Telemedizin und Training bei COPD

Zusammenfassung

In dieser Übersicht wird ein Teilaspekt des telemedizinischen Monitorings herausgegriffen. In vielen Studien konnte gezeigt werden, dass regelmäßiges körperliches Training bzw. körperliche Aktivität bei COPD die Lebenserwartung und Lebensqualität verbessert. Die Frequenz und Dauer des häuslichen Trainings hängt allerdings entscheidend von der Motivation des Patienten ab. Telemedizinische Überwachung mit Compliance-Monitoring kann zur Lösung dieses Problems beitragen. Die tägliche körperliche Aktivität zu Hause, während sportlicher Betätigung und Freizeit kann mithilfe von Fragebögen erfasst und quantifiziert werden. Aufgrund fehlender Genauigkeit können diese insbesondere für die Beurteilung therapeutischer Interventionen auf individueller Basis nicht empfohlen werden. Bessere Ergebnisse versprechen Bewegungssensoren wie Schrittzähler und Accelerometer zur Bewegungsmessung, deren Ergebnisse über Mobiltelefon verschickt werden können. Diese Methoden zur routinemäßigen Erfassung von Trainingsdaten sind nur bedingt geeignet. Das Training mit einem Fahrrad-Ergometer kann mittels telemetrisch übertragener Trainingszeit quantifiziert werden.

Ein wichtiger Antrieb, regelmäßig zu trainieren, resultiert vor allem, wenn ein Feedback zum betreuenden Arzt, der Schwester oder Trainingsleiter über Telefon erfolgt. Telefonische Rücksprachen mit der Trainingsleitung sollten auf objektiven Informationen der Trainingsleistung beruhen. Unnötige Kontrollanrufe können vermieden werden. Eine Veränderung der Trainingsleistung oder Funktionsdaten kann ohne wesentliche Zeitverzögerung erkannt und die Ursache telefonisch analysiert werden. Telemetrisches Monitoring von häuslichem Training kann in Zukunft zu einer Verbesserung des Mobilitätsverhaltens von COPD-Patienten beitragen.

Abstract

The present review is focused on telemonitoring of domiciliary activity in patients with COPD. Many studies have shown that daily physical exercise improves survival and quality of life in COPD. Frequency and duration of home training, however, crucially depends on how patients are motivated. Telemonitoring of compliance may help to solve this problem. The daily physical activity at home, during leisure and sporting activities can be described and quantified by using questionnaires. Due to a lack of accuracy they cannot be recommended, in particular, for the assessment of therapeutic interventions. Better information is available using motion sensors and accelerometers to measure body movements, e. g., pedometers, the results of which can be transmitted via a mobile phone. However, these methods are of limited use for the routine collection of training data. Use of a bicycle ergometer for training at home can better be quantified. An important motivation for regular physical exercise results if feedback is provided via telephone by the attending physician, nurse, or the instructor. Telephone consultations with the nurse monitoring the patient should be based on the objective data of the training performance. Thus, unnecessary calls are avoided. A change in exercise performance can be detected without any significant time delay and analyzed by the telephone support. Telemetric monitoring of home training can contribute to improve the compliance behaviour of COPD patients in terms of physical activity.

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