Adaptación a un esquema de entrenamiento físico en pacientes con enfermedad pulmonar obstructiva crónica avanzada / Adaptation to a physical training protocol of severe chronic obstructive pulmonary disease patients

El ejercicio físico es un elemento básico en la rehabilitación en pacientes con EPOC. Sin embargo, los resultados son variables, lo que puede deberse a las diferentes estrategias de entrenamiento utilizadas. En 22 pacientes con EPOC avanzada (VEF, 35,6 ñ 15,7 por ciento: edad 63 ñ 15 años; x ñ DS) Evaluamos su adaptación a un esquema de entrenamiento (E) en bicicleta ergométrica que consistió en aplicar inicialmente una carga inicial de 30 por ciento de la máxima previamente determinada (CM) y aumentarla en 15 a 20 por ciento en las sesiones siguientes cuando el paciente era capaz de mantenerla por 45 minutos, hasta alcanzar la meta de 75 por ciento de la CM. La intensidad del E se midió en watts calculando el área bajo la curva de la relación entre las cargas aplicadas y el número de sesiones de entrenamiento. El efecto del E se evaluó a través de los cambios en la carga y el VO2 máximos, la duración de un ejercicio submáximo, la frecuencia cardíaca, (FC), disnea, fatiga de las extremidades inferiores y lactato sanguíneo para una misma carga y tiempo de ejercicio. La CM de E fue 61 ñ 23 por ciento (x ñ DS) del máximo. Seis pacientes no fueron capaces de alcanzar la carga establecida como meta. En los restantes ésta se alcanzó en un número variable de sesiones (12 ñ 7). La intensidad del entrenamiento fue de 952 ñ 325 watt. El E produjo un aumento de la CM (p<0,02) y del tiempo de ejercicio (p<0,0001) y una disminución significativa de la FC, disnea, fatigabilidad y lactato sanguíneo. La duración del ejercicio se correlacionó con la reducción de la disnea (r= -0,448; p<0,05) y la intensidad del entrenamiento con la disminución de la fatiga (r= -0,5176; p = 0,014) y también del lactato sanguíneo (r= -0,488; p = 0,021). Los resultados demuestran que aún cuando la adaptación al esquema de entrenamiento fue variable de acuerdo a la capacidad individual y no pudo ser aplicada a todos los pacientes, la mayoría de ellos obtuvo efectos beneficiosos

Calidad de vida en pacientes con enfermedad pulmonar obstructiva crónica e impacto del entrenamiento físico / Quality of life in patients with chronic pulmonary obstructive disease and the impact of physical training

Background: Health related quality of life (QoL) is severely impaired in COPD patients as a consequence of dyspnea and limited exercise tolerance, which lead to physical deconditioning and muscle atrophy resulting in weakness and fatigue. Psychosocial factors such as depression and anxiety also contribute to this impairment. Aim: To evaluate: a) the impact of COPD on quality of life, and b) the effect of 10 weeks of exercise training on exercise performance and on QoL. Patients and methods: The Spanish version of the Chronic Respiratory Questionnaire (CRQ) was applied to 55 COPD patients (FEV1 37 ñ 13 percent pred) for the assessment of QoL and in 30 of them submitted to exercise training for 10 weeks. Exercise performance was evaluated by measuring: six-minute walking distance, maximal workload (Wmax), maximal O2 consumption (VO2max) as well as endurance time, blood lactic acid, dyspnea and leg fatigue during a submaximal exercise. Trained patients were evaluated before and after training. Results : COPD patients showed a reduction (mean ñ SD) in the four domains of the CRQ: dyspnea (3.1 ñ 0.9); fatigue (4.3 ñ 1.3); mastery (4.65 ñ 1.3), emotional function (4.1 ñ 0.97), and in Wmax and VO2max (52 ñ 16 Watt and 970 ñ 301 ml/min). No significant relationship between the impairment in exercise tolerance and in QoL was observed. Exercise training significantly improved the four domains of QoL (p < 0.0001), Wmax (p < 0.05), VO2max (p < 0.02) and endurance time (p < 0.001). Isotime exercise measurements of dyspnea, leg fatigue and lactic acid decreased after training (p < 0.001, each). No significant relation between changes in QoL and changes in exercise performance were observed. Conclusions: Our results demonstrate that QoL is seriously impaired in patients with COPD and confirm: (a) the lack of relationship of QoL to the usually measured physiological parameters, and (b) the beneficial effect of exercise training on QoL through the reduction of symptoms. These findings stresses the need of measuring quality of life in our patients if we want to evaluate the impact of therapeutic procedures on well-being from the patients' perspective

Entrenamiento selectivo de los músculos respiratorios en pacientes con insuficiencia cardíaca crónica / Selective training of respiratory muscles in patients with chronic heart failure

