Unfortunately, the assumption that patients with dyspnea should avoid exertion is still widespread. Yet precisely the opposite is true: Medical training therapy is an important part of any rehabilitation – including that of patients with pulmonary diseases.
Sports in pulmonological rehabilitation
Done properly, sporting increases endurance, strength, coordination, and agility. And these mean quality of life for patients. Both in healthy people and in those with pulmonary conditions, a combination of endurance and strength training is the best training for the body.
Increasing physical endurance is pivotal for improved quality of life. For optimum training effect, during and after rehabilitation patients should do sports at least three times a week (per unit approximately 20–30 minutes). If the patient’s stamina increases during the therapy, trainings up to a maximum of 60 minutes can be completed. Fast walking or riding the bicycle ergometer are well suited to this.
The optimal training intensity differs from patient to patient and is assessed, inter alia, based on the severity of the individual patient’s dyspnea. Even regular physical exercise at low intensity (50–60 % of maximum heart rate or wattage) reduces dyspnea in COPD patients. Nevertheless: The higher the intensity, the greater the effect. If constant intensity is aimed at during training, however, 70–85 % of the maximum heart rate should not be exceeded. Only during interval trainings may this value be higher: Here also a wattage of more than 85 % is possible. Studies show that such interval training with high stress is very effective. The decisive factor, however, is that the breaks between exercises are respected.
Initial oxygen saturation monitoring is important in endurance training – also during the training. If during exercise this decreases below 90 %, additional oxygen should be administered.
In addition to endurance training, strength training is part of pulmonological rehabilitation. Building up of muscles is important for lung patients in several ways. Dyspnea mostly results in lack of physical activity. The resulting muscle weakness is countered with strength training; dorsal and supporting structures are strengthened again. Thereby the patient’s posture is straightened, facilitating breathing as well, because upon inhalation the lung can expand more easily.
The endurance training should therefore be complemented with strength training twice to thrice a week. The training therapist instructs the patient and explains the adequate breathing technique. 8–10 muscle groups should be trained. 8–12 iterations are recommended per muscle group, to be repeated in 1–3 sets each. Once the patient copes with the exercises without major physical effort, the weight can be increased.
Breathing muscle training
The lung is a muscle – and this can be trained, too. Not only patients with chronic respiratory diseases benefit from respiratory muscle training; athletes also do. For respiratory muscle training relieves dyspnea and increases physical performance.
Here mainly inspiratory muscle training (for short: IMT) is practiced. This means that those muscles are trained that are active during inspiration. There are several methods:
- Resistive Load: In this case, inspiration is done through a device that produces resistance by means of a narrowed orifice. The lungs must therefore use more force to actually fill with air. At least 30 % of the maximum possible strength should be used for inhalation.
- Threshold Load: The initial situation is similar as in the case of resistive load, but here during inhalation resistance is built up, which increases up to a predetermined threshold. Above this threshold, the resistance remains the same.
- Normocapnic Hyperpnea: Exercise with quick inhalation and exhalation. An appropriate training device prevents the patient from hyperventilating.
By using this special equipment, both strength and endurance of the lung can be increased. The recommendation is 15-minute units twice a day, five days per week. By application of regular units, dyspnea upon exertion can be reduced, and physical performance increased significantly. The risk of being dependent on additional ventilation later decreases. People who are already dependent on an oxygen supply may even become independent of it again.
These articles might also interest you:
+ "Asthma, COPD - what is this?" - from Dr. Ralf Harun Zwick
+ "Pulmonological rehabilitation in Austria" - from Dr. Ralf Harun Zwick
+ Part 1 "What is Gender Medicine? - The Genders - from Univ. Prof. Dr. Alexandra Kautzky-Willer
+ "The Orpheus Program" - from Prim. Univ. Prof. Dr. Michael Musalek