Preventive and Curative Effect of Five-animal Exercises On Stable Phase Chronic Obstructive Pulmonary Disease

Zhao Qiaoliang

The First People’s Hospital of Zhengzhou City，Zhengzhou Henan China 450000

ABSTRACT：Objective：To observe the clinical curative on the preventive and curative effect of Five-animal exercises on stable phase chronic obstructive pulmonary disease in community. Methods: 60 cases were divided into experiment group and control group. The control group was given drugs and education of TCM，while the experimental group was given Five-animal exercises beside those methods on the control group for 3 months, with 3 times each week, and 40 minutes each time. Observation items include pulmonary ventilation function, 6 minutes walking test, Borg index, ST George’s respiratory questionnaire (SGRQ) scores. Results: 3 months later, in the experiment group, the percentage of the first second largest forced expiratory volume FEV1 to the total exhale (FEV1%)，FEV1/expected value(%) improved significantly (P<0.05); 6 minutes walking test, Borg index, ST George’s respiratory questionnaire score and TCM syndrome all improved significantly (P<0.01). However, the pulmonary ventilation function, 6 minutes walking test, Borg index，ST George’s respiratory questionnaire score improvement of the control group did not improved significantly (P>0.05). The experiment group’s 6-minute walking test，Borg index and ST George’s respiratory questionnaire score were better than that of the control group (P<0.01). Conclusion: Five-animal exercises can improve the exercising capacity of patients with COPD，be helpful in overcoming breathing difficulties and to improve the life quality and TCM syndromes.

KEYWORDS:chronic obstructive pulmonary disease; Five-animal exercises; 6-minute walking test; Borg index; St George’s respiratory questionnaire score

Chronic obstructive pulmonary disease (COPD) is a common clinical disease characterized by not complete reversible airflow limitation, which can be prevented and treated. The limited airflow is progressive accompanying with pulmonary toxic particles or gases lungs to cause chronic inflammation and airway anomalies. The chronic inflammation can cause the destruction of lung parenchyma leading to emphysema and destroy the normal repairing and defense mechanism at the same time leading to small airway fibrosis^[1]. Acute exacerbation and its complications affect the severity of the disease. There isn’t any terminology of chronic obstructive pulmonary disease in traditional Chinese medicine. According to the clinical manifestations of the disease, it can be classified in traditional Chinese medicine as “cough”, “gasping syndrome”, or “lung swelling” and so on. With high incidence and mortality of the disease, the repeated attacks of the disease may result in a progressive decline in lung function and seriously affect the patients’ life quality and lead to increasing treatment burden to family and society^[2]. Therefore, to prevent and delay COPD’s further deterioration is the long-term goal of the treatment^[3]. The author has applied five-animal exercises to 30 patients with stable COPD in community to prevent and control the progression and obtained good clinical effect. It is reported as follows.

1 Materials and Methods

1.1 Information

60 patients with COPD in stable stage in community health service center in Henan province Zhengzhou Hanghai East Road from July 2012 to July 2014 were selected and randomly divided into experiment group and control group. In the two groups of patients’ general data comparison, there was no statistically significant differences (P>0.05). See Table 1. 

Table 1 Comparison of the general data of the two groups

Groups	n	Age	Sex		Course(t/a)	Smoker(n)
			Male	Female
Experiment	30	56.66士6.43	19	11	6.52土2.42	16
Control	30	58.91士5.86	20	20	6.81士2.34	17

1.2 Diagnostic criteria

The diagnostic criteria of the cases are based on the diagnostic criteria guidelines in treatment of chronic obstructive pulmonary disease (2013 revision) of chronic COPD in stable stage, which was published by China Medical Association Respiratory Neurology in 2013.

1.3 Inclusive criteria

(1) Aged from 40 to 75 years old; (2) COPD patients with mild or stable cough, expectoration, and shortness of breath for at least 3 months; (3) Patients with bronchiectasis disease, asthma, tuberculosis, congestive heart failure and other serious heart, liver, kidney, or hematopoietic system diseases and orthopedic diseases which seriously affect the ability of physical exercising, etc. were excluded; (4) With normal cognitive function and without mental illness; (5) With good adherence; (6) Patient who have not participated in any form of regular exercises during former treatment.

1.4 Exclusive criteria

Patients who were under 40 years old or above 80 years old; (2) COPD exacerbation period; (3) With bronchiectasis disease, asthma, pulmonary tuberculosis, congestive heart failure and other serious heart, liver, kidney, hematopoietic system diseases and orthopedic diseases which seriously affect patients’ exercising capacity; (4) Patients with cognitive dysfunction or suffer from manic mental illness.

