THE INFLUENCE OF BREATHING EXERCISES ON ANXIETY AND DEPRESSION OF CARDIOSURGICAL PATIENTS WITHIN THE STATIONARY PROGRAM OF PHYSICAL THERAPY
Authors: Al-Hawamdeh К. М. , Vitomskyi V. ‌V. , Vitomska М. V. , Gavreliuk S. V. 
Published: January 2021

Purpose: to evaluate the effect of deep breathing exercises on the level of anxiety and depression among cardiac surgery patients.
Materials and methods. The research involved 75 patients who underwent cardiac surgery. All interventions were performed through a median sternotomy with artificial circulation. Patients were randomly divided (1: 1, envelope method) into control group (CG, n=38) and training group (TG, n=37). Before the operation, patients received a brief consultation with a physiotherapist about the goals and content of physical therapy, the algorithm of activation after surgery. The postoperative protocol provided for early mobilization of the patient and training with a physiotherapist. If necessary (the patient's condition, the need for motivation), the number and / or duration of classes could be increased at the discretion of the physiotherapist. The postoperative protocol of PT provided for the following practice of early patient’s mobilization: sitting on the bed with the legs dangling on the 1 postoperative day (POD); standing (getting up with the help and under the control of a physiotherapist, holding on a medical movable walker; agreed with an anesthesiologist) and on-the-spot walking if feasible on the 1-2 POD; on-the-spot walking, walking within the ward on the 2 POD; walking in the hospital corridor on the 3 POD; walking up and down the stairs on the 4-5 POD. Besides, all patients performed therapeutic exercises with a physiotherapist and therapeutic walking under the control of a physical therapist. The difference between the groups was respiratory physical therapy. For CG patients, respiratory physical therapy was limited to cough. TG patients additionally performed deep breathing exercises. Demographics and clinical history were recorded at inclusion in the research. The Hospital Anxiety and Depression Scale was used to assess the level of anxiety and depression.
Results of research. No significant differences in anthropometric parameters, NYHA functional class, time parameters of the operation were found. The obtained preoperative results show that the total sample was 18.7% of patients with clinically severe anxiety, which is less than in other researches. This may indicate a good preoperative consultation with doctors, physiotherapist, good information of the patient about his health and possible steps in its correction, as well as the high professionalism of medical staff. According to the data obtained, the level of depression was better than the level of anxiety. The results confirmed the tendency to reduce the level of anxiety after surgery. The dynamics of the level of depression was less pronounced, which according to correlation analysis was the result of a better initial level. According to the results of the first questionnaire, the overall indicators of anxiety and depression did not differ in CG and TG: ±S for anxiety were 7.68±3.89 points and 6.48±3.25 points (p = 0.153), respectively, and for depression 5.66±4.11 and 5.89±3.31 (p = 0.787). A similar conclusion was obtained when comparing the results of the groups of the final questionnaire: alarm 4 (1; 7.25) points against 5(3;8) points (p = 0.263); depression 4.74±3.25 points against 5.54±3.61 points (p = 0.314).
Conclusions. The positive effect of the inclusion of deep breathing exercises in the postoperative program of physical therapy on the dynamics of anxiety and depression has not been established.