
==== Front
J Cardiothorac Surg
J Cardiothorac Surg
Journal of Cardiothoracic Surgery
1749-8090
BioMed Central London

3042
10.1186/s13019-024-03042-w
Research
Efficacy and safety of step-by-step Baduanjin exercise based on doctor-nurse-patient integration mode for pulmonary rehabilitation in patients after lobectomy due to pulmonary tuberculosis: a randomized controlled clinical trial
Wu Dengzhu
Wang Linghua
Zhang Lin 67363748@qq.com

grid.417400.6 0000 0004 1799 0055 Department of Tuberculosis Intensive Care Unit, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, 208 Huancheng Road East, Hangzhou, 310003 Zhejiang Province China
9 9 2024
9 9 2024
2024
19 52012 12 2023
31 8 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Background

Some pulmonary tuberculosis patients may require lung resection surgery. Postoperative pulmonary rehabilitation is essential to restore the lung function and maintain quality of life. We aimed to study the pulmonary rehabilitation outcomes and complications of step-by-step Baduanjin exercise under a doctor-nurse-patient integration mode in patients after lobectomy due to pulmonary tuberculosis.

Methods

We performed a randomized controlled clinical trial in patients undergoing lobectomy due to pulmonary tuberculosis between September 2017 and August 2021. Eligible patients were randomly assigned into the control group or interventional group. The control group received routine postoperative care. The interventional group received step-by-step Baduanjin exercise based on the doctor-nurse-patient integration mode in addition to the routine care. The primary outcomes were the pulmonary functions, including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC. The secondary outcomes were the maximum walking distance in a 6-min walk test and postoperative pulmonary complications, including atelectasis, pneumonia, and respiratory failure.

Results

A total of 100 patients were enrolled into the study, with 50 patients in the control and interventional groups. There were 60 female patients (60%). The mean patient age was 37.9 (± 2.8) years old. At the one- and two-month postoperative follow-ups, pulmonary function tests showed statistically significantly better performances in FEV1/prediction, FVC/prediction, and FEV1/FVC in the interventional group than the control group. The 6-min walk test also revealed longer walking distances in the interventional group than the control group. There were no statistically significant differences in postoperative complications between the two groups.

Conclusions

A step-by-step Baduanjin exercise regimen under the doctor-nurse-patient integration mode could safely improve pulmonary rehabilitation in patients after lobectomy due to pulmonary tuberculosis.

Keywords

Tuberculosis
Lobectomy
Baduanjin
Doctor-nurse-patient integration
Pulmonary rehabilitation
Zhejiang Province Traditional Chinese medicine science and technology project2022ZB268; 2020ZB185 2022ZB268; 2020ZB185 2022ZB268; 2020ZB185 Hangzhou Medical and Health Technology Project20220919Y031; 2018A14 20220919Y031; 2018A14 20220919Y031; 2018A14 issue-copyright-statement© BioMed Central Ltd., part of Springer Nature 2024
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pmcBackground

Tuberculosis is a serious infectious disease caused by Mycobacterium tuberculosis. In 2021, there were over 10 million patients with tuberculosis worldwide [1]. In China, the incidence and mortality of tuberculosis have greatly decreased over the past 30 years [2]. However, China is one of the eight countries with the highest tuberculosis burden [3]. After infection, tuberculosis primarily affects the pulmonary system. A significant number of tuberculosis patients require surgical resection, such as lobectomy or pneumonectomy, because of the presence of cavity lesions or tuberculomas, or failed chemotherapy from multidrug-resistant strains [4]. Postoperatively, some patients show poor pulmonary function from lung tissue loss, pain, and surgical injuries to the respiratory muscles, leading to delayed recovery and complications [5]. Appropriate postoperative pulmonary rehabilitation is essential to restore the lung functional capabilities and improve patient quality of life [6].

Baduanjin is a traditional Chinese qigong exercise that was created over 1,000 years ago [7]. It involves the coordination of body movements and posture with breathing and meditation to improve the overall health status. Previous studies have demonstrated its benefits in patients with cognitive defects, psychological illnesses, and cardiovascular diseases [8–10]. Clinical trials have shown that Baduanjin improves the pulmonary function, exercise capacity, and quality of life in patients with chronic obstructive pulmonary disease (COPD) or lung nodules [11, 12]. A recent study compared the Baduanjin with routine rehabilitation in patients after surgery for lung cancer, which showed better symptom and lung function improvement with the Baduanjin exercises [13]. However, whether Baduanjin can improve pulmonary rehabilitation and the quality of life of patients after lobectomy from tuberculosis has not been explored.