1.5 Termination criteria

Patients who were naturally lost to follow-up, died, or quitted the experiment during the trial; (2) Patients with poor adherence, or did not meet the requirements of the test in practicing Five-animal exercises, or cases with the curative effectiveness not being measured; no regular practicing of Five-animal Exercises; (3) Patients with adverse events such as acute complications or illness, which was not suitable for the observation the experiment any longer. (4) Patients who have reached the longest experiment observation time always.

1.6 Therapeutic methods

Control group: treatment with routine drug without any form of exercises besides daily activities; Experimental group: treatment with routine drug and doing Five-animal Exercises, with the target heart rate = (220－age)×(50% ~ 60%). If tired, a break was permitted before continuing and eventually the Five-animal Exercises were completed. Sports training intensity: according to each patient’s physical condition, appropriate adjustments to the difficulty in exercising were made, with the maximum heart rate of the patients being within the scope of target heart rate. After one week’s learning of Five-animal Exercises, the experiment group do the exercises three times a week together, and they do the practices at home in other 4 days of the week. Patients can call at any time to consult if necessary. Practice session is from July 2014 to October 2014, with practice time from 4 to 5 pm every day and 40 minutes long. Public practicing spot is on Hanghai East Road Square in front of Zhengzhou city community health service center. The activity was organized by a coach and lasted for 3 months.

1.7 Observational index

Patients’ Lung ventilation function: the first second largest forced expiratory volume (FEV1), the percentage of FEV1 to the total expiratory volume (FEV1 %), the forced vital capacity y(FVC), FEV1/FVC, FEV1/expected value (%), 6-minute walking test^[4], the Borg index^[5], ST George's respiratory questionnaire score^[6-8]were observed.

1.8 Efficacy standardization

1.8.1The comprehensive efficacy standardization

According toGuidelines of Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease (2013 Revision)issued by the COPD group of Chinese medical association breathing neurology, the condition classification and outcome standards are used for the synthetic evaluation of curative effect. The detailed standardization are as follows: (1) Recovery: with cough disappeared or occasional cough, and white sputum occasionally being seen with the daily sputum volume less than 30 ml. Chest tightness and shortness of breath improved obviously, and heart and lung function improved by 2 levels. (2) Improving: cough got eased obviously, and only a small amount of white sputum in mucous or purulent mucus less than 50 mL per day. The cardiopulmonary function improved, such as the ease of chest tightness and shortness of breath, by 1level. (3) Invalid: No improvement or even deterioration is found in above-mentioned indexes. The result can be worked out by using the formula of Efficient = (recovery + improvement) /n×100%.

1.8.2Effect in traditional Chinese medicine criteria

According to “Clinical Research Guiding Principles of New Chinese Medicine”, syndrome integral evaluation was done by using Nim horizon scoring method; and syndrome integral decrement rate was calculated and expressed in percentage. (1) Clinical controlled cases: the basic clinical symptoms, signs and syndrome disappeared or almost disappeared with reduced integral decrement rate being 95% or higher. (2) Obviously improved cased: clinical symptoms, signs improved significantly with reduced syndrome integral decrement rate being more than 70%. (3) Effective cases: clinical symptoms and signs improved with reduced syndrome integral rate being 30% or higher. (4) Invalid: without significant improvement in clinical symptoms, signs, or even becoming worse with reduced syndrome integral being less than 30%. 

The result can be worked out by using the formula of Effective rate = (clinical controlled + obviously improved + effective) /n×100%.

1.9 Statistical analysis

SPSS 20.0 statistic software was used, measurement data was processed with formula of mean ± standard deviation(`x±s) and comparison between groups was made by usingttest.P<0.05 means the differences were statistically significant.

2 Results

2.1 Comparison of lung function between two groups before and after treatment

Comparison of lung function between two groups before and after treatment is shown in details in Table 2.

Table 2 Comparison of lung function between two groups before and after treatment(`x±s, %)

Groups	n	Time	FEV1	FEV1/FVC	FEV1/Expected value
Experiment	30	Before	87.65±4.94	65.44±3.36	57.46±4.31
	30	After	86.65±4.29	65.17±2.82	57.77±3.89
Control	30	Before	85.80±4.12	64.34±3.96	55.68±4.69
	30	After	86.00±3.71*	64.62±3.65*	55.92±3.95*

Note: Compared with the control group, *P<0.05

2.2 Comparison of 6-minute walking test between two groups before and after treatment

Comparison of 6 minutes walking test between two groups before and after treatment is shown in Table 3.

Table 3 Comparison of 6-minute walking test between two groups before and after treatment(`x±s, m)

Groups	n	Before	After
Experiment	30	403.12±20.97	401.59±26.67■
Control	30	398.96±21.41	439.04±31.27※★

Note: Compared with the control group,^※P<0.01; Compared with the before treatment,^★P<0.01; Compared with the before treatment,^■P>0.05

2.3Comparison of ST George’s respiratory questionnaire (SGRQ) scores between two groups before and after treatment

Comparison of ST George’s respiratory questionnaire(SGRQ) scores between two groups before and after treatment is shown in Table 4.

