Abstract
An adequate analysis of the pathophysiology of the disease and of its ensuing type
and degree of limitations is essential for evaluating the abilities for physical performance
in patients with pulmonary diseases. Maximal exercise testing is an indispensable
diagnostic tool in this respect. In light of moderate obstructive disease (FEV1 >
approximately 60% pred), the exercise limitation comes from the cardio-circulatory
system and/or peripheral muscle function. A rehabilitation program for these patients
can be based on endurance training at high heart rate levels. Patients with a ventilatory
limitation (FEV1 <40%-60% pred.) show a failure of the respiratory pump, resulting
in hypercapnia during exercise. Rehabilitation treatment will contain ergonomics,
exercises for mobility and agility, breathing exercises with low-frequency breathing,
relaxation exercises, and inspiratory muscle training. An oxygen-uptake limitation
can be found in patients with a diffusion problem, severe ventilation-perfusion mismatch,
or a reduced contact time between blood and alveolar gas. Such problems can often
be seen in emphysema, and express themselves as isolated hypoxaemia during exercise.
These patients benefit from a program consisting of ergonomics, exercises for mobilising
the thoracic wall, low-frequency breathing, and exercising with additional oxygen.
Many patients with chronic obstructive pulmonary disease (COPD) are limited for psychosocial
reasons. The dyspnea is a negatively rewarding side effect of exercise in these patients.
They tend to avoid all exertion, and thus get into a vicious circle of inactivity,
low fitness, and unpleasant sensations during exercise. The inactivity often is also
induced by the patient's family, since a ‘patient-role’ requires a quiet lifestyle.
Key words
Obstructive lung disease - exercise - exercise testing - pulmonary rehabilitation
