Abstract
Background: Sputum expectoration of lung secretionsin HIV infected children with associated respiratory conditions is oftendifficult. Chest physiotherapy is often recommended to assist in thisprocess but is not always successful. A erobic exercises may have bene-ficial effects on sputum expectoration but its safety is uncertain. Aim: The primary aim of this study was to determine if cycle ergometerand rebound exercises are safe for mild to moderately symptomatic HIV infected children and if these aerobic exercises followed by chestphysiotherapy could augment sputum expectoration.Method: Thirty six A frican 8-12 year old males performed 15 minutesof either cycle ergometer or rebound exercises. A modified 6 minutewalking test to ensure fitness of the enrolled subjects prior to randomization was performed. Heart and respiratoryrates, blood pressure and oxygen saturation was monitored for safety. Sputum expectorated was measured in a calibratedvial at baseline, 5, 10, and 15 minutes post exercise followed by 30 minutes of conventional chest physiotherapy. R esults: Total sputum produced during and post rebounding exercise was significantly higher than cycle ergometerexercises (12.6 vs. 9.8mls p=0.0002). The quantity of sputum obtained over each time point after rebound exercise wassignificantly more than cycle ergometer (5, 10 & 15 minutes; p=0.0084, p= 0.0002, p=0.0002 respectively). There wereno significant differences in heart and respiratory rates, blood pressure and oxygen saturation of enrolled subjectsbetween these exercises and no cases reached the threshold for stopping the exercise.Conclusion: Cycle ergometer and rebound exercises are safe for mild to moderately symptomatic HIV infected children. Rebound exercises followed by chest physiotherapy can be used as a safe adjunct to significantly increasesputum expectoration.
Highlights
The Human Immune-deficiency Virus (HIV) suppresses the immune system and makes its host susceptible to opportunistic chest infections
Rebound exercises followed by chest physiotherapy can be used as a safe adjunct to significantly increase sputum expectoration
The effect of chronic respiratory limitations due to ventilatory adaptations alters lung volumes and capacities, increasing tidal volume and minute ventilation and reduces cardiopulmonary fitness at rest and during low intensity daily activities. These children develop a sedentary lifestyle with a decrease capacity for aerobic exercise leading to hyperventilation which perpetuates cardiopulmonary compromise resulting in a dyspnoea spiral (Prefaut et al 1995)
Summary
The Human Immune-deficiency Virus (HIV) suppresses the immune system and makes its host susceptible to opportunistic chest infections. The effect of chronic respiratory limitations due to ventilatory adaptations alters lung volumes and capacities, increasing tidal volume and minute ventilation and reduces cardiopulmonary fitness at rest and during low intensity daily activities These children develop a sedentary lifestyle with a decrease capacity for aerobic exercise leading to hyperventilation which perpetuates cardiopulmonary compromise resulting in a dyspnoea spiral (Prefaut et al 1995). Patients are positioned into gravity assisted postures based on the anatomy of the bronchial tree to allow secretions to be loosened and cleared from airway walls Following this procedure tenacious thick secretions are removed optimizing bronchial hygiene, improving ventilation and cardiopulmonary function, slowing the proteolytic destruction of airways and SA JOURNAL OF PHYSIOTHERAPY 2008 VOL 64 NO 3 generally reducing the risk of secondary chest infections (Pryor & Webber 1999)
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