Cox N J, van Herwaarden C L, Folgering H, Binkhorst R A
Department of Pulmonary Diseases, University of Nymegen, Medical Centre Dekkerswald, Groesbeek, The Netherlands.
Sports Med. 1988 Sep;6(3):180-92. doi: 10.2165/00007256-198806030-00005.
Exercise protocols and training are used more and more in diagnostic procedures and as a tool in improving physical, social and psychological functioning in chronic obstructive lung disease patients. Before starting a training programme in chronic obstructive lung disease patients, one should exclude ventilatory-limited patients from the group. A maximal ergometer test with arterial blood samples or pulse oximetry must be performed. In mild forms of chronic obstructive lung disease with no ventilatory insufficiency demonstrable with exercise testing, the patient can be trained with no restrictions. Endurance training is permitted. It should be noted that it is possible to train the muscular and cardiovascular system up to a new, possible ventilatory maximum. In severe chronic obstructive lung disease endurance training is accompanied by hypoxia, with an associated risk of rhythm disturbances and right heart failure. Training with supplemental oxygen can reduce this risk, but should be done only under close medical supervision. In very severe chronic obstructive lung disease, when endurance training is only marginally possible even with supplemental oxygen, suppleness, coordination and relaxation exercises should be emphasised in rehabilitation programmes. Postural exercises and breathing control exercises can also give great subjective improvements in this often very disabled group of patients. Furthermore they can reduce fear and panic when dyspnoea occurs. Training of the respiratory muscles in patients with chronic obstructive lung disease must be regarded as an experimental therapy. The clinical importance remains uncertain. Exercise-induced bronchoconstriction should not limit exercises or training, provided it is treated correctly.
运动方案和训练在诊断程序中越来越多地被使用，并作为改善慢性阻塞性肺疾病患者身体、社交和心理功能的一种工具。在对慢性阻塞性肺疾病患者开始训练计划之前，应将通气受限的患者排除在该组之外。必须进行带有动脉血样本或脉搏血氧饱和度测定的最大测力计测试。在轻度慢性阻塞性肺疾病且运动测试未显示通气不足的情况下，患者可以不受限制地进行训练。耐力训练是允许的。应当注意，可以将肌肉和心血管系统训练到一个新的、可能的通气最大值。在严重慢性阻塞性肺疾病中，耐力训练会伴有缺氧，存在心律失常和右心衰竭的相关风险。补充氧气进行训练可以降低这种风险，但应仅在密切的医疗监督下进行。在非常严重的慢性阻塞性肺疾病中，即使使用补充氧气耐力训练也只能勉强进行时，康复计划中应强调柔韧性、协调性和放松练习。姿势练习和呼吸控制练习也可以使这类通常严重残疾的患者在主观上有很大改善。此外，它们可以减少呼吸困难发作时的恐惧和恐慌。对慢性阻塞性肺疾病患者进行呼吸肌训练必须被视为一种实验性疗法。其临床重要性仍不确定。只要治疗正确，运动诱发的支气管收缩不应限制运动或训练。
