Murphy Niamh, Bell Christopher, Costello Richard W
Department of Medicine, Royal College of Surgeons in Ireland, Smurfit Building, Beaumont Hospial, Dublin, Ireland.
Respir Med. 2005 Oct;99(10):1297-302. doi: 10.1016/j.rmed.2005.02.033. Epub 2005 Mar 31.
The principals of rehabilitation medicine are to prevent muscle atrophy and improve mobility. Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with muscle atrophy and yet many patients do not undergo pulmonary rehabilitation until they have been in stable health for some time. We investigated the outcome of a supervised home exercise programme initiated immediately after hospitalisation for an exacerbation of COPD. Thirty-one patients were randomised into an exercise group (n=16, FEV(1) 0.94+/-0.34 L) and a control group (n=15, FEV(1) 1.08+/-0.33 L). The exercise group received a twice-weekly supervised exercise programme, in their homes, for 6 weeks. Spirometry, exercise capacity, isometric muscle strength, dyspnea level, quality of life at baseline and 6 weeks as well as subsequent exacerbations were quantified. At 6 weeks, the exercise group, improved the shuttle walk test (198 m+/-95-304+/-136 m) and increased 3 min step test capacity (119+/-40-163+/-26s) (both P<0.001). Knee extensor muscle strength and quality of life scores also increased. Neither exercise capacity nor muscle strength altered in the control group. Follow-up at 3 months showed that three of the control group and none of the exercise group had experienced subsequent exacerbations (P=0.06). Early rehabilitation via a home from hospital programme improved exercise tolerance, muscle strength, dyspnea scores, quality of life in COPD patients and reduced the number of subsequent exacerbations.
康复医学的原则是预防肌肉萎缩并改善活动能力。慢性阻塞性肺疾病（COPD）的急性加重与肌肉萎缩相关，但许多患者直到病情稳定一段时间后才接受肺康复治疗。我们调查了COPD急性加重住院后立即启动的一项有监督的家庭锻炼计划的效果。31名患者被随机分为运动组（n = 16，第一秒用力呼气容积[FEV(1)]为0.94±0.34升）和对照组（n = 15，FEV(1)为1.08±0.33升）。运动组在其家中接受每周两次的有监督的锻炼计划，为期6周。对肺活量测定、运动能力、等长肌肉力量、呼吸困难程度、基线和6周时的生活质量以及随后的急性加重情况进行了量化。6周时，运动组的往返步行试验得到改善（198米±95 - 304米±136米），3分钟阶梯试验能力增加（119秒±40 - 163秒±26秒）（均P<0.001）。膝关节伸肌力量和生活质量评分也有所提高。对照组的运动能力和肌肉力量均未改变。3个月的随访显示，对照组有3人经历了随后的急性加重，而运动组无人经历（P = 0.06）。通过出院后在家中进行的计划进行早期康复，可改善COPD患者的运动耐量、肌肉力量、呼吸困难评分、生活质量，并减少随后急性加重的次数。
