Zusammenfassung
In einer kontrollierten/prospektiven klinischen Studie untersuchten wir 125 Patienten
mit chronisch obstruktiver Atemwegskrankheit (Alter 48,2 ± 11 Jahre, FEV1 62,7 ± 13 % des Solls), von denen 84 ein sportmedizinisch orientiertes Trainingsprogramm
hoher Intensität auf dem Fahrradergometer absolvierten. Spiroergometrisch wurde die
anaerobe Schwelle (AT) bestimmt und daraus die Trainingsbelastung abgeleitet (AT +
40 % der Differenz zur Maximalleistung). Angestrebt wurden im Verlauf von 4 Wochen
minimal 22 Trainingseinheiten à 40 Minuten. Bei vergleichbarer Verbesserung der Lungenfunktion
durch Optimierung der Medikation und Physiotherapie fand sich nur für die Trainingsgruppe
eine statistisch signifikante Verbesserung der maximalen Leistungsfähigkeit (VO2
max Zunahme um 286,4 vs. 72,4 ml im Kontrollkollektiv, maximale Wattleistung verbessert
um 20,0 vs. 5,7 Watt), der Ausdauerleistungsfähigkeit (AT verbessert um 8,4 vs. 5,1
Watt), subjektiver und metabolischer Beanspruchung bei der Trainingsbelastung sowie
der Lebensqualität (SF-36).
Abstract
In a controlled/prospective clinical trial we examined 125 patients with moderate
COAD, 84 of which performed a high-intensity training program on cycle ergometers.
Methods: All participants (controls n = 39, training-group n = 84, age 48.7 versus 48.1 years,
FEV1 62.3 % vs. 63.1 % of predicted) were examined spiroergometrically (ramp protocol,
increment 10 W/min), the anaerobic threshold (AT) determined and a training intensity
calculated (AT + 40 % of the difference to peak exercise). Training was carried out
on cycle ergometers with 5 training units weekly at 40 minutes each. We aimed at a
minimum of 22 training units during 4 weeks. Results: Both groups improved in the lung function at rest (FEV1 + 11 % versus + 12 % in the controls). Only for the training group we found a statistically
significant improvement in maximum exercise capacity (O2 uptake + 286.4 ml vs. + 72.4 ml, maximum workrate + 20.0 watts vs. + 5.7 W), of the
anaerobic threshold (AT improved by 8.4 watts vs. 5.1 W) as well as in the metabolic
load (lactate decreased by 1.3 mmol vs. 0.2 mmol, ventilation decreased by 3.8 l/min
vs. 2.3 l/min). In most subscales of the SF-36 questionnaire quality of living improved
more clearly in the training group, whereas the LAQ questionnaire showed no group-specific
differences and no improvement after training. Conclusion: We conclude from the result that a high intensity training program can be recommended
as a useful and low-risk component in pulmonary rehabilitation programs.
Literatur
- 1
Donner C F, Muir J F.
Selection criteria and programmes for pulmonary rehabilitation in COPD patients.
Eur Respir J.
1997;
10
744-757
- 2
Patessio A, Casaburi R, Prefaut C, Folgering H, Donner C.
Excercise training in chronic lung disease: exercise prescription.
Eur Respir Mon.
1997;
6
129-140
- 3 Hollmann W, Hettinger Th. Sportmedizin, Arbeits- und Trainingsgrundlagen. Schattauer
1990: 476-483
- 4
Gosselink R, Troosters T, Decramer M.
Exercise training in COPD patients: the basic questions.
Eur Respir J.
1997;
10
2884-2891
- 5
Casaburi R, Patessio A, Ioli F, Zanaboni S, Donner C F, Wassermann K.
Reductions in exercise lactic acidosis and ventilations as a result of exercise training
in patients with chronic obstructive lung disease.
Am Rev Resp Dis.
1991;
143
9-18
- 6
Carter R, Coast R, Idell S.
Exercise training with chronic obstructive pulmonary disease.
Medicine and Science in Sports and Exercise.
