EXERCISE LIMITATIONS IN PATIENTS WITH PULMONARY-DISEASES

An adequate analysis of the pathophysiology of the disease and of its ensuing type and degree of limitations is essential for evaluating the abilities for physical performance in patients with pulmonary disease s. Maximal exercise testing is an indispensable diagnostic tool in thi s respect. In light of moderate obstructive disease (FEV1 >approximate ly 60% pred), the exercise limitation comes from the cardio-circulator y system and/or peripheral muscle function. A rehabilitation program f or these patients can be based on endurance training at high heart rat e levels. Patients with a ventilatory limitation (FEV1<40%-60% pred.) show a failure of the respiratory pump, resulting in hypercapnia durin g exercise. Rehabilitation treatment will contain ergonomics, exercise s for mobility and agility, breathing exercises with low-frequency bre athing, relaxation exercises, and inspiratory muscle training. An oxyg en-uptake limitation can be found in patients with a diffusion problem , severe ventilation-perfusion mismatch, or a reduced contact time bet ween blood and alveolar gas. Such problems can often be seen in emphys ema, and express themselves as isolated hypoxaemia during exercise. Th ese patients benefit from a program consisting of ergonomics, exercise s for mobilising the thoracic wall, low-frequency breathing, and exerc ising with additional oxygen. Many patients with chronic obstructive p ulmonary disease (COPD) are limited for psychosocial reasons. The dysp nea is a negatively rewarding side effect of exercise in these patient s. They tend to avoid all exertion, and thus get into a vicious circle of inactivity, low fitness, and unpleasant sensations during exercise . The inactivity often is also induced by the patient's family, since a 'patient-role' requires a quiet lifestyle.