Effektivität eines Gleichgewichtstrainings und eines Krafttrainings auf die Leistungsfähigkeit und Lebensqualität bei COPD-Patienten im Rahmen des ambulanten Lungensports

ntroduction: Limited exercise capacity is one of the main systemic manifestations of chronic obstructive pulmonary disease (COPD) associated with poor health-related quality of life, exacerbations and increased mortality risk. Skeletal muscle mass and strength have been shown to be reduced in patients with COPD compared to age-matched healthy controls. There is also a growing evidence that individuals with COPD have important deficits in balance control that may be associated with an increased risk of falls. Exercise interventions aimed at improving skeletal mass function have the potential to improve the physical function and health-related quality of life. It has also been shown that the exercise component of conventional PR has only minimal effect on measures of balance and fall risk. Most guidelines on exercise for patients with COPD recommend a combination of endurance and strength training. However balance training and fall prevention strategies are not included. After pulmonary PR outpatient lung sports is at the moment the only possibility to keep in motion for a longer time. Therefore, in this study the effects of a strength and balance training on exercise capacity and health-related quality of life within pulmonary exercise programs were evaluated.Methods: 65 participants (65,9 ± 6,9 years) with stable COPD volunteered as subjects in this study. They were distributed into three groups (strength group – KT; balance group – GG; lung sport group – KG). Subjects received a twelve week training program with two training sessions a week. Strength and balance group performed additional workout at home. The strength group realized a lower limb resistance strength training using their own body weight and minimal resources as elastic bands or ankle weights. The balance group carried out a well structured intensive balance training on wobble boards, balance pads and uneven surfaces. The lung sport group conducted usual program as upper limb resistance training and breathing techniques. All participated in a self-management education program. Subjects were pre and post tested on parameters concerning functional exercise capacity and health-related quality of life. The primary endpoint was a change in five-time sit-to-stand (5STS).Results: The three groups were similar regarding age and FEV1(%). At post-tests, the within- group differences were in favour of the balance group on the 5STS (-1,54 ± 2,33 sec.). Between the groups no changes found. By contrast, in the six-minute-walking-distance (6MWD) significant intra-group difference was found in all groups but only the balance group reached clinical change (33,04 ± 36,26 m). Between the isometric maximal strength assessment at 24 weeks and baseline, the difference for the right (p=0,027) and left (p=0,007) leg was significant in the balance group, but not in the other groups. There was no statistical significance found between and within the groups in COPD assessment test. Significant within- group differences were found in change scores on the FAB scale, but the minimal clinical important difference ist yet not known. The SGRQ – a disease specific questionnaire – revealed a significant improvement (-7,08 ± 10,71 points in Total) in the balance group. Clinical change is achieved at a decline of four points.Conclusion: Clinically meaningful and statistically improvements in physical capabilities and health-related quality of life may be achieved using long-term pulmonary exercise programs. The result of the study especially support the effectiveness of balance training in patients with COPD.