Nutzen eines intensiven Trainingsprogrammes bei Patienten mit obstruktiver Atemwegskrankheit

Zusammenfassung

In einer kontrollierten/prospektiven klinischen Studie untersuchten wir 125 Patienten mit chronisch obstruktiver Atemwegskrankheit (Alter 48,2 ± 11 Jahre, FEV₁ 62,7 ± 13 % des Solls), von denen 84 ein sportmedizinisch orientiertes Trainingsprogramm hoher Intensität auf dem Fahrradergometer absolvierten. Spiroergometrisch wurde die anaerobe Schwelle (AT) bestimmt und daraus die Trainingsbelastung abgeleitet (AT + 40 % der Differenz zur Maximalleistung). Angestrebt wurden im Verlauf von 4 Wochen minimal 22 Trainingseinheiten à 40 Minuten. Bei vergleichbarer Verbesserung der Lungenfunktion durch Optimierung der Medikation und Physiotherapie fand sich nur für die Trainingsgruppe eine statistisch signifikante Verbesserung der maximalen Leistungsfähigkeit (VO_{2 max} Zunahme um 286,4 vs. 72,4 ml im Kontrollkollektiv, maximale Wattleistung verbessert um 20,0 vs. 5,7 Watt), der Ausdauerleistungsfähigkeit (AT verbessert um 8,4 vs. 5,1 Watt), subjektiver und metabolischer Beanspruchung bei der Trainingsbelastung sowie der Lebensqualität (SF-36).

Abstract

In a controlled/prospective clinical trial we examined 125 patients with moderate COAD, 84 of which performed a high-intensity training program on cycle ergometers. Methods: All participants (controls n = 39, training-group n = 84, age 48.7 versus 48.1 years, FEV₁ 62.3 % vs. 63.1 % of predicted) were examined spiroergometrically (ramp protocol, increment 10 W/min), the anaerobic threshold (AT) determined and a training intensity calculated (AT + 40 % of the difference to peak exercise). Training was carried out on cycle ergometers with 5 training units weekly at 40 minutes each. We aimed at a minimum of 22 training units during 4 weeks. Results: Both groups improved in the lung function at rest (FEV₁ + 11 % versus + 12 % in the controls). Only for the training group we found a statistically significant improvement in maximum exercise capacity (O₂ uptake + 286.4 ml vs. + 72.4 ml, maximum workrate + 20.0 watts vs. + 5.7 W), of the anaerobic threshold (AT improved by 8.4 watts vs. 5.1 W) as well as in the metabolic load (lactate decreased by 1.3 mmol vs. 0.2 mmol, ventilation decreased by 3.8 l/min vs. 2.3 l/min). In most subscales of the SF-36 questionnaire quality of living improved more clearly in the training group, whereas the LAQ questionnaire showed no group-specific differences and no improvement after training. Conclusion: We conclude from the result that a high intensity training program can be recommended as a useful and low-risk component in pulmonary rehabilitation programs.

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