Background: Patients with chronic heart failure have a lower inspiratory muscle strength and fatigue endurance. Aim: To assess the effects of selective training of respiratory muscles in patients with heart failure. Patients and methods : Twenty patients with stable chronic heart failure, aged 58.3 ñ 3 years with an ejection fraction of 28 ñ 9 percent, were subjected to respiratory muscle training with threshold valves. The load was fixed in 30 percent of maximal inspiratory pressure (PImax) in 11 and in 10 percent of PImax in nine. Two sessions of 15 minutes, 6 days per week, during 6 weeks were done. Degree of dyspnea (Mahler score), maximal oxygen uptake, distance walked in 6 minutes, respiratory muscle function and left ventricular ejection fraction were measured before and after training. Results: Both training loads were associated to an improvement in dyspnea (+2.7 ñ 1.8 and +2.8 ñ 1.8 score points with 30 percent Plmax and 10 percent PImax respectively), maximal oxygen uptake (from 19 ñ 3 to 21.6 ñ 5 and from 16 ñ 5 to 18.6 ñ 7 ml/kg/min with 30 percent PImax and 10 percent PImax respectively, p< 0.05), PImax (from 78 ñ 22 to 99 ñ 22 and from 72 ñ 34 to 82.3 cm H20 with 30 percent Plmax and 10 percent PImax respectively), sustained PImax (from 63 ñ 18 to 90 ñ 22 and from 58 ñ 3 to 69 ñ 3 cm H20 with 30 percent PImax and 10 percent PImax respectively), and maximal sustained load (from 120 ñ 67 to 195 ñ 47 and from 139 ñ 120 to 192 ñ 154 g with 30 percent PImax and 10 percent PImax respectively). The distance walked in 6 min only increased in subjects trained at 30 percent PImax (from 451 ñ 78 to 486 ñ 68 m). Conclusions: Selective training of respiratory muscles results in a functional improvement of patients with chronic heart failure

Potencia de los músculos inspiratorios en insuficiencia cardíaca crónica y en enfermedad pulmonar obstructiva crónica / Respiratory muscle power output in patients with chronic heart failure and patients with chronic pulmonary obstructive disease

Background: The maximal pressure generated by inspiratory muscles (PIMax) is an index of their strength which is diminished in both chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). Although inspiratory muscle power output (IMPO), which includes both strength and velocity of shortening, has been shown to be reduced in COPD, there is no information regarding IMPO in CHF. Aim: To measure Impo in patients with CHF and COPD. Patients and methods: We studied 9 CHF patients with functional capacity II and III and 9 patients with severe COPD. Eight normal subjects of similar ages were included as controls. Power output was measured using the incremental threshold loading test. Results: Maximal IMPO was significantly reduced in both groups of patients. Power output developed with each increasing load was also diminished, basically as a consequence of a reduction in insp. The degree of dyspnea at the end of the test was greater in COPD than in CHF patients and normal subjects. For a given level of power, dyspnea was also greater in patients than in normals subjects. There was no decrease in SpO2 during the test. Conclusions: IMPO is equally reduced in COPD and CHF patients. Power output is better related to dyspnea than PIMax, probably because of the inclusion of shortening velocity

Efecto del entrenamiento muscular inspiratorio en el costo de oxígeno de la ventilación en pacientes con enfermedad pulmonar obstructiva crónica / Effects of inspiratory muscle training on the oxygen cost of breathing in patients with chronic obstructive pulmonary disease

Background: Patients with chronic obstructive pulmonary disease have an increased inspiratory work, since they must overcome high loads due to increased airway resistance. Aim: To determine if the reduction in the metabolic cost of exercise observed in patients with chronic obstructive pulmonary disease (COPD) after inspiratory muscle training, was due to a reduction in the oxygen cost of breathing. Patients and methods: Nine patients with COPD (FEV1 39 ñ 13 percent) subjected to inspiratory muscle training, using a training load of 30 percent of maximal inspiratory pressure, during 10 weeks; 5 patients with COPD (FEV1 44 ñ 18 percent) not subjected to training, and 7 healthy controls (FEV1 110 ñ 10 percent) were studied. The cost of breathing was calculated as the difference in VO2 measured at rest and after breathing a gas mixture containing air and 5 percent CO2. Exercise VO2 was measured at submaximal exercise. Results: Oxygen cost of breathing was increased in patients with COPD and it was inversely correlated with FEV1 (r= -0.86 p<0.001). Inspiratory muscle training increased maximal inspiratory pressure and decreased exercise VO2. Oxygen cost of breathing increased in six and decreased in three trained patients. Changes in this parameter after training did not correlate with the reduction in exercise VO2 or the increment in maximal inspiratory pressure. Conclusions: The reduction in exercise VO2 after inspiratory muscle training is not due to a reduction in the oxygen cost of breathing

Efectos clínicos del entrenamiento muscular inspiratorio en pacientes con limitación crónica del flujo aéreo / Clinical effects of inspiratory muscular training in patients with chronic airway flow limitation

The clinical role of inspiratory muscular training (IMT) in chronic obstructive pulmonary disease (COPD) has not been established, because data on its clinical effect is scarce and controversial. To further investigate these aspects we studied 20 COPD patients (FEV1 37ñ3 percent P) who were randomly and double blindy trained for 30 minutes a day during 10 weeks using a threshold inspiratory trainer with either 30 percent (group 1) or 10 percent (group 2) of PIMax as a training load. The training load was cossed after each patient completed 10 weeks of training. Effects were assessed through changes in PIMax, dyspnea through the transition dyspnea index (ITD) and the respiratory effort with Borg's score. Walking capacity was measured with the six minutes walking distance test (6WD) and depression symptoms with Beck's score. Daily life activities were also assessed. Results showed that after 10 weeks of IMT, PIMax increased in both groups (p<0.05), dyspnea improved in group 1 as compared to group 2 (p<0.04), 6WD increased significantly in group 1 disclosed a significant deterioration in PIMax whereas group 2 disclosed significant improvements in PIMax, dyspnea and 6WD. We conclude that IMT using a threshold device with 30 percent PIMax is a useful procedure for the treatment of severe COPD patients