Table 4 Comparison of SGRQ scores between two groups before and after treatment(`x±s, points)

Groups	n	Time	Syndrome	Active	Effect	Total
Experiment	30	Before	62.50±4.54	58.16±5.17	61.05±4.36	60.18±2.91
	30	After	61.93±4.27★	59.08±4.56★	60.76±6.12★	59.76±3.89★
Control	30	Before	65.18±11.41	62.47±11.96	63.02±9.71	62.75±7.57
	30	After	53.76±15.91※	54.28±12.99※	51.19±13.98※	53.28±13.92※

Note: Compared with the before treatment,^※P<0.01; Compared with the before treatment,^★P>0.05

2.4 Comparison of Borg index between two groups before and after treatment

Comparison of Borg index between two groups before and after treatment is shown in Table 5.

Table 5 Comparison of Borg index between two groups before and after treatment(`x±s)

Groups	n	Before	After
Experiment	30	6.39±0.65	6.51±0.97■
Control	30	6.27±0.89	5.01±0.74※

Note: Compared with the control group,^※P<0.01; Compared with the before treatment,^■P>0.05

2.5 Comparison of clinical symptom total score between two groups before and after treatment

Comparison of clinical symptom total score between two groups before and after treatment is shown in Table 6.

Table 6 Comparison of clinical symptom total score between two groups before and after treatment(`x±s)

Groups	n	Before	After
Experiment	30	8.18±1.24	7.84±1.58
Control	30	8.40±2.00	5.58±1.64※■

Note: Compared with the control group,^■P<0.01; Compared with the before treatment,^※P<0.01

2.6 Comparison of TCM syndrome between two groups after treatment

Comparison of TCM syndrome between two groups after treatment is shown in Table 7.

Table 7 Comparison of TCM syndrome between two groups after treatment

Groups	n	Clinical controlled	Obviously improved	Effective	Invalid	Percentage of effectiveness
Experiment	30	0(0)	0(0)	2(6.67)	28(93.33)	6.67
Control	30	0(0)	0(0)	12(40.00)※	18(60.00)	40

Note: Compared with the control group,^※P<0.01

2.7 Comparison of the comprehensive effect between the two groups after treatment

Comparison of the comprehensive effect between the two groups after treatment is shown in Table 8.

Table 8 Comparison of compositive effect between two groups after treatment

Note: Compared with the control group,^※P<0.05

3 Discussion

With the development of the society and the air pollution, the incidence of various respiratory system diseases including COPD has increased year by year. COPD is the chief reason of the increasing death^{[9, 10]}. Studies have proved that patients with COPD exacerbations have increasing mortality with both short-term and long-term cases. More severe the cases are or more times of COPD exacerbations are, there would be more cases of death^[11]. Therefore, how to reduce the acute attack times of COPD patients to improve prognosis and the quality of patients’ life becomes a recent focus. Research reported that traditional Chinese medicine can extend the pulmonary infection control window of COPD^[12], catgut implantation at acupoint can positively intervene COPD in stable stage, with TCM syndrome being improved and the frequency of acute attack being reduced^[13], because the Qi treatment strategy of TCM can improve immune function of patients in stable phase of COPD^[14]and the pulmonary rehabilitation can improve the symptoms of dyspnea of COPD patients and improve their quality of life^[15]. Wang Zhenwei^[16]observed the clinical affect and found that “Six-character Formula of TCM” can improve the quality of life and TCM syndrome of patients with COPD. Zhu Yi^[17]reported that “Five-animal Exercises” can obviously improve the pulmonary function patients with COPD and the degree of difficulty in breathing, and eventually prevent the disease from further development. Cui Yongsheng^[18]suggested that after some middle-aged or old women practicing the healthcare Qigong-“Five-animal Exercises” for 3 months, their physiological and psychological indexes such as blood pressure, pulse, grip strength, vital capacity and other physiological indexes got improved quite much, hence the improvement of the cardiopulmonary function took place. 

The results of this study indicate that “Five-animal Exercises” can improve the sports ability and sports endurance of patients, reduce the degree of difficulty in breathing, and improve the syndromes and improve patients’ quality of life. “Five-animal Exercises” can be used as an effective treatment and healing measure.

However, further researches are needed to see the improvement of lung function. Being a safe and reliable method, in clinical observation it was found that no patient felt discomfort during or after practicing “Five-animal Exercises”. Studies have reported that long-time practice of it can enhance human’s viscera function and immunity power Therefore, in stable phase of COPD, “Five-animal Exercises” can play a positive role during the treatment.

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Foundation item:Henan Provincial Natural Science Fund Project (number:25698647)

Received10 September 2017;accepted20 October 2017

Correspondence:Zhao Qiaoliang;E-mail:zqlzzl@163.com

Editor:Wang Jihui