Wijkstra P J, van der Mark T W, Kraan J, van Altena R, Koëter G H, Postma D S
Asthma Centre Beatrixoord, Haren, Netherlands.
Eur Respir J. 1996 Jan;9(1):104-10. doi: 10.1183/09031936.96.09010104.
We investigated whether 12 weeks of rehabilitation at home in patients with chronic obstructive pulmonary disease (COPD) had a beneficial effect on lactate production, metabolic gas exchange data, workload of the inspiratory muscles, and dyspnoea during a maximal bicycle ergometer test. A second aim was to assess whether a change in dyspnoea was related to a change of inspiratory muscle workload. Forty three COPD patients with severe airways obstruction were included in the study: mean forced expiratory volume in one second (FEV1) 1.3 +/- 0.4 L (44% predicted), mean FEV1/inspiratory vital capacity (IVC) 37 +/- 8%. Twenty eight patients started a rehabilitation programme, whilst 15 patients received no rehabilitation. Rehabilitation was carried out at home; patients were supervised by a general practitioner, a physiotherapist and a nurse. Exercise tolerance was measured by means of a 6 min walking distance test (6MWD) and maximal workload (Wmax) during an incremental symptom-limited cycle ergometer test. Inspiratory muscle workload at Wmax was assessed with the Tension Time Index (TTI), and dyspnoea at Wmax with the Borg scale. After 12 weeks, the rehabilitation group showed a significantly larger increase in 6MWD (from 438 to 447 m) and in Wmax (from 70 to 78 W) compared with the control group. A significant improvement in oxygen consumption (V1O2) (from 1.0 to 1.1 L), lactate level (from 3.7 to 3.1 mEq.L(-1)), dyspnoea (from 6.0 to 4.5) and TTI (from 0.10 to 0.08) at Wmax occurred in the rehabilitation group during the programme. The reduction in TTI was not significantly correlated with the fall in dyspnoea, as assessed by the Borg scale. We conclude that 12 weeks of rehabilitation at home in COPD patients increases symptom-limited V1O2 in combination with an increased Wmax. At this significantly higher Wmax, there was a reduction in dyspnoea, lactate level and inspiratory muscle workload. The reduction in dyspnoea was not related to a decreased inspiratory muscle workload. This study shows that rehabilitation at home can produce beneficial physiological improvements during exercise in patients with chronic obstructive pulmonary disease.
我们调查了慢性阻塞性肺疾病（COPD）患者在家中进行12周康复训练是否对乳酸生成、代谢气体交换数据、吸气肌工作量以及在最大运动强度自行车测力计测试中的呼吸困难情况产生有益影响。第二个目的是评估呼吸困难的变化是否与吸气肌工作量的变化相关。43例患有严重气道阻塞的COPD患者纳入研究：一秒用力呼气容积（FEV1）平均值为1.3±0.4L（预计值的44%），FEV1/吸气肺活量（IVC）平均值为37±8%。28例患者开始康复计划，15例患者未接受康复治疗。康复在家中进行；患者由全科医生、物理治疗师和护士监督。运动耐力通过6分钟步行距离测试（6MWD）和递增症状限制的自行车测力计测试中的最大工作量（Wmax）来测量。在Wmax时的吸气肌工作量用张力时间指数（TTI）评估，Wmax时的呼吸困难用Borg量表评估。12周后，与对照组相比，康复组的6MWD（从438米增加到447米）和Wmax（从70瓦增加到78瓦）显著增加。在康复计划期间，康复组在Wmax时的耗氧量（V1O2）（从1.0升增加到1.1升）、乳酸水平（从3.7毫当量·升⁻¹降至3.1毫当量·升⁻¹）、呼吸困难（从6.0降至4.5）和TTI（从0.10降至0.08）有显著改善。根据Borg量表评估，TTI的降低与呼吸困难的减轻无显著相关性。我们得出结论，COPD患者在家中进行12周康复训练可增加症状限制下的V1O2，并同时增加Wmax。在这个显著更高的Wmax时，呼吸困难、乳酸水平和吸气肌工作量降低。呼吸困难的减轻与吸气肌工作量的减少无关。这项研究表明，在家中进行康复训练可使慢性阻塞性肺疾病患者在运动期间产生有益的生理改善。
