The Application Of "Upper-body Yoga" In The Elderly With Hip Fracture

Objective:Aging generates reduction of respiratory function,which is embodied in the decline of pulmonary volume and respiratory muscle strength.Hip fracture leads to decreased activity and increased risk of pulmonary complications.In the first month,the patients spend most of their time in bed,and vital capacity and forced expiratory flow of the elderly get further impaired.No specific prophylaxis is recommended to prevent and reduce the occurrence of pulmonary complications as yet for bedridden senile patients.We designed“upper-body yoga”training by combining yoga and upper limb movement.The main purpose of this present study was to assess the effectiveness and feasibility of this“upper-body yoga”training on the elderly with hip fracture.Methods:This was a prospective randomized single-blind study.Between April 2018 and September 2018,eighty-four subjects of hip fracture above 65 who met the inclusion and exclusion criteria were randomly divided into either a yoga or a control group,they performed a abdominal breathing program or a“upper-body yoga”program until 4 weeks after surgery.The forced vital capacity/predicted value(FVC%),peak cough flow(PCF)and Barthel Index(BI)were measured in the first day,one week after training and 4 weeks after surgery.The subjects were investigated if they had got the right training skills and their tendency to the current training protocal on the eighth day of admission and 4 weeks after surgery.Thirty-nine in yoga group and forty in control group completed this study with five patients withdraw.Results:1.FVC% On the first day of admission,the baseline values of FVC%in yoga group and control group were 72.85±14.03%and 70.51±10.94%.After a week of training,FVC%in yoga group and control group were 74.15±13.11%and 70.87±10.46%.Four weeks after surgery,FVC%in yoga group and control group were 78.83±13.31%and 72.20±10.53%.The results of repeated measurement ANOVA showed that the difference of FVC%at different time was statistically significant(F=58.152,P<0.001).FVC%increased gradually with the extension of time.The interaction between time and group was statistically significant(F=18.145,P<0.001).By multiple comparisons of FVC%between the two groups at each time point,it showed that there was no statistically significant difference in FVC%between the two groups on the first day and 1 week after admission(t=0.86,P=0.393;t=1.20,P=0.231).After 4 weeks of surgery,FVC%in yoga group was significantly higher than that in control group(t=2.43,P=0.016).2.PCF On the first day of admission,the baseline values of PCF in yoga group and control group were 191.44±33.96 L/min and 193.13±37.49 L/min.After a week of training,PCF in yoga group and control group were 204.80±33.45 L/min and 189.06±34.80L/min.Four weeks after surgery,PCF in yoga group and control group were 216.16±39.29 L/min and 194.95±31.14 L/min.By repeated measurement ANOVA,the difference of PCF at different time points was statistically significant(F=21.770,P<0.001),and the PCF increased gradually with the extension of time.The interaction between time and group was statistically significant(F=19.184,P<0.001).Multiple comparison of PCF between the two groups at each time point showed that on the first day of admission,there was no significant difference in PCF between the two groups(t=0.21,P=0.831).One week after admission and 4 weeks after surgery,PCF in yoga group was significantly higher than that in control group(t=1.99,P=0.048;t=2.68,P=0.008).3.BI On the first day of admission,the baseline value of BI were 18.08±6.85 scores and19.00±9.62 scores.After a week of training,BI were 38.59±8.66 scores and 33.00±9.32scores.Four weeks after surgery,BI in yoga group and control group were 70.77±10.23scores and 65.75±11.30 scores.The results of repeated measurement ANOVA showed that the difference in BI at different time points was statistically significant(F=642.977,P<0.001),and the BI gradually increased with the extension of time.The interaction between time and group was statistically significant(F=5.313,P=0.007).Multiple comparisons of BI between the two groups at each time point showed that on the first day of admission,there was no statistical difference in BI between the two groups(t=0.43,P=0.665).BI in yoga group was significantly higher than that in control group(t=2.63,P=0.009;t=2.36,P=0.019)at 1 week after admission and 4 weeks after surgery.4.Pneumonia Four weeks after surgery,one in control group was diagnosed with pneumonia,and nobody suffered pulmonary complication in yoga group,there were no significant difference between the two groups.5.Adverse events,right skills and compliance No adverse events were observed in both control group and yoga group.After a week of training,29(74.36%)in yoga group and 33(82.5%)in control group got the right skills.There was no statistical difference between the two groups(c~2=0.775,P=0.379).An follow-up at 4 weeks after surgery showed that 33(84.62%)in yoga group and 16(40.00%)in control group admitted that they would like to continue the training protocal in a long period of time.There was a statistically significant difference between the two groups(c~2=16.688,P<0.001).Conclusion:Elderly patients with acute hip fractures are at risks of impaired lung capacity,activity and inadequate cough."Upper-body yoga"training is safe and feasible,it may improve the ability of daily life,lung capacity and peak cough flow,which makes it a better long-term routine training program for bedridden hip fracture.