紀要論文 各種疾患患者における呼吸筋トレーニングの効果とそのエビデンス
The effects and evidence of respiratory muscle training in patients with various diseases

佐々木, 誠  ,  SASAKI, Makoto

25 ( 1 )  , pp.71 - 97 , 2017-03-31 , 秋田大学大学院医学系研究科保健学専攻
ISSN:18840167
NII書誌ID(NCID):AA12447617
内容記述
呼吸器疾患患者や他の一部の疾患患者は呼吸筋の筋力低下を経験する.吸気筋の筋力低下は,様々な疾患の特異性により種々の原因で生じ,息切れや運動障害を招き日常生活活動(activities of daily living : ADL)の能力や生活の質(quality of life : QOL)を低減させる.また呼気筋の筋力低下は,咳嗽の能力を制限し気道内分泌物を貯留させて, あるいは誤嚥を生じさせて呼吸器合併症のリスクを高める.呼気筋の筋力低下に伴う呼気筋疲労は,運動時や ADL 中の呼吸をより努力的なものにして,運動能力,ADL の能力,QOL を低下させる可能性がある.最新のステートメントでは,吸気筋トレーニング(inspiratory muscle training : IMT)は呼吸リハビリテーションの中の検討すべき項目の1つとされている.IMT の効果に関して,多くの臨床試験といくつかのシステマティックレビューやメタアナリシス,コクランライブラリーがあり,ガイドラインやステートメントで取り上げられている.一方,呼気筋トレーニング(expiratory muscle training : EMT)の効果については,報告が比較的少なくエビデンスの構築は十分とは言えない.本稿では,IMT と EMT の呼吸筋力・筋持久力,自覚症状,呼吸機能,咳嗽の能力,運動能力,ADL の能力, QOL,その他に対する効果とそのエビデンスについて疾患別に言及する.
Patients with respiratory diseases and certain other diseases experience a reduction in respiratory muscle strength. The decline of inspiratory muscle strength, which is caused by various factors that are associated with these diseases, causes breathlessness, reduces the exercise capacity and the ability to perform activities of daily living (ADL), and is associated with a decline in the quality of life (QOL). In addition, expiratory muscle weakness may increase the risk of pulmonary complications by limiting the cough capacity, causing the retention of internal respiratory tract secretions or cause aspiration. Expiratory muscle fatigue due to expiratory muscle weakness may increase the effort associated with breathing during exercise and ADL. Consequently, this may reduce the exercise capacity, the ability to perform ADL, and the QOL. This suggests that inspiratory muscle training (IMT) should be considered in pulmonary rehabilitation. There have been numerous clinical trials, several systematic reviews, a meta-analysis and a Cochrane review on the effects of IMT, and guidelines and statements about IMT have been developed. On the other hand, there are relatively few reports on the effects of the expiratory muscle training (EMT), and the supporting evidence is currently insuffi- cient. This review investigates the effects of IMT and EMT in various diseases and provides evidence of the influence of IMT and EMT on the strength and endurance of the respiratory muscles, symptoms, the pulmonary function, the cough capacity, the exercise capacity, the ability to perform ADL, the QOL, and other factors.
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