Pneumologie 2016; 70(01): 37-48
DOI: 10.1055/s-0041-109312
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Atemmuskeltraining: State-of-the-Art

Respiratory Muscle Training: State of the Art
O. Göhl
1   Rehaklinik Heidelberg-Königstuhl, Heidelberg
,
D. J. Walker
2   II. Medizinische Klinik, Pneumologie, Kardiologie und Intensivmedizin, Klinikum Konstanz
,
S. Walterspacher
2   II. Medizinische Klinik, Pneumologie, Kardiologie und Intensivmedizin, Klinikum Konstanz
,
D. Langer
3   KU Leuven – University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgien
,
C. M. Spengler
4   Exercise Physiology Lab, Institut für Bewegungswissenschaften und Sport, ETH Zürich, und Zentrum für Integrative Humanphysiologie, Universität Zürich, Schweiz
,
T. Wanke
5   Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel und Karl Landsteiner Institut, Abteilung für Atmungs- und Lungenerkrankungen, Wien, Österreich
,
M. Petrovic
5   Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel und Karl Landsteiner Institut, Abteilung für Atmungs- und Lungenerkrankungen, Wien, Österreich
,
R.-H. Zwick
6   Univ. Klinik für Innere Medizin, Univ. Klinikum Tulln, Karl Landsteiner Privatuniversität, Ambulante Pneumologische Rehabilitation, Therme Wien Med, Wien, Österreich
,
S. Stieglitz
7   Medizinische Klinik I – Pneumologie und Kardiologie, Petrus Krankenhaus Wuppertal
,
R. Glöckl
8   Schön Klinik Berchtesgadener Land, Fachzentrum Pneumologie, Schönau am Königssee
,
D. Dellweg
9   Fachkrankenhaus Kloster Grafschaft GmbH, Lehrkrankenhaus der Universität Marburg, Schmallenberg
,
H.-J. Kabitz
2   II. Medizinische Klinik, Pneumologie, Kardiologie und Intensivmedizin, Klinikum Konstanz
› Author Affiliations
Further Information

Publication History

eingereicht 18 August 2015

akzeptiert nach Revision 10 November 2015

Publication Date:
20 January 2016 (online)

Zusammenfassung

Spezifisches Atemmuskeltraining (IMT) ist in der Lage, die Funktion der Atemmuskulatur zu verbessern. Anhand der Studienlage und klinischen Praxis haben sich 3 Methoden etabliert: 1.) kontrollierte Stenoseatmung („resisitive load“), 2.) „threshold load“ und 3.) normokapnische Hyperpnoe. Die jeweiligen Methoden und zugehörigen Trainingsgeräte weisen spezifische Charakteristika auf. Die Einleitung eines IMT erfordert eine vorausgehende Diagnostik der Atemmuskelfunktion und eine detaillierte individualisierte Trainingseinweisung und -anleitung.

Ziel dieser Übersichtsarbeit ist es, anhand der aktuell verfügbaren Literatur die unterschiedlichen IMT-Methoden bei den wichtigsten Indikationsgebieten zu beleuchten und kritisch zu diskutieren. Bei den neuromuskulären Erkrankungen werden Muskeldystrophien, spinale Muskelatrophien, amyotrophe Lateralsklerose, Phrenicusparese und Verletzungen des Rückenmarks dargestellt. Zudem werden die Bereiche interstitielle Lungenerkrankungen, Sarkoidose, Linksherzinsuffizienz, pulmonal-arterielle Hypertonie, Kyphoskoliose und Adipositas beleuchtet. Bei den obstruktiven Atemwegs- und Lungenerkrankungen werden COPD, Asthma, Mukoviszidose und „Non-CF-Bronchiektasen“ aufgearbeitet. Abschließend finden sich Ausarbeitungen für den Bereich Weaning vom Respirator und im Zusammenhang mit körperlicher Aktivität.

Abstract

Specific respiratory muscle training (IMT) improves the function of the inspiratory muscles. According to literature and clinical experience, there are 3 established methods: 1.) resistive load 2.) threshold load and 3.) normocapnic hyperpnea. Each training method and the associated devices have specific characteristics. Setting up an IMT should start with specific diagnostics of respiratory muscle function and be followed by detailed individual introduction to training.

The aim of this review is to take a closer look at the different training methods for the most relevant indications and to discuss these results in the context of current literature.

The group of neuromuscular diseases includes muscular dystrophy, spinal muscular atrophy, amyotrophic lateral sclerosis, paralysis of the phrenic nerve, and injuries to the spinal cord. Furthermore, interstitial lung diseases, sarcoidosis, left ventricular heart failure, pulmonary arterial hypertension (PAH), kyphoscoliosis and obesity are also discussed in this context. COPD, asthma, cystic fibrosis (CF) and non-CF-bronchiectasis are among the group of obstructive lung diseases. Last but not least, we summarize current knowledge on weaning from respirator in the context of physical activity.

 
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