Zusammenfassung:
Belastungseinschränkung und Dyspnoe bei Patienten mit COPD führten zu unterschiedlichen
Rehabilitationsprogrammen mit dem Ziel einer Steigerung der Leistungsfähigkeit bei
gleichzeitiger Besserung der Dyspnoe. Zur Klärung der Effizienz eines Ausdauertrainings
(Trainingsgruppen P1 und P4), eines Krafttrainings (P2 und P5) oder einer Kombination
von beiden (P3 und P6) wurden 69 Patienten mit mittel- bis schwergradiger COPD (44
Männer/25 Frauen) randomisiert einem dreiwöchigen stationären Trainingsprogramm ohne
(P1 - P3) oder mit Sauerstoffgabe (P4 - P6) zugeführt. Vor und nach dem Rehaprogramm
wurden bei allen Patienten Lungenfunktionsuntersuchungen und Belastungstests durchgeführt.
Die subjektive Dyspnoe wurde mittels einer visuellen Analogskala, das Belastungsgefühl
mit der Borg-Skala gemessen. Das Ausdauertraining erfolgte dreimal wöchentlich auf
einem kalibrierten Fahrradergometer mit 70 % der maximalen Leistungsfähigkeit, das
Krafttraining dreimal wöchentlich kraftausdauerorientiert mit 40 % der berechneten
Maximalkraftleistung.
Die Lungenfunktion und arteriellen Blutgase blieben weitgehend unverändert. Der 6-Minuten-Gehstreckentest
(6MT) zeigte bei allen Gruppen (außer P2) eine signifikante Zunahme der Gehstrecke
zwischen 60 - 83 m. Die benötigte Zeit für den Test alltagsmotorischer Fertigkeiten
(TAF) verbesserte sich in allen Gruppen um 5 bis 58 Sekunden und erreichte bei P1,
P3, P5 und P6 Signifikanzniveau.
Die Dyspnoe nach dem 6MT besserte sich bis auf P4 in allen Gruppen, signifikant in
P1 und P3, nach dem TAF in allen Gruppen, signifikant in P2 und P5.
Zusammenfassend belegen die Untersuchungen die Effizienz eines kurzzeitigen stationären
Rehaprogramms. Patienten mit weit fortgeschrittener Erkrankung (P4 - P6) profitieren
deutlicher von einem Kraftausdauertraining (allein als auch in Kombination), während
Patienten der Gruppen P1 - P3 ein Ausdauertraining eher zu empfehlen ist. Die Verbesserungen
der Belastbarkeit und der Dyspnoe tragen zu einer Steigerung der täglichen Aktivitäten
und letztendlich zu einem gesteigerten Wohlbefinden bei.
Functional Effects of Different Training in Patients with COPD:
Disability and exertional dyspnea associated with chronic obstructive pulmonary disease
has led to the development of rehabilitation programmes that aim to increase exercise
tolerance and relief of dyspnea. To evaluate whether aerobic training (training groups
P1 and P4), strength training (P2 and P5) or a combination of both (P4 and P6) is
useful, 69 patients (44 m/25 f) with moderate to severe COPD were randomised to a
three week inpatient training program. The training consisted of three weekly twenty
minute exercise sessions without (P1 - P3) or with supplemental oxygen (P4 - P6) on
a calibrated ergocycle (70 % Wmax) or three weekly sessions of 20 - 25 repetitions of 2 - 4 training series (40 % Wmax) or a combination of both.
In general, the programme failed to demonstrate significant changes in lung function
and arterial blood gases. Evaluation of exercise capacity via the six-minute-walking
test (6MT) yielded a significant increase of the walking distance in all groups except
P2 (60 - 83 m), The time to finish a test-set of daily activities (TAF) was reduced
in all groups (5 - 58 sec) and reached significance in P1, P3, P5 and P6.
After the 6MT, exertional dyspnea improved in all groups except P4 and was significant
in P1 and P3; after the TAF, dyspnea again was reduced in all groups with a significant
change in P2 and P5.
These data support the hypotheses that a short term inpatient training programme is
suitable to improve exercise-capacity and dyspnea. Patients with advanced disease
(P4 - P6) show greater benefits with strength training (alone or in combination with
aerobic training) while for patients with moderate disease (P1 - P3) aerobic training
is favourable. These changes may translate into improved performance of daily activities
and general well-being.
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1 Diese Arbeit ist Teil der Promotionsarbeit von Frau K. Bastian.
PD Dr. med. G. Würtemberger
Karlstr. 81 A
79104 Freiburg
