COPD revalidatie: minder hard trainen met meer resultaat!

Transcription

1 COPD revalidatie: minder hard trainen met meer resultaat! Dr Peter Klijn Klinisch inspanningsfysioloog Merem Behandelcentrum Heideheuvel 27 mei 2016 Outline Rationale inspanningstraining. Achtergrond studie. Resultaten. 1

2 Spierkracht (kg) Rationale inspanningstraining. Improvement of peripheral muscle function. Rationale inspanningstraining. COPD Gezond * ~ 20% ~ 10% * ~ 10% * Quadriceps Pectoralis major Latissimus dorsi Bernard et al. AJRCCM

3 (µmol/min/g) Rationale inspanningstraining. 60 CS 10 HADH Oxidatieve capaciteit 20 * 2 * * p < H COPD 0 H COPD Maltais et al. AJRCCM 1996 Achtergrond studie Cornerstone of cardiopulmonary rehabilitation. (An Official American Thoracic Society/European Respiratory Society Statement. AJRCCM 188 (8), 2013) High-intensity paradigm (Troosters et al 2010) Both low-intensity and high-intensity exercise training produce clinical benefits for patients with COPD (Ries et al., Chest 131, 2007) Optimal resistance training prescription for patients with COPD is not determined. (O Shea et al., Chest 2009) Non-responders: 1/4 to 1/3 do not improve their exercise capacity following pulmonary rehab 3

4 Achtergrond studie Overload Specificity Resistance training Progression Variation Fleck and Kraemer; Designing resistance training programs. 2004; ACSM position stand. Progression models in RT for healthy adults. Med Sci Sports Exerc 2009 Achtergrond studie Serres et al., Chest 113(4), 1998 Mador et al., Am J Respir Crit Care Med 168(1) 2003 Van t Hul et al., Muscle Nerve 29(2) 2004 Janaudis-Ferreira et al., Respir Med 100(8) 2006 Beachle and Earle. Essentials of strength training and conditioning

5 Achtergrond studie Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise. Garber et al., Medicine & Science in Sports & Exercise. 43(7): , July Achtergrond studie N= jaar 54% Hubal et al., Variability in muscle size and strength Med Sci Sports Exerc

6 Achtergrond studie 89% De Man et al., ERJ COPD FEV 1 % < 50%, FEV 1 /VC <70% VVMi < 16 kg/m 2 male VVMi <15 kg/m 2 female N=110 Stratification VVMi 16 kg/m 2 male VVMi 15 kg/m 2 female NLPE Randomisation depleted EPR NLPE Randomisation nondepleted EPR N=33 N=34 N=22 N=21 60±7.1yr 61.3±5.8yr 61.9±5.3yr 61.3±6yr FEV 1 %pred 30.6±9.2 FEV 1 %pred 32.7±9.7 FEV 1 %pred 34.6±9 FEV 1 %pred 31.2±9 FFMi (kg/m 2 ) 13.7±1.0 FFMi (kg/m 2 ) 13.9±1.0 FFMi (kg/m 2 ) 18.1±1.6 FFMi (kg/m 2 ) 17.4±1.6 6

7 Measurements Exercise training Constant Work rate Test (CWT) 75% peak work rate (CPET) Maximaal 20 min Quality of life Chronic Respiratory Questionnaire Isotonic 1-RM strength Leg press Leg extension, pull down, chest press Bio-impedance analysis Fat Free Mass 3-times/wk 10 weeks Mon Wed - Fri min/session Supervised training Needs analysis An assessment of factors that determine the specific training program appropriate for an individual. Physiological requirements Biomechanical requirements Individual deficiencies 7

8 Principle of orderly recruitment Type IIx Type IIa Type I Cerny & Burton. Exercise physiology for health care professionals Endurance and Progressive Resistance training Treadmill walking 60% 6MWT speed, 10 min Progression: week 12, 15 min, 75% 6MWT speed Cycle ergometer 30% W peak first week Progression: week 12, 20-24min, 70-80% W peak Borg AH 4: intensity increase Borg AH 5-6: intensity unchanged Borg AH 7 intensity decrease leg press, leg extension, chest press, pull down, first week: 2 series, [8-10] repetitions, 50%1-RM Progression: 3 series, 60- >70% 1-RM Bernard et al. Am. J. Respir. Crit. Care Med. 159(3) 1999 Spruit et at., Eur.Respir. J. 19(6) Ortega et al. Am. J. Respir. Crit. Care Med. 166(5) 2002 Mador et al. Chest 125(6) Maltais et al. Am. J. Respir. Crit. Care Med. 155(3)

9 Cycle endurance (seconds) Cycle endurance (seconds) Resultaten EPR-depleted NLPE-depleted Baseline 6 w eeks 12 w eeks Measurement Baseline Measurement EPR-nondepleted NLPE-nondepleted 12 weeks CWT EPR (n=55) NLPE (n=55) Difference (95% CI) Time, s +238 s +539 s 300.6( ) End Sp O ,5 ( ) dyspneu 6,4 5,5-0,9 (-1,6 - -0,1) leg fatigue ( ) 9

10 Resultaten CWT Depleted patients EPR (n=34) NLPE (n=33) CWT Non-depleted patients EPR (n=21) NLPE (n=22) First training period 15% (n=5) Second training period 25% (n=7) 42% (n=14) 52% (n=16) End of training 24% (n=5) 64% (n=14) CRQ-score EPR (n-55) NLPE (n=55) Difference (95%CI) dyspnea ( ) fatigue ( ) emotions ( ) mastery ( ) Resultaten Niet-lineair Traditioneel 10

11 Resultaten EPR NLPE 95% BI Leg press ( ) Leg extension ( ) Pull down ( ) Chest press ( ) VVMi (kgvvm)/m ( ) * BMI (kg/m 2 ) ( ) Resultaten 11

12 Training smart! Take home message 12