Infra-Abdominal Muscles Activation Brings Benefits to the Pulmonary Function of Patients with Sternal Instability after Cardiac Surgery

Abstract Objective: To compare physical therapy strategies involving abdominal muscle stabilization, with and without upper limb movement, in patients with sternal instability after heart surgery and during in-hospital care. Methods: This prospective, longitudinal, randomized, and comparative clinical study included 20 patients, which were divided into two groups: ARM, the arm group (n=10), and LEG, the leg group (n=10). The study involved the evaluation of scores of visual analog scales for sternal instability, pain, discomfort, functional impairment, lung function, and maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) before and after the interventions. Two protocols consisting of abdominal exercises in both groups with upper limb movements (ARM) and just abdominal activation with leg movements (LEG) were used for three weeks. Results: There were statistically significant (P≤0.01) improvements in pain, discomfort, and functional impairment scores, and in MIP (P=0.04) and MEP (P≤0.01) after intervention in both groups and just LEG showed improvement in forced vital capacity (P=0.043) and forced expiratory volume in one second (P=0.011). Conclusion: Both strategies promoted improvement in pain, discomfort, and functional impairment scores and in the values of inspiratory and expiratory pressures. Perhaps they were influenced by the time and resolution of the infection process, although exercises with upper limb movements seem to be safe in this population. The activation of the infra-abdominal muscles through leg movements seems to bring more benefits to lung function.

研究目的：对比心脏术后胸骨不稳定患者住院期间，分别联合与不联合上肢运动的腹肌稳定物理治疗策略的疗效。研究方法：本研究为前瞻性、纵向、随机对照临床研究，共纳入20例患者，分为两组：上肢组（ARM，n=10）与下肢组（LEG，n=10）。干预前后，分别对患者的胸骨不稳定、疼痛、不适、功能障碍的视觉模拟量表（visual analog scales）评分，以及肺功能、最大吸气压力（maximum inspiratory pressure, MIP）、最大呼气压力（maximum expiratory pressure, MEP）进行评估。两组均实施为期3周的干预方案：上肢组采用联合上肢运动的腹部训练方案，下肢组采用仅通过下肢运动进行腹部激活的方案。研究结果：两组患者干预后，疼痛、不适与功能障碍评分，以及MIP（P=0.04）、MEP（P≤0.01）均出现具有统计学意义的改善；仅下肢组的用力肺活量（forced vital capacity）与一秒用力呼气容积（forced expiratory volume in one second）分别在P=0.043与P=0.011水平得到改善。研究结论：两种治疗策略均可改善患者的疼痛、不适与功能障碍评分，以及吸气、呼气压力水平。尽管干预效果可能受感染病程时长与转归的影响，但联合上肢运动的训练方案在该人群中安全性良好。通过下肢运动激活腹下肌群，似乎能为肺功能带来更多获益。