Atemmuskeltraining: State-of-the-Art

O. Göhl; D. J. Walker; S. Walterspacher; D. Langer; C. M. Spengler; T. Wanke; M. Petrovic; R.-H. Zwick; S. Stieglitz; R. Glöckl; D. Dellweg; H.-J. Kabitz

doi:10.1055/s-0041-109312

Pneumologie, Inhaltsverzeichnis

Pneumologie 2016; 70(01): 37-48
DOI: 10.1055/s-0041-109312

Übersicht

Atemmuskeltraining: State-of-the-Art

Respiratory Muscle Training: State of the Art

O. Göhl

¹Rehaklinik Heidelberg-Königstuhl, Heidelberg

,

D. J. Walker

²II. Medizinische Klinik, Pneumologie, Kardiologie und Intensivmedizin, Klinikum Konstanz

,

S. Walterspacher

²II. Medizinische Klinik, Pneumologie, Kardiologie und Intensivmedizin, Klinikum Konstanz

,

D. Langer

³KU Leuven – University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgien

,

C. M. Spengler

⁴Exercise Physiology Lab, Institut für Bewegungswissenschaften und Sport, ETH Zürich, und Zentrum für Integrative Humanphysiologie, Universität Zürich, Schweiz

,

T. Wanke

⁵Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel und Karl Landsteiner Institut, Abteilung für Atmungs- und Lungenerkrankungen, Wien, Österreich

,

M. Petrovic

⁵Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel und Karl Landsteiner Institut, Abteilung für Atmungs- und Lungenerkrankungen, Wien, Österreich

,

R.-H. Zwick

⁶Univ. Klinik für Innere Medizin, Univ. Klinikum Tulln, Karl Landsteiner Privatuniversität, Ambulante Pneumologische Rehabilitation, Therme Wien Med, Wien, Österreich

,

S. Stieglitz

⁷Medizinische Klinik I – Pneumologie und Kardiologie, Petrus Krankenhaus Wuppertal

,

R. Glöckl

⁸Schön Klinik Berchtesgadener Land, Fachzentrum Pneumologie, Schönau am Königssee

,

D. Dellweg

⁹Fachkrankenhaus Kloster Grafschaft GmbH, Lehrkrankenhaus der Universität Marburg, Schmallenberg

,

H.-J. Kabitz

²II. Medizinische Klinik, Pneumologie, Kardiologie und Intensivmedizin, Klinikum Konstanz

› Institutsangaben

Abstract

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.

Volltext

Referenzen

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