2.7.1. Experimental group.
hip joints, chest tightness, fatigue, vertigo, shortness of breath
In addition to conventional medication and health education, the experimental group will be given Yi Jin Jing exercise, treadmill exercises and strength training. Patients will wear Polar heart rate belt during training, and the rehabilitation therapist will monitor the patients’ exercise in real-time through the heart rate bands and make an immediate assessment of the patient’s fatigue level according to the Borg scale. Patients should stop the training immediately if they showed chest tightness, shortness of breath or vertigo during the training. All patients should try to maintain their pre-experimental daily routine and dietary habits and be prohibited from participating in other regular exercises. The patient’s daily activities, diet and, rest habits will be understood through regular questionnaires and telephone interviews.Yijinjing exercise protocolThe patients will be taught by a dedicated rehabilitation therapist for 24 weeks, with a learning period for the first 4 weeks and an intensive training period for the last 20 weeks, practicing 3 times a week (Mondays, Wednesdays and Fridays) for 30 minutes each time, with a 5 minutes warm-up and relaxation.Yijinjing exercise consists of 12 movements. Its intensity is quantified by the target heart rate, which is monitored in real-time by the patient wearing a Polar heart rate belt. The target heart rate is based on a reserve heart rate of 60% to 70% for moderate intensity aerobic training. The specific algorithm for the target heart rate isTreadmill exercises protocolThe intensity of treadmill exercises is still monitored by the target heart rate. Patients will wear a Polar heart rate belt and first performs an acclimatization run on the treadmill, followed by a formal run. The running speed is gradually increased, but the heart rate is generally controlled within the range of the target heart rate. If the patient’s heart rate is outside or below that range, the intensity of the exercise is reduced or increased as appropriate. The running time is 30 minutes, including a 5-minutes warm-up. Exercise frequency is 3 times/week (Monday, Wednesday, and Friday) for 24 weeks.Strength training protocolThe strength training consists of five movements: bridge exercise, plank, seated training, swiss ball wall squats and ball squats, see Figure Strength training protocol. (A) Bilateral bridge. (B) Plank. (C) Seated training. (D) Swiss ball wall squats. (E) Ball squats.Bilateral bridgeThe bridge exercise is based on an unstable support surface. The patients are placed in the supine position, and the proximal ends of both lower legs are placed in the wide sling, and the trunk, knee, shoulder, and hip joints are maintained in the same line by raising the hips and extending the hips, and the movement lasts for 10 seconds.PlankThe patients are placed in a prone position, with both elbows bent over the bed, and the proximal ends of both lower legs set into the wide sling, then the body leaves the bed, ensuring that the ankle, hip, shoulder and head remain in a straight line. the movement lasts for 10 seconds.Seated trainingThe patients sit on the swiss ball with the trunk neutral and both lower extremities naturally separated. The therapist instructs the patient’s pelvis to tilt and rotate anteriorly, posteriorly, left and right on the swiss ball, maintaining each position for 5 seconds.Swiss ball wall squatsThe patients squat with the back against the Swiss ball and holds the movement for 15 seconds, followed by standing up. Each movement is repeated 10 to 15 times depending on the situation.Ball squatsThe patients maintain a deep squat, holds the upper limb straight and lifts the gravity ball (2 kg) 15~20 times, paying attention to the sunken shoulder and squatting posture.