RT Journal Article
SR Electronic
T1 Strategies of muscle training in very severe COPD patients
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 971
OP 975
DO 10.1183/09031936.00075011
VO 38
IS 4
A1 I. Vogiatzis
YR 2011
UL http://erj.ersjournals.com/content/38/4/971.abstract
AB There is strong evidence that exercise training, constituting the cornerstone of pulmonary rehabilitation, improves exercise tolerance, dyspnoea sensations, functional capacity and quality of life in patients with severe chronic obstructive pulmonary disease. However, intolerable sensations of breathlessness and/or peripheral muscle discomfort may prevent such patients from tolerating high-intensity exercise levels for sufficiently long periods of time to obtain true physiological training effects. Accordingly, the major issue that arises is the selection of the appropriate training strategy, which is tailored to the cardiovascular, pulmonary and peripheral muscle limitations of the individual patient and is aimed at maximising the effect of exercise conditioning. Within this context, the present article explores the application of strategies that optimise exercise tolerance by reducing dyspnoea sensations, namely noninvasive mechanical ventilation, oxygen and/or heliox supplementation. Administration of heliox or oxygen during exercise also increases peripheral muscle oxygen delivery, thereby delaying the onset of peripheral muscle fatigue. Particular emphasis is also given to interval exercise and resistance-muscle training as both modalities allow the application of intense loads on peripheral muscles with tolerable levels of dyspnoea sensations. In patients with profound muscle weakness and intense breathlessness upon physical exertion, execution of short bouts of interval or local muscle strength conditioning, along with oxygen breathing, may constitute a feasible and effective approach to pulmonary rehabilitation.