1992;
24: 3
281-291
- 7
Behnke M, Taube C, Kirsten D, Lehnigk B, Jörres R A, Magnussen H.
Long term effects of home-based exercise training in patients with severe COPD.
Am J Respir Crit Care Med.
1999;
159
A477
- 8
Baum M, Liesen H.
Sport und Immunsystem.
Dt Ärztebl.
1998;
95 [Heft 10]
A-538-541
- 9
Dickhut H.-H, Löllgen H.
Trainingsberatung für Sporttreibende.
Deutsches Ärzteblatt.
1996;
93
939-943
- 10
Borg G AV.
Psychophysical bases of perceived exertion.
Med Sci Sports Exerc.
1982;
14
377-381
- 11
Muehlig S, Petermann F.
Krankheitsspezifische Erhebungsverfahren zur Lebensqualität bei Patienten mit Asthma
und chronisch-obstruktiver Bronchitis.
Rehabilitation.
1998 Aug;
37; 3
25-28
- 12
ERS Consensus Statement .
Optimal assessment and management of chronic obstructive pulmonary disease.
Eur Respir Rev.
1996;
6: 39
270-275
- 13
Pulmonary Rehabilitation .
Joint ACCP/AACVPR Evidence-Bases Guidelines.
Chest.
1997;
112
1363-1396
- 14 Empfehlungen der Deutschen Atemwegsliga zum Sport und körperlichen Training bei
Patienten mit obstruktiven Atemwegserkrankungen. Pneumologie 2000 54: 61-67
- 15
Wijkstra P J, Van der Mark T W, Kraan J, Van Altena R, Koeter G H, Postma D S.
Long-term effects of home rehabilitation on physical performance in chronic obstructive
pulmonary disease.
Am J Respir Crit Care Med.
1996;
153
1234-1241
- 16
Wijkstra P J, Ten Vergert E M, Van Altena R, Otten V, Kraan J, Postma D S, Koeter G H.
Long term benefits of rehabilitation at home on quality of life and exercise tolerance
in patients with chronic obstructive pulmonary disease.
Thorax.
1995;
50
824-828
- 17
Clark C J, Cochrane L, Mackay E.
Low intensity peripheral muscle conditioning improves exercise tolerance and breathlessness
in COPD.
Eur Resp J.
1996 Dec; 9705;
9; 12
2590-2596
- 18
Maltais F, Le Blanc P, Simard C, Jobin J, Berube C, Bruneau J, Carrier L, Belleau R.
Skeletal muscle adaptation in patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med.
1996;
154; 2 Pt 1
442-447
- 19
Lacasse Y, Wong E, Guyatt G H, King D, Cook D J, Goldstein R S.
Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease.
Lancet.
1996 Oct 26; 9702;
348; 9035
1115-1119
- 20
Chest Editorials .
Is there really a controversy surrounding the effectiveness of respiratory rehabilitation
in COPD?.
Chest.
July 1998;
114
1
- 21 Casaburi R. Exercise Training in Chronic Obstructive Lung Disease. In Principles
and Practice of Pulmonary Rehabilitation. Saunders 1993: 204-224
- 22
Patessio A.
Exercise training in lung disease.
Eur Respir Mon.
2000;
13
90-98
- 23
Juniper E, Guyatt G, Ferrie P, Griffith L.
Measuring Quality of Life in Asthma.
Am Rev Respir Dis.
1993;
147
832-838
- 24 Bergmann K Ch. Asthma und Lebensqualität. Präv.-Rehab., Jahrgang 6 1994 4: 154-158
- 25
Donner C F, Carone M, Bertolotti G, Zotti A M.
Methods of assessment of quality of life.
European Respiratory Review.
1997;
7
67-80
- 26
Boueri F MV, Bucher-Bartelson B L, Glenn K A, Make B J.
Quality of Life Measured With a Generic Instrument (Short Form-36) Improves Following
Pulmonary Rehabilitation in Patients with COPD.
Chest.
2001;
119
77-84
Dr. med. H.-J. Lepthin
Fachklinik Aukrug der LVA Schleswig-Holstein
24611 Aukrug-Tönsheide