Successful performance of Baduanjin exercise requires correct guidance. A doctor-nurse-patient integration mode involves close interactions and combined efforts among physicians, nurses, and patients. Physicians and nurses work together to develop the appropriate individualized treatment regimen and guide patients in exercises. Patients can also give timely feedback and improve treatment compliance. This tripartite interaction model has shown benefits during perioperative care, psychological state and nutritional improvements, and diabetic control [14–16].

In this randomized controlled clinical trial, we compared the impacts between Baduanjin exercise and routine care on the postoperative pulmonary rehabilitation of patients after lobectomy due to pulmonary tuberculosis. The patients were educated on Baduanjin exercise performance using a doctor-nurse-patient integration mode. We hypothesized that Baduanjin exercise could provide better postoperative pulmonary rehabilitation without increasing postoperative complications than the routine care.

Methods

Study design and participant selection

We performed a randomized controlled clinical trial in patients who underwent lobectomy due to pulmonary tuberculosis at the Department of Tuberculosis Surgery at the Zhejiang Provincial Integrated Chinese and Western Medicine Hospital, China between September 2017 and August 2021. The study protocol was approved by the hospital ethics committee (approval number 2022-006). All study participants provided signed informed consent.

The inclusion criteria for the study were as follows: (1) patient age ≥ 18 years old; (2) diagnosis of pulmonary tuberculosis with lesions confined in a single pulmonary lobe; (3) scheduled for lobectomy after failure of at least one standard anti-tuberculosis chemotherapy; (4) expected survival period ≥ 6 months; and (5) ability to complete the necessary physical exercises. The exclusion criteria were as follows: (1) severe cerebral, cardiovascular, hepatic, or renal dysfunction; (2) previous history of COPD, pulmonary bulla, pneumothorax, or hemothorax; or (3) admission into the intensive care unit after the surgical operation.

Study protocol

Preoperatively, the possible pulmonary function changes after the surgery and the importance of the postoperative pulmonary rehabilitation were explained to each patient. Smoking and alcohol drinking were stopped one month before the surgery. Data on demographics, height, occupation, educational level, family income, operation duration, and volume of intraoperative hemorrhage were recorded. Baseline pulmonary tests, including the forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC were measured on a respiratory function test device (Minato Medical Science Co., Ltd., Japan) and the results of a 6-min walk test [17] were recorded.

The participants were randomized assigned into the interventional group or the control group based on a randomization table generated in SPSS (version 21.0, IBM, NY, USA). The interventional group performed the step-by-step Baduanjin exercise based on the doctor-nurse-patient integration mode in addition to receiving routine care. The control group received routine postoperative care.

Postoperatively, anti-tuberculosis treatment, including isoniazid 300 mg once a day, rifampicin 450 mg once a day, and ethambutol 750 mg once a day, was continued. The postoperative routine care included adequate pain control and simple breathing exercises, such as pursed-lip breathing at an inhalation: exhalation duration of 1:3, bottle blowing breathing (exhalation > 10 s), abdominal breathing, and deep breathing exercises. The breathing exercises were performed for 10–15 min three times a day. In the interventional group, the Baduanjin exercise was guided by a pulmonary rehabilitation management team that included a nurse manager as the team leader, a licensed nurse specialized in pulmonary rehabilitation, and a physician. All team members had more than 5 years of experience in perioperative care for tuberculosis patients.

Baduanjin training and exercises

The nurse manager and physician created the educational materials on the postoperative pulmonary rehabilitation, pain control, and Baduanjin exercise based on the “Chinese Health Qigong Baduanjin” recommended by the Chinese Health Qigong Association [18]. All team members were assessed on their theoretical knowledge and skills on perioperative care, pulmonary rehabilitation, and Baduanjin exercise before administering the interventions to patients. A WeChat group (similar to a group chat on Instagram) was set up to facilitate communication among the team members and patient. During the interventions, the physician and nurse made the daily ward round together. Based on the evaluations of the patient, the physician outlined the rehabilitation plan and nursing requirements. The nurse provided feedback on any issues and achievements during the previous rehabilitation session. Both the physician and nurse communicated in a timely manner to reach an individualized plan for the next step of rehabilitation and Baduanjin exercise for the patient. All team members met together once a week to discuss the progress and determine the next step of pulmonary rehabilitation.

