Gosselink R, Troosters T, Decramer M
Respiratory Rehabilitation and Respiratory Division, University Hospitals, Katholieke Universiteit Leuven, Belgium.
Eur Respir J. 1997 Dec;10(12):2884-91. doi: 10.1183/09031936.97.10122884.
Pulmonary rehabilitation programmes aim at improving exercise capacity, activities of daily living, quality of life and perhaps survival in patients with chronic obstructive pulmonary disease (COPD). Recently, well-designed studies investigated and confirmed the efficacy of comprehensive pulmonary rehabilitation programmes, including exercise training, breathing exercises, optimal medical treatment, psychosocial support and health education. In the present overview, the contribution of exercise training in clinical practice to the demonstrated effects of pulmonary rehabilitation is discussed by means of six basic questions. These include: 1) the significance of exercise training; 2) the optimal intensity for exercise training; 3) prescribing training modalities; 4) the effects of exercise training combined with medication, nutrition or oxygen; 5) how training effects should be maintained; and 6) where the rehabilitation programme should be performed: in-patient, out-patient or homecare? First, exercise training has been proven to be an essential component of pulmonary rehabilitation. Training intensity is of key importance. High-intensity training (>70% maximal workload) is feasible even in patients with more advanced COPD. In addition, the effects on peripheral muscle function and ventilatory adaptations are superior to low-intensity training. There is, however, no consensus on the optimal training modalities. Both walking and cycling improved exercise performance. Since peripheral muscle function has been recognized as an important contributor to exercise performance, specific peripheral muscle training recently gained interest. Improved submaximal exercise performance and increased quality of life were found after muscle training. The optimal training regimen (strength or endurance) and the muscle groups to be trained, remain to be determined. Training of respiratory muscles is recommended in patients with ventilatory limitation during exercise. The additional effects of anabolic-androgenic drugs, oxygen and nutrition are not well-established in COPD patients and need further research. In order to maintain training effects, close attention of the rehabilitation team is required. The continuous training frequency necessary to maintain training effects remains to be defined. At this point in time, out-patient-based programmes show the best results and guarantee the best supervision and a multidisciplinary approach. Future research should focus on the role of homecare programmes to maintain improvements.
肺康复计划旨在提高慢性阻塞性肺疾病（COPD）患者的运动能力、日常生活活动能力、生活质量，并可能改善其生存率。最近，精心设计的研究调查并证实了综合肺康复计划的有效性，该计划包括运动训练、呼吸练习、最佳药物治疗、心理社会支持和健康教育。在本综述中，通过六个基本问题讨论了临床实践中的运动训练对肺康复已证实效果的贡献。这些问题包括：1）运动训练的意义；2）运动训练的最佳强度；3）规定训练方式；4）运动训练与药物、营养或氧气联合使用的效果；5）如何维持训练效果；6）康复计划应在何处进行：住院、门诊还是居家护理？首先，运动训练已被证明是肺康复的重要组成部分。训练强度至关重要。即使是病情更严重的COPD患者，高强度训练（>70%最大工作量）也是可行的。此外，其对周围肌肉功能和通气适应的影响优于低强度训练。然而，对于最佳训练方式尚无共识。步行和骑自行车都能改善运动表现。由于周围肌肉功能已被认为是运动表现的重要影响因素，最近特定的周围肌肉训练受到关注。肌肉训练后发现次最大运动表现得到改善，生活质量提高。最佳训练方案（力量或耐力）以及需要训练的肌肉群仍有待确定。对于运动时存在通气受限的患者，建议进行呼吸肌训练。合成代谢雄激素药物、氧气和营养的额外效果在COPD患者中尚未得到充分证实，需要进一步研究。为了维持训练效果，康复团队需要密切关注。维持训练效果所需的持续训练频率仍有待确定。目前，基于门诊的计划显示出最佳效果，并能保证最佳的监督和多学科方法。未来的研究应关注居家护理计划在维持改善方面的作用。
