İlgın SADE, Esin ŞİRİNTAŞ, Murat İNANIR, Çiğdem ÇEKMECE, İlknur BAŞYİĞİT

Kronik Obstrüktif Akciğer Hastalarında Solunum Egzersizlerinin Etkinliği

Amaç: Bu çalışmada KOAH’lı hastalarda solunum egzersizleri ile bunlara ilave aerobik egzersizlerin solunum parametreleri, aerobik kapasitesi, yaşam kalitesine ve hastanın psikolojik durumu üzerine olan etkinliğinin araştırılması amaçlandı.Yöntem: Altmış beş hasta pulmoner egzersiz, kombine egzersiz (pulmoner+aerobik egzersiz) ve kontrol grubu olmak üzere 3 gruba randomize edildi. Demografik veriler kaydedildi. Solunum fonksiyon testleri, maksimal inspirasyon basıncı (Pİmax), PEmax (maksimal ekspirasyon basıncı) ve Egzersiz Tolerans Testi (ETT) değerlendirildi. Medical Research Council (MRC) Dispne Skalası, modifiye Bruce ETT ve 6 dakika yürüme testi ile egzersiz kapasiteleri, vücut kitle indeksi (B), obstrüksiyon (O), dispne skalası (D), egzersiz kapasitesi (E) BODE indeksi, Kısa Form-36 (KF-36), Saint George Solunum Sorgulaması (SGRS) ile yaşam kalitesi parametreleri tedavi öncesi ve 8 haftalık tedavi sonrası kaydedildi.Bulgular: Tedavi sonrası pulmoner egzersiz ve kombine egzersiz grubunda 1. Saniye zorlu ekspiratuvar volüm (FEV1), FEV1/zorlu vital kapasite (FVC), Pİmax, PEmax; kombine egzersiz grubunda FVC, vital kapasite (VK) değerlerinde istatistiksel olarak anlamlı artış tespit edildi (tüm parametreler için p<0,05). Her iki egzersiz grubunda MRC dispne skalası, Metabolik eşdeğer MET değerleri, SGRS ve KF-36 bazı parametrelerinde istatistiksel olarak anlamlı fark gözlendi (tüm parametreler için p<0,05). Kontrol grubunda incelenen parametrelerin hiçbirinde anlamlı gözlenmedi. Tedavi sonrası parametrelerde pulmoner ve kombine egzersiz grubu arasında fark saptanmadı (p>0,05).Sonuç: Solunum ve kombine (solunum+ aeorobik) egzersiz uygulamalarının KOAH’lı hastalarda egzersiz kapasitesi, dispne ve yaşam kalitesini anlamlı şekilde artırdığı saptanmıştır.

Anahtar Kelimeler:

Pulmoner rehabilitasyon, Egzersiz, Dispne, Kronik Obstrüktif Akciğer Hastalığı

Efficacy of Pulmonary Exercises in Chronic Obstructive Pulmonary Disease

Objective: The aim of this study was to determine the effectiveness of pulmonary rehabilitation on respiratory parameters, aerobic exercise capacity, quality of life and psychological status of the patients with chronic obstructive pulmonary disease (COPD). The addition of aerobic exercise on pulmonary exercises was also evaluated to provide further improvements on these parameters. Methods: Sixty-five patients were randomly assigned to carry out pulmonary exercise, combined (respiratory plus aerobics) and, a control groups. Demographic characteristics were noted. Respiratory function tests, maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax) values and, exercise tolerance test (ETT) were assessed. Medical Research Council (MRC) dyspnea scale, body mass index (B), airway obstruction (O), dyspnea scale (D), exersice capacity (E) (BODE) index, Short Form 36 (SF-36), and Saint George Respiratory Questionnaire (SGRQ) obtained from each patient were recorded before the treatment, and after the 8-week treatment. Results: After the treatment significant increases were found in forced expiratory volume-one second (FEV1), FEV1/forced vital capacity (FVC) ratio, PImax, PEmax values in pulmonary and combined exercise groups, and FVC, vital capacity (VC) values in combined exercise group (p<0.05 for all parameters). Statistical differences were observed in both exercise groups regarding MRC Dyspnea score, Maksimum Equivalent Task (MET) values, SGRQ and some parameters of SF-36 (p<0.05 for all parameters). In the control group no noticeable difference was observed in any of the parameters. After treatment there was no difference between pulmonary and combined exercise group in any parameters (p<0.05). Conclusion: Both pulmonary and combined exercise programs improved exercise capacity, dyspnea, and the life quality of the COPD patients.