We used the Wen-style Baduanjin exercise in this clinical trial. After a comprehensive evaluation of the psychological status, physical activity ability, and pulmonary functions of the patient on the first day of hospital admission, a detailed pulmonary rehabilitation plan and Baduanjin exercise regimen were prepared for each patient. Before the operation, patients watched a video on the Wen-style Baduanjin and learned the Baduanjin exercises under nurse guidance twice a day for two days. After the surgical operation, the pulmonary rehabilitation management team evaluated the postoperative cardiopulmonary functions and laboratory test results. Together with consideration of the preoperative pulmonary function assessment results, an individualized Wen-style Baduanjin exercise regimen was finalized for each patient.

The Baduanjin exercise included six sessions (Table 1) that were started on different postoperative days (Table 2). Each patient practiced Baduanjin exercise twice a day for 15–20 min each time. The patient’s heart rate and symptoms were closely monitored during the exercise. If the heart rate increased more than 20 beats/min over the resting status or patients had shortness of breath, diaphoresis, or chest pain, the exercise was immediately terminated and physicians were notified for appropriate management. The future exercise frequency and duration might be modified. At hospital discharge, a disk with a recording of Baduanjin exercise was given to the patient to take home. The patient was instructed to practice the Baduanjin exercise together with a family member twice a day for 30 min each time. The pulmonary rehabilitation management team called the patient once a week to follow up and answer questions.

Table 1 Wen-style Baduanjin exercises

Sessions	Exercises	
1, Hand and arm exercises	Put palms together and rub to warm; rub the backs of hands alternately until they are warm. The right hand holds the proximal part of the left wrist and rubs along the inner inside of the arm to reach the axilla; rub from the top of the shoulder down to the back of the hand. The left hand rubs the right arm in the same way. The whole process is repeated more than 10 times	
1, Nose and leg exercises	Both thumbs slightly flex with the other fingers to make a fist. Use the back of thumbs to rub both sides of the nose up and down (not necessary in a fixed order) more than 10 times while making sure that there is no discomfort. Both hands wrap around the groin areas and rub downward to the knee and then rub back to the groins more than 10 times. Rub from the knee to the heel and then back to the knee more than 10 times. Repeat the same process to the other leg.	
3, Eye rotations	Sits straight, keep focused, rotate the eyes to the left for 5–6 times and then look forward for a while. Rotate the eyes to the right for 5–6 times and then look forward for a while.	
6, Waist rubbing	Both palms face downward. Arms bend down to place palm heel to the back of waist. Push down to the pelvic area for several times while make sure that there is no discomfort.	
7, Abdominal rubbing	Men: left hand is placed at the waist. Right hand rubs from the left chest downward and cross the left abdomen, suprapubic area, right abdomen, and back to the left chest. Then, switch hands and repeat the same process for a total of 30 times.

Women: left hand is placed at the waist with left thumb in forward position. Right hand rubs from the left chest downward to umbilicus. Then, right hand is placed at the waist with right thumb in forward position. Left hand starts from the suprapubic area and moves to right abdomen and back to the left chest.

	
8, Sole rubbing	Rub the bilateral soles for more than 10 times after hand and foot exercises.	

Table 2 Timing of the Wen-style Baduanjin exercises after operation

Timing of the exercises after operation	Sessions	
6–24 h	1, 3	
2–5 days (with drainage catheter)	1, 3, 6	
6–10 days (from catheter removal to suture removal)	1, 3, 6	
11–14 days (from suture removal to hospital discharge)	1, 3, 6, 7	
After 15 days	1, 3, 6, 7, 8	

Outcome measurements

After the hospital discharge, patients were followed up by telephone calls once a week. At one and two months after the operation, the patients were invited to come to the clinic for repeat pulmonary function evaluations.

The primary outcomes were pulmonary functions, including FEV1, FVC, and FEV1/FVC. The secondary outcomes were the 6-min walk test to record the maximum walking distance by a patient. In addition, postoperative pulmonary complications, including atelectasis (imaging studies), pneumonia (fever, cough, abnormal laboratory tests, and imaging studies), and respiratory failure (partial oxygen pressure < 60 mmHg and/or partial carbon dioxide pressure > 50 mmHg), were recorded. Other potential complications, such as alveolar collapse and pulmonary embolism, or readmission into intensive care unit, if happened, were also documented.

