ d ices in a n y o n e su b je c t, th e y m e a su re d lu n g fu n c tio n 2-w eekly a n d d iv id e d th e stu d y in to f o u r p e rio d s o f 12 weeks e a c h — a p re lim in a ry p e r io d w ith o u t e x ercise, a p e rio d o f g ra d e d e x e rc ise su p e rv ise d b y th e p h y sio ­ th e ra p y d e p a r tm e n t, a p e rio d w ith o u t tra in in g , a n d in som e in sta n c e s a se c o n d tr a in in g p e rio d . A m ild e r m o d i­ fica tio n o f th e w e ll-k n o w n R o y a l C a n a d ia n A ir F o rc e e x ercise p ro g ra m m e w a s used. T h e a v e ra g e im p ro v e ­ m e n t in th e 12 m in u te w a lk a f te r 12 w e ek s o f tra in in g w as f r o m 961 m e tre s to 1 049 m e tre s (ju st o v e r 9 p e r cent) a n d th is im p ro v e m e n t w as v irtu a lly m a in ta in e d d u rin g th e fo llo w in g th r e e m o n th s b u t n o t f u r th e r e n ­ h a n c e d b y a se c o n d tra in in g p e rio d . O b je c tiv e m e a s u re m e n ts also c h an g e d . F o rc e d e x p ira ­ to ry v o lu m e in o n e m in u te (F E V i) sh o w ed a sm a ll b u t sig n ific a n t in cre ase, tr a n s f e r f a c to r fo r c a r b o n m o n o x id e w as g re a te r, a n d th e d iffere n ce b e tw e e n a lv e o la r a n d a rte r ia l oxygen te n sio n s d e c re a se d . O t h e r in d ic e s o f c a rd io re s p ira to ry fitness d id n o t c h an g e , a n d th e a u th o rs - suggest t h a t th is m a y b e b e c a u se th e s e r e s p ira to ry c rip p les co u ld n o t u n d e r ta k e sufficiently in te n se tra in in g . H o w p h y sic a l tr a in in g w o rk s is still a m y ste ry in view o f th e in c o n s is te n t im p ro v e m e n t in lu n g fu n c tio n . ' M o tiv a tio n m a y p la y a p a r t b u t if so w h y d o e s th e effect p e rsist? D o th e y w alk b e tte r b e c a u se th e lim b m u sc le s w o rk m o re efficiently? I n th e D u n d e e stu d y , le n g th o f strid e in c re a s e d b u t lim b m u sc le stre n g th (fid n o t. W h a te v e r th e effect, it ta k e s tim e . T h e D u n d e e g ro u p a c h ie v e d m a x im u m b e n e fit on ly a f te r eig h t 'm o n th s. T h e a u th o r s o f th is r e p o r t b e lie v e t h a t im ­ p ro v e m e n t p r o b a b ly d e p e n d s o n th e p a tie n ts ’ b e tte r to le ra n c e o f d y sp n o e a a n d b e tte r a d a p ta tio n to th e ir p h y sic a l in c a p a c ity . I t h a s b e e n su g g e ste d t h a t th e m a in lim ita tio n on ph y sic al e ffo rt in o b stru c tiv e a irw ay s d ise a se d e p e n d s on th e m e c h a n ic a l difficulty o f m a in ta in in g th e v e n tila ­ tio n n e e d e d f o r a d e q u a te oxygen in ta k e . T h is y e a r B e lm a n a n d M ittm a n (1980) r e p o rte d a n a tte m p t to tr a in th e r e s p ira to ry m u scles, u sin g a m a c h in e w h ic h fo rc e d th e p a tie n t to b r e a th e a t th e m a x im u m su s ta in e d v e n tila to ry c ap a city , w ith c o n tro lle d C:0= re b re a th in g . A fte r u sin g th e m a c h in e f o r 15 m in u te s tw ice a d a y f o r 6 w eeks, p a tie n ts co u ld w alk 12 p e r c e n t f u r t h e r in 12 m in u te s, a n d th e ir e n d u ra n c e in leg a n d a r m cycling - Inhoud A S tu d y o f th e P a tie n ts A tte n d in g th e A s th m a Room a t G ro o te S c h u u r H o s p ita l — R. M eye rs 102 R e p o rt on a R e fre s h e r C o u rs e h eld by th e N a ta l C o a s ta l B ra n c h o v e r th e w e e k e n d o f 11 to 13 J u ly 1980 .................................................................. 