Adaptación a un esquema de entrenamiento físico en pacientes con enfermedad pulmonar obstructiva crónica avanzada

Abstract

Exercise training is an important component of pulmonary rehabilitation in COPD. Clinical studies show highly variable results, probably due to the use of different training strategies. Our aim was to evaluate the adaptation of 22 severe COPD patients (FEV1: 36 ± 16% Pred; 63 ± 15 years of age; x ± SD) to a training protocol: a) Target load 75% of maximal workload (WRmax), b) an initial load of 30% WRmax and c) 15 to 20% increments of the load at the time the patients were able to sustain the previous load for 45 min. Training intensity was calculated by measuring the area under the workload times the number of training sessions. Sixteen patients reached the target load within 12 ± 7 training sessions, whereas 6 were unable to reach it. Mean training load was 61 ± 23% of WRmax. Training intensity was 952 ± 325 watt, WRmax as well as endurance time increased with training (p < 0.02 and 0.0001 respectively). Significant reduction in heart rate (HR), dyspnea, leg fatigue, and blood lactate for the same exercise load and time were observed (p < 0.02, 0.001, 0.001 and 0.02 respectively). Asignificant negative correlation was found between endurance time and reduction in dyspnea (r = -0.48; p < 0.05). Training intensity was found to correlate with both reduction in leg fatigue (r = -0.518; p = 0.014) and blood lactate (r = -0.488; p = 0.021). Our results show that not all patients reach the target training load and that a large variability exists in the number of sessions required to reach either the maximum load or the target load. We concluded that in spite of the large variability in training intensity the majority of severe COPD patients benefit with training