|
As therapists are only too aware, chronic obstructive pulmonary disease is a debilitating, progressive and often fatal disease. The typical COPD population is characterized by airflow obstruction, impaired gas exchange and peripheral muscle weakness. This is exhibited by reduced muscle mass, fiber type and profile, strength and endurance.1,2
Studies show that patients with COPD have diminished balance, coordination and functional mobility.3 As such, a pulmonary rehabilitation program's primary goal should center on improving the maximum level of independence and functioning in patients who have COPD by improving their exercise capacity, activities of daily living and quality of life.
Exercise is a known essential component for COPD; and even though there have been various investigations regarding resistance training, there are still insufficient guidelines for pulmonary rehabilitation programs.4,5
Most rehabilitation training programs in place today place emphasis on aerobic training and typically limit the workload of COPD patients to limited resistance training using low workloads and intensity.
Perhaps it's time to take a closer look at what can be done in alternative training programs. Current methods for training athletes, for example, may be of special benefit for pulmonary rehab programs because they offer a more structured guideline for resistance training.
Key Training Theories
Typically when training athletes for optimal performance, trainers rely on three theories:
- overload
- specificity of training
- periodization.
Overload - For a muscle to increase in strength, the workload to which it is subjected during exercise must be increased beyond what it normally experiences. In other words, the muscle must be overloaded.
Muscles adapt to increased workloads by becoming larger and stronger and by developing greater endurance. Increased loading can be a function of increased intensity, volume, frequency, duration or any combination of these.6
In weight-training programs, the term "intensity" refers to the weight lifted in relationship to a maximum strength level (e.g., one repetition maximum), or a multiple repetition maximum (e.g., 10 repetition maximum).
In a running or conditioning program, intensity is often used to describe a percentage of an age predicted maximum heart rate or Vo2 max. In general, the higher the intensity, the lower the volume of a particular exercise or workout. The term "training volume" is used to reference the total number of exercise sets and reps performed in a strength training program and the distance and/or time of a conditioning program.
Specificity of training - The law of specificity notes that in the nature of the training, stimulus is related to the muscle actions involved, speed of movement, range of motion, muscle groups trained, energy systems involved and intensity and volume of training.
All of these combine to determine the training effect.7
One example of specificity might be the use of high resistance and low repetitions. This action will increase muscle strength and power.
On the other hand, a low resistance, high repetition program would increase muscular endurance. Increases in strength are specific to the type of exercise, even when the same muscle groups are used. (See Figure 1.)
Periodization - This aspect of training centers on a systematic approach to dividing a training program into periods of time, using specific cycles of training and periods of rest and recovery to prevent overtraining and optimize the adaptations of a resistance training program.8
Many training variables can be manipulated in an attempt to optimize the exercise program: the number of sets per exercise, repetitions per set, the types of exercises, number of exercises per training session, rest periods between sets and exercises, resistance used for a set, type and tempo of muscle action (e.g., eccentric, concentric, isometric) and the number of training sessions per day and per week. (See Figure 2.)
A good resistance training program for pulmonary rehabilitation needs to include:
- physiological analysis
- training goals
- proper exercise selection
- program variables (days of training, flexibility, balance, etc.)
- load intensity prescription
- volume prescription (sets and repetitions)
- rest and other components.
Other Forces at Work
After considering overload, specificity and periodization for our rehab program design, we want to look as well at other important ingredients such as simulating typical activities of daily living movements. To accomplish this goal, we can consider using resistance training programs including weight training with free weights, pulley systems, elastic tubing or therabands, pushing, pulling, squatting in and out of chairs, moving at different rates of speed, twisting and turning.
These, after all, are the movements we typically perform in our normal activities. If our goal for pulmonary rehabilitation programs is to help restore function and independence, we need to incorporate these movements into our programs.
For better guidelines, pulmonary rehabilitation programs may need to look to the athletic training community for guidance, by incorporating some fundamental philosophies for training in order to maximize the potential of our COPD patients.
References
1. Skeletal muscle dysfunction in chronic obstructive pulmonary disease. A statement of the American Thoracic Society and European Respiratory Society. Am J Respir Crit Care Med. 1999;159(4 Pt 2):S1-40.
2. Hamilton N, et al. Muscle strength, symptom intensity, exercise capacity, in patients with cardiorespiratory disorders. Am J Respir Crit Care Med. 1995;152(6 Pt 1):2021-31.
3. Butcher S, et al. Reductions in functional balance, coordination, and mobility measures among patients with stable chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2004;24(4):274-80.
4. Ortega F, et al. Comparison of effects of strength and endurance training in patients with chronic obstructive pulmonary disease. Am Resp Crit Care Med. 2002;166(5):669-74.
5. Ellis B, Ries A. Upper extremity training in pulmonary rehabilitation. J Cardiopulm Rev. 1991;11:227-31.
6. Fry RW, et al. Periodisation and the prevention of overtraining. Can J Spt Sci. 1992;17(3):241-8.
7. Freeman W. Peak when it counts, 3rd edition. 1996.
8. Sale DG. Neural adaptation to resistance training. Med Sci Sports Exer. 1988;20(5 Suppl):S135-45.
Erich Kalbfell, RRT, CPT, is a Florida respiratory therapist who is a certified physical trainer.
For more on pulmonary rehab, read the Home Pathways column in the March print issue of ADVANCE for Managers of Respiratory Care.
|