104 R e p o rt on th e 8 th m e e tin g o f th e N a tio n a l C o m ­ m itte e o f R e p re s e n ta tiv e s held on S a tu rd a y 1 N o v e m b e r in J o h a n n e s b u r g .............................. 109 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) te s ts im p ro v e d c o n s id e ra b ly . P e r h a p s th e n th e v a lu e in ex erc ise lies in re s p ir a to r y m u sc le tra in in g . T h e y n e ed to g e t b re a th le s s a n d su s ta in h ig h levels o f v e n tila tio n w ith o u t b e c o m in g a la rm e d . T h e L a n c e t e d ito ria l h a s th e la s t w o rd o n exercise p ro g ra m m e s . “ S h o u ld w e n o t n o w e n c o u ra g e o u r p h y s io th e ra p is ts to ta k e u p this ta s k (o f a rra n g in g e x e r­ cise p ro g ra m m e s ) as a f o r m o f th e ra p y w ith p ro v e n b e n e fit? ” S .G . R e fe re n c e s 1. B e lm a n , M . J. a n d M ittm a n , C. (1980). V e n tila to ry m u sc le tra in in g im p ro v e s e xercise c a p a c ity in c h ro n ic I N T E R N A T I O N A L Y E A R O F D IS A B L E D P E R S O N S H o w m u c h is g e n e ra lly k n o w n a n d a c c e p te d a b o u t c o n g e n ita l a n d a c q u ir e d d isa b ilitie s s u c h as ep ile p sy , b lin d n e s s , p a ra ly sis, d e a fn e ss, m e n ta l r e ta r d a t io n a n d m e n ta l ill h e a lt h ? T h e d is a b le d p e rs o n e v o k es a w k w a rd ­ ness a n d is o f te n a v o id e d so c ially , b e in g r e g a rd e d as in c o m p e te n t a n d a b u r d e n o n th e c o m m u n ity . A C o ­ o rd in a tin g C o m m itte e , c o m p risin g th e v a rio u s o rg a n is a ­ tio n s d e a lin g w ith th e d isa b le d , h a s b e e n e sta b lish e d (c o o rd in a to r M r s H . P a r k e r, IY D P , P .O . B ox 1375, C a p e T o w n 8000) to fo c u s o n a sp e c ts o f d is a b ility in 1981. T h e s e w ill in c lu d e th e a b ilitie s o f th e d isa b le d ; a c h ie v e m e n t o f in d e p e n d e n c e a n d p ro b le m s (su c h as lac k o f p u b lic tr a n s p o r t fa c ilitie s, access to p u b lic b u ild in g s a n d c o n v e n ie n c e s) t h a t h in d e r in d e p e n d e n c e ; g a in fu l e m p lo y m e n t a n d so c ia l life fo r th e d isa b le d . T o c o o rd in a te in fo rm a tio n a n d a c tiv itie s, specific fields o f d is a b le m e n t will b e h ig h lig h te d as fo llo w s : M a r c h : P h y s ic a lly d isa b le d . A p r il: R e c r e a tio n a l fa c ilitie s fo r th e d isa b le d . M a y : T h e B lin d . 15 A u g u s t - 15 S e p te m b e r: M e n ta l d isa b ility . 15 S e p t e m b e r - 15 O c to b e r : E p ile p sy . 15 O c t o b e r - 1 5 N o v e m b e r : C e re b ra l P a lsy . 92 F I S I O T E R A P I E DESEMBER 1980 o b s tru c tiv e p u lm o n a ry d isease p a tie n ts . A m . R e v . R e s p . Dis. 121, 273-280. 2. E d ito ria l (1980) L a n c e t, 2, 514. 