IJCS | Volume 31, Nº5, September / October 2018

502 Table 2 - Dynamics of clinical parameters in both groups Parameter Patients CG (n = 54) IG (n = 48) At baseline At discharge At baseline At discharge RR at rest, per min 24.3 ± 2.2 20.2 ± 1.6* 24.2 ± 2.1 18.1 ± 1.7* Office HR, beats/min 71.8 ± 3.9 66.7 ± 2.5* 72.1 ± 3.8 62.4 ± 2.4* 6MWT, m 215.2 ± 24.8 275.7 ± 22.1* 219.1 ± 25.1 308.3 ± 24.1* Number of points by CES 10.8 ± 0.3 7.2 ± 0.4* 10.7 ± 0.6 5.9 ± 0.6* Severity of dyspnea by the Borg scale, points 7.2 ± 0.8 5.2 ± 0.3* 7.4 ± 0.6 3.2 ± 0.4* SpO 2 , % 93 (84; 95) 94 (83; 97)* 93 (84; 95) 98 (95; 98)* CG: control group; IG: intervention group; BMI: body mass index; FC: functional class; NYHA: New York Heart Association; FEV1: forced expiratory volume for 1 second; FVC: forced vital capacity. Babkina et al. Influence of pulmonary rehabilitation Int J Cardiovasc Sci. 2018;31(5)499-504 Original Article Thus, our findings showed that the application of pulmonary rehabilitation in addition to standard therapy in patients with CHF and COPD is associated with a significant increase of exercise tolerance and decrease in length of hospital stay. Discussion One important extrapulmonary manifestation of COPD is skeletal and respiratory muscle dysfunction. 10 With the increasing severity of the disease, COPD patients lose exercise endurance and often complain of fatigue and dyspnea. These symptoms curtail patients’ ability to exercise and compromise cardiac fitness, which further limits their exercise tolerance, creating a vicious downward spiral that can eventually lead to generalized debility and immobility. 11 Encouragingly, early interventions with exercise programs may restore some of the lost health status related to muscle dysfunction and increase patients’ exercise tolerance and stamina. 12-14 On this basis, a perspective direction of physical rehabilitation among patients with COPD and CHF is training of respiratory muscles. By increasing the strength and endurance of the respiratorymuscles, aswell as improving the efficiency of gas exchange, application of the full yogic breathing leads to an improvement of spirometry indices and arterial oxygen saturation. In our research we obtained data of increased arterial oxygen saturation after practicing the full yogic breathing. The positive impact of the yogic breathing exercises in the rehabilitation among patients with CHF and COPD has been described by many researchers. Thus, Soni et al. 15 have noted a positive effect of yoga training on diffusion capacity in COPD patients. The results of another study 16 have shown that 1 month of yoga practice, including breathing exercises, led to a significant reduction of dyspnea according to the visual analogue scales. A prospective, randomized, controlled study 17 involving 24 patients with COPD, who performed pranayama in addition to standard therapy, has also shown the improvement of lung function parameters and quality of life. Similar results have been described by Bernardi et al., 18 who have noted an increase in exercise tolerance and a decrease in dyspnea severity after one month of performing the full yogic breathing by patients with CHF. In addition, Gomes-Neto et al. 19 have shown that yoga practice, including breathing exercises, led to an increase in exercise tolerance in patients with CHF. Mechanisms of influence of the full yogic breathing on the status of patients withCHF andCOPD are not entirely clear. It is known that CHF is characterized by impaired autonomic regulation - decreased parasympathetic tone and, consequently, increased sympathetic activity. 20 There is evidence of autonomic balance optimization and increasing sensitivity of arterial baroreflex on the background of yoga. 21 By acting on lung tissue baroreceptors, as well as stretch receptors located in the smoothmuscle layer of the large airways, slowdeep yogic