Postoperative RMT, aerobic exercise and respiratory physiotherapy
horizontal abduction, knee joints, abduction, hip joints
Beginning 1 day postoperatively, patients in the SG started daily deep inspiratory training with a respiratory trainer, along with daily abdominal pressure breathing. Patients were placed in the supine position, with sandbags weighing 0.5 kg, 1.0 kg, 2.0 kg, or 5.0 kg or no sandbags placed on their abdomens. Patients were instructed to inhale through their nose and maintain abdominal distension for 2–3 s, followed by retraction of the lips and slow exhale, with an inhalation/exhalation ratio of 1:2–1:3. Muscle strength training of the limbs was performed with American Thera elastic bands (red, medium strength). These exercises consisted of training of the shoulder joints, including forward flexion and abduction and horizontal abduction; training of the hip joints, including forward flexion and abduction; and extension of the knee joints. Initially, each breathing or training exercise was performed 10 times per day, with three times of exercises performed and a 1 min rest time alternately. The numbers of aerobic exercise or respiratory muscle training increased by five per day, with the training lasting for 5 days.During these training sessions, professional physiotherapists and specialized nurses provided one-to-one guidance to patients, including the proper ways to inhale and exhale and not to hold their breath. Systemic relaxation was performed after training.Patients in the CG were given a respiratory trainer for deep inhalation training, as well as routine drugs and nursing care as determined by their physicians.In addition to the above training, patients in both groups received bedside training in sitting up, urination, dressing, directed coughing, and percussion and vibration of chest wall.