3. M c G a v in , C. R ., G u p ta , S. P ., L lo y d , E . L., a n d M c H a rd y , C. J. R . (1977). P h y s ic a l re h a b ilita tio n f o r th e c h ro n ic b ro n c h itic : R e su lts o f a c o n tro lle d tria l o f exercises in th e h o m e . T h o r a x , 32, 307-311. 4. M u n g a ll, I. P . F . a n d H a in s w o rth , R . (1980). A n o b je c tiv e a sse ssm e n t o f th e v a lu e o f ex erc ise tra in in g to p a tie n ts w ith c h ro n ic o b s tru c tiv e a irw a y s d isease. Q uart, J. M e d ., 49, 77-85. 5. S in c la ir, D . J. M . a n d In g ra m , C. G . (1980). C o n ­ tro lle d tria l o f su p e rv ise d ex erc ise tra in in g in c h ro n ic b ro n c h itis. B rit. M e d . J., 280, 519-521. I N T E R N A S I O N A L E J A A R V A N G E S T R E M D E P E R S O N H o e v e e l is a lg e m e e n b e k e n d en a a n v a a r o m tre n t a a n g e b o re en v e rw o rw e g e s tre m d h e d e so o s ep ile p sie. b lin d h e id , v e rla m m in g , d o o fh e id , v e rs ta n d e lik e v e r tr a ^ gin g en g e e s te s o n g e s te ld h e id ? D ie g e s tre m d e p e rso o ™ v e rw e k o n g e m a k en w o rd d ik w e ls so s ia a l verrny, d a a r h y b e sk o u w o rd as o n b e k w a a m e n ’n la s v ir die g e m e e n s k a p . ’n K o o rd in e re n d e K o m ite e , b e s ta a n d e u it die v e rs k ille n d e o rg a n is a s ie s w a t m e t die g e stre m d e g e m o e id is, is sa a m g e ste l ( K o o r d i n e e r d e r : m ev. H . P a r k e r, I J G P , P o s b u s 1375, K a a p s ta d , 8000) o m a sp e k te v a n g e s tre m d h e id in 1981 te b e k le m to o n . D it slu it in d ie b e k w a a m h e id v a n g e s tre m d e s ; v e rw erw in g v a n o n a f- h a n k lik h e id e n p ro b le m e (g e b re k a a n p u b lie k e v e rv o er- fa silite ite , to e g a n g to t p u b lie k e g e b o u e en g e rie w e ) w a t o n a fh a n k lik h e id k o rtw ie k ; b e ta le n d e w e rk sg e le e n th e d e en so sia le o m g a n g v ir d ie g e stre m d e . O m in lig tin g te k o o rd in e e r, sal spesifieke a s p e k te v a n g e s tre m d h e id as v olg n a v o re g e b rin g w o rd : M a a r t : F isie se g e stre m d h e id . A p r il: O n ts p a n n in g s fa s ilite ite v ir g e stre m d e s . M e i: B lin d e s. 15 A u g u s tu s - 1 5 S e p te m b e r: G e e s te s g e s tre m d h e id . 15 S e p t e m b e r - 15 O k to b e r : E p ile p sie . 15 O k t o b e r - 15 N o v e m b e r : S e re b ra le V e rla m m in n g . NEW! A PORTABLE “PUFF” FOR ASTHMA AND BRONCHITIS MANAGEMENT The familiar Wright Peak Flow Meter now comes in mini-version ideal for use by patients in their own homes in the management of asthma and chronic bronchitis. It measures the patient’s maximum expiratory flow rate during .i forced expiration. The patient keeps a record of the readings from which the physiotherapist is able to monitor response to treatment. It’s a valuable aid! PRICE: R29.50 +GST M ED IC A L D IS TR IB U TO R S |PTY) L T D EDM S IBI’ KI P O BOX 3378 JO H AN N E SBU R G 2000 PHONE 29 0611 P O BO X 195 C A PE T O W N 8000 P H O N E 4 7 - 4 4 4 0 /P O BO X 5298 D U R B A N 4000 P H O N E 37-1501 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )