This study was designed to examine the reproducibility and the learning effects of incremental maximal cycle ergometer testing in patients with obstructive lung diseases who are untrained and have never done such a test before. Eleven patients were studied on 2 consecutive days with an interval of 24 h. The reproducibility (expressed in relative duplicate error) of most of the parameters tested was good: workload (watt) 4.5%, maximal oxygen consumption (VO2max 3.5%, gas exchange ratio (R) 3.4%, and heart rate 3.7%. Moderate reproducibility was found in maximal ventilation (VEmax) 6.6%, carbon dioxide production (VCO2max 6.0%, and respiration frequency (RF) 8.3%. The reproducibility of the time between the start of the test and the minimum value of VE/VO2 and VE/VCO2 was low. We concluded that in these patients the results of incremental cycle ergometer testing showed good reproducibility in a test-retest procedure. There were no learning effects.

No abstract

The effects of a pulmonary rehabilitation program on 44 patients with chronic obstructive pulmonary disease (COPD) were compared to a control group. The treated group was admitted to the program for a period of three months. The program consisted of several parts, such as physical training, health education, and psychological and social matters. Before participation, the patients were thoroughly examined and provided with optimal medical treatment. Both groups were assessed by means of biometrical tests and questionnaires for a period of 2 years. The rehabilitation group improved significantly in endurance, psychological parameters, and consumption of medical care. Working days increased and their way of life became more active. Smoking habits and body fat percentage decreased. Bronchial hyperreactivity, need for pulmonary drugs, and coughing and sputum production did not improve in the rehabilitation group compared to the control group. Airway obstruction, expressed as forced expiratory volume in one second, and complaints of dyspnea, allergy and hyperreactivity scores on questionnaires improved only in the short term (< 1 year), but did not improve significantly in the long term. This study shows that pulmonary rehabilitation can result in improvements in patients with asthma or COPD who have many complaints despite the fact that their pulmonary function is not severely disturbed.

No abstract

Exercise protocols and training are used more and more in diagnostic procedures and as a tool in improving physical, social and psychological functioning in chronic obstructive lung disease patients. Before starting a training programme in chronic obstructive lung disease patients, one should exclude ventilatory-limited patients from the group. A maximal ergometer test with arterial blood samples or pulse oximetry must be performed. In mild forms of chronic obstructive lung disease with no ventilatory insufficiency demonstrable with exercise testing, the patient can be trained with no restrictions. Endurance training is permitted. It should be noted that it is possible to train the muscular and cardiovascular system up to a new, possible ventilatory maximum. In severe chronic obstructive lung disease endurance training is accompanied by hypoxia, with an associated risk of rhythm disturbances and right heart failure. Training with supplemental oxygen can reduce this risk, but should be done only under close medical supervision. In very severe chronic obstructive lung disease, when endurance training is only marginally possible even with supplemental oxygen, suppleness, coordination and relaxation exercises should be emphasised in rehabilitation programmes. Postural exercises and breathing control exercises can also give great subjective improvements in this often very disabled group of patients. Furthermore they can reduce fear and panic when dyspnoea occurs. Training of the respiratory muscles in patients with chronic obstructive lung disease must be regarded as an experimental therapy. The clinical importance remains uncertain. Exercise-induced bronchoconstriction should not limit exercises or training, provided it is treated correctly.