Abstract
PurposesHip fracture leads to decreased activity and an increased risk of pulmonary complications. The main purpose of this study was to observe the lung capacity, cough capacity of the elderly patient with acute hip fracture, and assess the effects and the feasibility of using a special-designed “upper-body yoga” training to treat elderly patients with hip fracture.MethodsThis was a prospective, randomized, and single-blind study. Eighty-four subjects aged over 65 years were randomly divided into either a control group or a yoga group to undergo an abdominal breathing program or an “upper-body yoga” program until 4 weeks after surgery. The primary outcomes were forced vital capacity/predicted value (FVC%), peak cough flow (PCF), Barthel Index (BI), and the incidence of pneumonia. The secondary outcomes were the rates of right skills and inclination.ResultsThirty-nine subjects in the yoga group and 40 subjects in the control group completed this study. At the end of the first training week, FVC% (74.14% ± 13.11% vs. 70.87% ± 10.46%, P = 0.231) showed no significant difference between the two groups, while the value of PCF (204.80 ± 33.45 L/min vs. 189.06 ± 34.80 L/min, P = 0.048) and BI (38.59 ± 8.66 vs. 33.00 ± 9.32, P = 0.009) in the yoga group was higher. After 4 weeks of treatment, FVC%, PCF, and BI were higher in the yoga group (78.83% ± 13.31 % vs. 72.20% ± 10.53%, P = 0.016; 216.16 ± 39.29 L/min vs. 194.95 ± 31.14 L/min, P = 0.008; 70.77 ± 10.23 vs. 65.75 ± 11.30, P = 0.019). One in the control group and nobody in the yoga group was diagnosed with pneumonia. There was no significant difference between the two groups in terms of the rates of right skills, whereas more elderly people preferred the training program of the “upper-body yoga.”ConclusionElderly patients with acute hip fractures are at risk of impaired lung capacity and inadequate cough. “Upper-body yoga” training may improve the quality of daily life, vital capacity, and cough flow in elderly patients, making it a better choice for bedridden patients with hip fracture.
Highlights
Among elderly patients with hip fracture, pneumonia is known to be a devastating complication in the peri-operative period and during post-discharge recovery, in which the incidence of pneumonia is 4.1–7.0% [1, 2] and its 30-day mortality is 14–27.1% [2, 3]
The absence of regular deep breaths, the presence of postural restriction, and the weakness of expiratory muscles impair the ability of these patients to cough, eventually leading to the loss of ventilation, retention of airway secretion, aggravating pre-existing medical conditions and predisposing the elderly patients to atelectasis, pneumonia, and potentially life-threatening respiratory failure
The results of repeated measurement ANOVA showed that the difference of Forced vital capacity (FVC)% at different time was statistically significant (F = 58.152, P < 0.001)
Summary
Among elderly patients with hip fracture, pneumonia is known to be a devastating complication in the peri-operative period and during post-discharge recovery, in which the incidence of pneumonia is 4.1–7.0% [1, 2] and its 30-day mortality is 14–27.1% [2, 3]. Up to 1 month after surgical procedures, the physical activity of the patients remains seriously affected [4], and most of the time the patients are restricted to bed rest. During this period, elderly patients tend to breathe with a low tidal volume. In the routine peri-operative functional exercise, the lower limb movement is emphasized, and the upper limb movement is often ignored
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