Statistical analysis

In a previous study on the effects of Baduanjin in patients with COPD [19], the FVC was 2.3 ± 0.5 and 2.7 ± 0.7 in the control and interventional groups, respectively. With α = 0.05, power = 80%, we required 42 patients in each group to reach a statistically significant difference. Considering a 20% drop-off rate, we decided to include 50 patients in each group.

Continuous data were presented as mean ± standard deviation or median with interquartile range and compared by the independent t test or Mann–Whitney test, depending on the normality test results. Categorial data were presented as numbers with percentages and compared with the Chi square test or Fisher exact test, when appropriate. P < 0.05 was considered statistically significant. All statistical analyses were conducted using SPSS (version 21.0, IBM, NY, USA).

Results

Patient enrollment and baseline characteristics

After an initial assessment of 120 patient, a total of 100 patients were enrolled in the study, with 50 patients each in the interventional and control groups. The CONSORT flowchart is shown in Fig. 1. In the overall patient group, there were 60 female patients (60%). The mean patient age was 37.9 (± 2.8) years old. There were no statistically significant differences in the demographics, height, occupation, educational level, family income, operation duration, volume of intraoperative hemorrhage, surgical approach, baseline pulmonary tests and 6-min walk test between the two groups (Table 3).

Fig. 1 CONSORT flowchart

Table 3 Baseline characteristics of two patient groups

Characteristics	Control group
(N = 50)	Interventional group
(N = 50)	P	
Sex, female, N (%)	29 (58.0)	31 (62.0)	0.676	
Age, years	35.4 ± 9.6	36.2 ± 8.8	0.309	
Height, cm	170.1 ± 5.4	171.3 ± 4.5	0.134	
Intraoperative hemorrhage, mL	165.4 ± 85.8	159.3 ± 95.4	0.466	
Operation duration, min	112.2 ± 50.4	110.5 ± 43.5	0.455	
Surgical approach, N (%)			0.603	
 Thoracoscopic lobectomy	42 (84.0)	40 (80.0)		
 Open lobectomy	8 (16.0)	10 (20.0)		
Baseline pulmonary functions				
 FEV1, L	1.4 ± 0.5	1.4 ± 0.5	0.169	
 FVC, L	2.8 ± 0.6	2.8 ± 0.6	0.124	
 FEV1/FVC, %	43.2 ± 5.3	42.6 ± 7.6	0.263	
6-minute walk test, m	223.5 ± 19.6	225.3 ± 20.5	0.326	
Data are shown as mean ± standard deviation unless otherwise indicated. RMB, ren min bi (Chinese dollar); FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity

Comparison of pulmonary function between two groups

At the 1- and 2-month clinical follow-ups after the surgical operation, the pulmonary function tests showed better performances in FEV1/prediction, FVC/prediction, and FEV1/FVC in the interventional group compared with the control group (Table 4).

Table 4 Postoperative pulmonary function comparisons at 1- and 2-month follow-ups

Pulmonary functions	Control group
(N = 50)	Interventional group
(N = 50)	P	
FEV1/prediction, %				
 1-month follow-up	75.4 ± 5.5	80.2 ± 6.4	0.03	
 2-month follow-up	77.2 ± 5.3	82.3 ± 6.3	0.02	
FVC/prediction, %				
 1-month follow-up	77.3 ± 6.1	81.5 ± 5.5	0.04	
 2-month follow-up	77.8 ± 5.4	83.4 ± 5.2	0.013	
FEV1/FVC, %,				
 1-month follow-up	45.2 ± 6.9	55.1 ± 7.1	0.013	
 2-month follow-up	63.6 ± 5.3	79.7 ± 8.2	0.002	
Data are shown as mean ± standard deviation. FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity

Comparisons of secondary outcomes between two groups

The 6-minute walk test revealed longer walking distances in the interventional group than the control group (Table 5). There were no statistically significant differences in the postoperative complications between two groups (Table 5).