Keywords:

Pulmonary rehabilitation, Exercise, Dyspnea, Chronic Obstructive Pulmonary Disease,

PDF

___

Vos T, Flaxman AD, Naghavi M et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease study 2010. Lancet. 2012;380:2163-2196. doi:10.1016/s0140-6736(12)61690-0
Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 ages groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380: 2095-2128.
Corhay JL, Dang DN, Cauwenberge HV, et al. Pulmonary Rehabilitation and COPD: providing patients a good environment for optimizing therapy. Int J Chron Obstruct Pulmon Dis. 2014;9:27-39. doi:10.2147/copd.s52012
Rochester CL, Vogiatzis I, Holland AE, et al. An official American Thoracic Society/European Respiratory Society Policy Statement: Enhancing Implementation, Use, and Delivery of Pulmonary Rehabilitation. Am J Respir Crit Care Med. 2015;192:1373-1386. doi: 10.1164/rccm.201510-1966ST
Steiner MC, Morgan MDL. Enhancing physical performance in chronic obstructive pulmonary disease. Thorax. 2001;56:73-77. doi:10.1136/thorax.56.1.73
Janssens W, Corhay JL, Boagerts P, et al. How resources determine pulmonary rehabilitation programs: A survey among Belgian Chest Physicians. Chron Respir Dis. 2019;16: 1479972318767732. doi:10.1177/1479972318767732
Global Initative For Chronic Obstructive Lung Disease, Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructice Pulmonary Disease updated 2018 www.goldcopd.org. Accessed October 20, 2019.
Bestall JC, Paul EA, Garrod R, et al. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1997; 54(7):581-586. doi:10.1136/thx.54.7.581
Ware JE Jr, Snow KK, Kosinski M, et al. SF-36 health survey: manual and interpretation guide. Boston: The Health Institute, New England Medical Center; c1993.
Ferrer M, Villasante C, Alonse J, et al. Interpretation of quality of life scores the St George’s Respiratory Questionnaire. Eur Respir J. 2002; 19:405-413. doi: 10.1183/09031936.02.00213202
Koblízek V, Salajka F, Cermáková E, et al. Relationship between quality of life and BODE index of stable ex-smokers with chronic obstructive pulmonary disease. Vnitr Lek. 2009; 55(10):940-947.
An official American Thoracic Society/European Respiratory Society Policy Statement: Enhancing Implementation, Use, and Delivery of Pulmonary Rehabilitation. https://www.thoracic.org/statements/resources/copd/implem-pulm-rehab.pdf. Published 2015. doi:10.1164/rccm.201510-1966st
Rochester CL. Exercise training in Chronic Obstructive Pulmonary Disease. J Rehabil Res. Dev 2003; 40(5 Supplement 2):59–80. doi:10.1682/jrrd.2003.10.0059
Bourjeily G, Rochester CL. Exercise Training in Chronic Obstructive Pulmonary Disease. Clin Chest Med. 2000; 21:763-781. doi:10.1016/s0272-5231(05)70183-0
Stulbarg MS, Carrieri- Kohlman V, Demir- Deviren S, et al. Exercise Training Improves Outcomes of Dyspnea Self-management Program. J Cardiopulm Rehabil. 2002; 22(2):109-121. doi:10.1097/00008483-200203000-00010
Berry MJ, Rejeski WJ, Adair NE, Zaccaro D. Exercise Rehabilitation and Chronic Obstructive Pulmonary Disease Stage. Am J Respir Crit Care Med. 1999; 160:1248-1253. doi:10.1164/ajrccm.160.4.9901014
Withers NJ, Rudkin ST, White RJ. Anxiety and depression in severe Chronic Obstructive Pulmonary Disease: The effects of pulmonary rehabilitation. J Cardiopulm Rehabil. 1999; 19(6):362–365. doi:10.1097/00008483-199911000-00007
Carrieri-Kohlman V, Gormley JM, Douglas MK, Paul SM, Stulbarg MS. Exercise training decreases dyspnea and the distress and anxiety associated with it. Chest. 1996;110(6):1526–1535 doi:10.1378/chest.110.6.1526
Garuti G, Cilione C, Dell’orso D, Gorini P, Lorenzi MC, Totaro L, et al. Impact of Comprehensive Pulmonary Rehabilitation on anxiety and depression in hospitalized COPD patients. Monaldi Arch Chest Dis. 2003; 59(1):56-61.
Dheda K, Crawfard A, Hagan G, Robert C. Implementation of British Thoracic Society Guidelines for Acute Exacerbation of Obstructive Pulmonary Disease: Impact on Quality of Life. Medical Journal. 2004; 80(41):169-171. doi:10.1136/pgmj.2003.012831
Stewart DG, Drake DF, Robertson C, Marwitz JH, Kreutzer JS, Cifu DX. Benefits of an Inpatient Pulmonary Rehabilitation Program: A Prospective Analysis. Arch Phys Med Rehabil. 2001; 82(3):347-352. doi:10.1053/apmr.2001.20838
Tucker S, Canobbio M, Paquette E, Wells M. Patients Care Standarts. 7th ed. St Louis: Mosby; 2000. p. 241-250.