NAME : FANDI AKHMAD

NIM : P1337420619107

DEEP BREATHING EXERCISE AND ACTIVE RANGE OF MOTION INFLUENCE

PHYSIOLOGICAL RESPONSE OF CONGESTIVE HEART FAILURE PATIENTS

Heart and blood vessel disease is a major health problem in developed and developing
countries. This disease is the first leading cause of death in the world. The increasing prevalence
will cause disease, disability and socio-economic problems for families, communities and
countries. Therefore, comprehensive management of heart failure, especially symptom
management, needs to be addressed.
Dyspnea is a typical symptom of Congestive Heart Failure (CHF). Dyspnea impairs
functional capacity and quality of life. Dyspnea caused by ventricular dysfunction results in
decreased cardiac output and increased pulmonary venous pressure leading to pulmonary
congestion. This in turn causes extravasation of fluid into the interstitial spaces and alveoli of the
lung, which reduces lung compliance and impairs ease of breathing. Patients who have a
functional class NYHA III-IV will experience high-grade dyspnea complaints. Patients with
NYHA IV will be breathless every day, even during light activity or at rest. This is because
dyspnea affects the decrease in tissue oxygenation and energy production, so that the patient's
daily activities will also decrease which can reduce the patient's quality of life. Management in
the form of a systematic review and meta-analysis revealed that heart failure rehabilitation is
recommended for low and moderate risk of heart failure (NYHA II and III).
Cardiac rehabilitation may be of benefit in clinically stable patients with heart failure.
The American Heart Association recommends physical exercise for patients with stable CHF.
Physical exercise is carried out for 20-30 minutes with a frequency of 3-5 times every week.
Before starting physical exercise, a patient with CHF requires a comprehensive assessment of
risk stratification and is recommended to rest due to fatigue. This exercise is one that can be done
for people with NYHA II and III. Management of gradual activity in these patients is light and
regular physical activity so that peripheral blood circulation and tissue perfusion conditions can
be improved. In addition, giving positions and breathing exercises can be done to reduce energy
and improve respiratory muscle function. Exercise training or regular physical activity is
recommended as a safe and effective measure for patients with heart failure.
The use of deep breathing exercises and active range of motion as nursing interventions
in CHF patients have not been widely studied in Indonesia. No study has combined the two
interventions. This prompted the investigators to study the effect of deep breathing exercises and
active range of motion on dyspnea in CHF patients. Deep breathing exercises in heart failure
patients can improve cardiac autonomic regulation and decrease chemoreceptor sensitivity. This
exercise will increase the left ventricular ejection fraction, lower pulmonary pressure, and
decrease pulmonary edema. This may be due to an increase in the ventilator mechanism due to
regulation or modulation of cardiopulmonary reflexes. In addition, range of motion is a physical
exercise that can affect blood pressure because the efficiency of the heart or the heart's ability
will increase according to changes in heart frequency and cardiac output. Regular physical
exercise is done 3-5 times a week with 20-60 minutes of exercise once, and it can reduce blood
pressure.
Breathing exercises are done to improve ventilation and oxygenation. Increased
pulmonary compliance during breathing exercises can cause the amount of air entering the lungs
to increase, resulting in a lower respiratory rate. Oxygen needs are met, so tolerance to activity
will increase. The decreased respiratory rate after the intervention proved that there was an
improvement in respiratory function. Breathing exercises can optimize lung development and
minimize use of breathing muscles. By doing regular breathing exercises, respiratory function
will improve. Deep breathing can increase the ability of the lungs to develop and affect the
perfusion and diffusion function so that oxygen supply to the tissues is adequate. Lower pressure
in the intrathorac will cause air to flow from a higher atmospheric pressure into the lungs which
have lower pressure as a process of gas exchange or lung ventilation.
Reference:
Novita, N, Mardiyono M, Edi, D3, & Thohar, A. (2020). Deep breathing exercise and
active range of motion influence the physiological response of congestive heart failure patients.
Journal of Nurshing.