Table 5 Comparisons of 6-minute walk test and pulmonary complications between two groups

Secondary outcomes	Control group
(N = 50)	Interventional group
(N = 50)	P	
6-minute walk test, m				
 1-month follow-up	225.3 ± 17.5	307.2 ± 18.3	0.007	
 2-month follow-up	254.1 ± 25.3	438.9 ± 30.2	0.008	
Pulmonary complications, N (%)	7 (14.0%)	5 (10.0%)	0.538	
 Atelectasis	2 (4%)	1 (2%)		
 Pneumonia	3 (6%)	2 (4%)		
 Respiratory failure	2 (4%)	2 (4%)		
Data are shown as mean ± standard deviation unless otherwise indicated

Discussion

In the present study, we showed that patients undergoing lobectomy due to pulmonary tuberculosis showed improved postoperative pulmonary rehabilitation after Baduanjin exercise via a doctor-nurse-patient integration mode. The improved pulmonary rehabilitation was demonstrated by better pulmonary function test results in the interventional group than the control group. In the 6-min walk test, the interventional group also had a longer walking distance than the control group, likely due to better heart and lung capacities in the interventional group. This study is the first to demonstrate the potential efficacy of this treatment strategy in patients with tuberculosis.

Patients with tuberculosis have decreased pulmonary function because of the destruction of lung tissue by Mycobacterium tuberculosis. Surgical treatment combined with chemotherapy can improve the therapeutic success in tuberculosis patients, especially in patients with multidrug-resistant bacteria or severely damaged pulmonary function. However, common surgical treatments, such as lobectomy, can further reduce postoperative pulmonary function [5]. Therefore, postoperative pulmonary rehabilitation is essential for these patients to improve their recovery and quality of life [6]. Several randomized clinical trials have demonstrated that early and appropriate postoperative exercise training and aerobic activities can help pulmonary rehabilitation and functional compensation in patients after lung resection [20, 21]. However, most patients have limited knowledge and experience in the skills involved in postoperative pulmonary rehabilitation. While traditional Chinese physical exercises, such as Tai Chi Chuan and Qigong, have shown benefits in postoperative pulmonary rehabilitation in patients with lung cancer [22], these exercises involve complicated steps and are time-consuming. These exercises are not appropriate for patients during the postoperative period when the patients are still experiencing pain and weakness and carry multiple drainage tubes. In the present study, we applied a doctor-nurse-patient integration mode and formulated an individualized step-by-step Baduanjin exercise regimen for each patient. In this doctor-nurse-patient integration mode, physicians and nurses worked together to make ward rounds and comprehensively analyze the overall situation. An initial assessment was made after the hospital admission and before the surgical operation. The basic steps of Baduanjin exercise were taught to each patient. Each patient practiced and understood the basic steps preoperatively. After the surgical operation, patients were assessed again based on their postoperative condition. An appropriate personalized Baduanjin exercise regimen was then finalized for each individual patient. Patients were instructed to follow the prescribed exercise regimen and perform step-by-step movements. The patients provided prompt feedback on treatments and received immediate guidance. Appropriate and immediate adjustments on the Baduanjin exercise regimen were made based on the feedback and tolerance of the patients. The physician, nurse, and patient cooperated with each other with integrated efforts to achieve the goal of treatment. Previous studies have demonstrated that a doctor-nurse-patient integration mode could improve treatment compliance, increase staff and patient satisfaction, and promote postoperative recovery [14, 23]. Here, we also showed that a doctor-nurse-patient integration mode could be successfully applied to generate and administer an individualized treatment plan and Baduanjin exercise regimen after lobectomy. In this mode, the doctor and nurse stimulate and train patients to perform exercises. The doctor-nurse team periodically called patients to encourage them to complete the daily exercises. In the control group, patients were educated to perform a simple breathing exercise once after the operation, but there were no more doctor-nurse follow-ups. The doctor-nurse-patient integration mode may have helped patients comply with the exercises and have a positive impact on patients. Patients followed the instructions and performed Baduanjin exercise to achieve improved recovery and pulmonary functions. The application of a doctor-nurse-patient integration mode should be encouraged in clinical practice.

