摘要
肺康复方案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、生活质量和生存能力。最近,精心设计的研究调查并证实了综合肺部康复方案的效果,包括运动训练、呼吸练习、最佳医疗、社会心理支持和健康教育。在本综述中,运动训练在临床实践中对肺康复效果的贡献是通过六个基本问题来讨论的。这些包括:1)锻炼训练的重要性;2)最适运动训练强度;3)制定培训模式;4)运动训练与药物、营养或氧气结合的效果;如何保持培训效果;康复方案应该在哪里实施:住院、门诊还是家庭护理?首先,运动训练已被证明是肺康复的一个重要组成部分。 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.