Department of Physical Education and Sport Sciences, National and Kapodistrian University of Athens, Athens, Greece.
Eur Respir J. 2011 Oct;38(4):971-5. doi: 10.1183/09031936.00075011. Epub 2011 Jul 7.
There is strong evidence that exercise training, constituting the cornerstone of pulmonary rehabilitation, improves exercise tolerance, dyspnoea sensations, functional capacity and quality of life in patients with severe chronic obstructive pulmonary disease. However, intolerable sensations of breathlessness and/or peripheral muscle discomfort may prevent such patients from tolerating high-intensity exercise levels for sufficiently long periods of time to obtain true physiological training effects. Accordingly, the major issue that arises is the selection of the appropriate training strategy, which is tailored to the cardiovascular, pulmonary and peripheral muscle limitations of the individual patient and is aimed at maximising the effect of exercise conditioning. Within this context, the present article explores the application of strategies that optimise exercise tolerance by reducing dyspnoea sensations, namely noninvasive mechanical ventilation, oxygen and/or heliox supplementation. Administration of heliox or oxygen during exercise also increases peripheral muscle oxygen delivery, thereby delaying the onset of peripheral muscle fatigue. Particular emphasis is also given to interval exercise and resistance-muscle training as both modalities allow the application of intense loads on peripheral muscles with tolerable levels of dyspnoea sensations. In patients with profound muscle weakness and intense breathlessness upon physical exertion, execution of short bouts of interval or local muscle strength conditioning, along with oxygen breathing, may constitute a feasible and effective approach to pulmonary rehabilitation.
有强有力的证据表明，运动训练是肺康复的基石，它可以提高严重慢性阻塞性肺疾病患者的运动耐量、呼吸困难感、功能能力和生活质量。然而，无法忍受的呼吸困难感和/或外周肌肉不适可能会阻止这些患者耐受高强度运动水平足够长的时间，以获得真正的生理训练效果。因此，出现的主要问题是选择适当的训练策略，该策略要根据个体患者的心血管、肺部和外周肌肉的限制进行定制，并旨在最大限度地提高运动适应的效果。在这种情况下，本文探讨了通过减轻呼吸困难感来优化运动耐量的策略的应用，即无创机械通气、氧和/或氦氧混合气的补充。在运动期间给予氦氧混合气或氧气也会增加外周肌肉的氧气输送，从而延迟外周肌肉疲劳的发生。本文还特别强调了间歇运动和阻力肌肉训练，因为这两种方法都可以在外周肌肉上施加可耐受的呼吸困难感水平的强烈负荷。对于那些在体力活动时出现严重肌肉无力和强烈呼吸困难的患者，进行短暂的间歇或局部肌肉力量训练，同时进行吸氧，可能是肺康复的一种可行且有效的方法。