Baduanjin is a traditional Chinese mind-body exercise. In the present study, we provide evidence to show that Baduanjin exercise improved pulmonary function after the surgical procedure. This was consistent with previous studies showing that Baduanjin exercise significantly reduced the airway inflammatory response, improved pulmonary function, and increased exercise tolerance to maintain the quality of life in patients with COPD or lung nodules [11, 12]. Baduanjin exercise is a low-intensive aerobic activity that involves deep and slow breathing exercises, musculoskeletal relaxation and stretching, and mental concentration. The hand is the final place to collect meridians from the three Yin of hand, three Yang of hand, and finger channels. The elbow is the place to gather Qi from the heart and lung. Warmth from hand rubbing achieves the purpose of clearing the lungs and draining the heat of the heart and chest. The hand and arm exercises dredge the meridians, regulate Qi and blood, clear the heart, and moisten the lung. Nose rubbing warms and opens the lung to the nose and drains the Qi. Waist rubbing improves kidney function and increases endurance. Leg exercise and sole rubbing regulates Qi of the internal organs and coordinates Yin and Yang. The upper extremity stretching expands the thoracic cavity. The breathing exercises also strengthen the diaphragm and abdominal muscles to enhance activity tolerance. The exercise can make the alveoli fully expanded through regular slow and long breathing to increase ventilation and enhance lung capacity and reduces myocardial oxygen consumption by extremity movements to reduce cardiac pre- and after-load, thus improving cardia and pulmonary functions. Overall, Baduanjin exercise influences all visceral organs to facilitate pulmonary functional recovery [24, 25]. In addition, in patients with pulmonary tuberculosis, Baduanjin exercise nourishes Qi and blood, reduces the deficiency syndrome caused by the infection, and regulates the viscera function to control the fever and hemoptysis associated with tuberculosis [26].

Our current study showed that every outcome measurement was better in the Baduanjin group than the control group. A recent study also showed the benefits of Baduanjin exercise compared with the routine rehabilitation in patients after surgery for lung cancer [13]. This study showed better symptom and FEV1% improvement with Baduanjin than routine rehabilitation, although FVC%, 6-minute walk test, and Borg score were similar between two treatments. The differences between their results and ours might be due to different baseline illnesses (cancer versus pulmonary tuberculosis) or demographics.

Patients can develop complications after lobectomy. The most common postoperative complications included pulmonary infection and respiratory failure. Our study showed complication rates of 14.0% and 10.0% in the control and interventional groups, respectively, which was similar to those reported previously [27]. Our results suggested that Baduanjin exercise did not increase the risk of postoperative complications. However, our sample size was small, and we could not rule out the possibility of significant inter-group differences in the postoperative complications if the sample size is enlarged.

The limitations of our study included single-center research, small sample size, and a short follow-up period. In the current study, we applied Wen-style Baduanjin. Whether a different style or practice of Baduanjin exercise exerts benefits on postoperative pulmonary rehabilitation is unknown [28]. In addition, we compared the postoperative outcomes between the routine care and Baduanjin exercise, but did not compare the intra-group pre- and post-operative changes that was not the objective of this study. In addition, patients in the interventional group were encouraged to perform daily exercises by the medical staff, whereas patients in the control group were only taught the breath exercises initially but no follow-up encouragements. This might cause bias in our results. Other uncontrolled factors, such as the location of the resected lobe, concurrent illness such as extrapulmonary tuberculosis, previous COPD therapy, and surgical approach, could also confound our findings. Future multi-center studies with a large sample size and long follow-up period are required to confirm our findings and investigate the impacts of lobectomy on the pulmonary functions and effects of Baduanjin exercise on these impacts.

Conclusions

In summary, postoperative pulmonary rehabilitation in patients undergoing lobectomy due to pulmonary tuberculosis was improved by a step-by-step Wen-style Baduanjin exercise regimen administered under a doctor-nurse-patient integration mode. Future studies are warranted.

Acknowledgements

None.

Author contributions

DW: Roles/Writing - original draft; Formal analysis. LW: Funding acquisition; Project administration; Writing - review & editing. LZ: Project administration; Supervision. All authors read and approved the final manuscript.

Funding

This work was supported by Zhejiang Province Traditional Chinese medicine science and technology project (2022ZB268; 2020ZB185), Hangzhou Medical and Health Technology Project (20220919Y031; 2018A14).

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

The study protocol was approved by the ethics committee of Zhejiang Provincial Integrated Chinese and Western Medicine Hospital (approval number 2022-006). This study protocol is designed according to the Helsinki Declaration. All study participants provided signed informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Abbreviations

FEV1 Forced expiratory volume in 1 s

FVC Forced vital capacity

COPD Chronic obstructive pulmonary disease

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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