紀要論文 慢性閉塞性肺疾患患者における運動トレーニング ―上肢トレーニングと付加的介入を伴う全身持久力トレーニング―
Exercise training in patients with chronic obstructive pulmonary disease:   Upper limb training and endurance training with additional intervention

佐々木, 誠  ,  SASAKI, Makoto

内容記述
慢性閉塞性肺疾患(chronic obstructive pulmonary disease : COPD)は気道閉塞と気道の慢性炎症に特徴づけられる疾患である.臨床症状には呼吸困難,疲労,運動耐容能の低下,身体活動の減少,生活の質の低減が含まれる.COPD 患者は,筋機能不全,日常生活活動の制限,睡眠障害,気分の不調を頻繁に呈し,さらにバランス能力の低下を伴う可能性がある.運動トレーニングは,COPD 患者のこれらの病態と症状を改善し長期的なアウトカムを向上させることが期待される.上肢トレーニングはプログラムの構成要素として組み込まれ,また,付加的介入(酸素投与や非侵襲的陽圧換気)は全身持久力トレーニング実施の際に併用が試みられている.本総説の目的はCOPD 患者を対象とした上肢を使用した運動・活動の生体への影響,上肢トレーニングと付加的介入を伴う全身持久力トレーニングについて,期待される効果,急性効果,長期効果,エビデンスに言及することである.それぞれの介入が始まってから2017年までの論文を概観すると,いくつかの未解決の争点が認められた.これらについて,さらなる検討によるエビデンスの構築が重要であると考える.
Chronic obstructive pulmonary disease (COPD) is marked by respiratory tract obstruction and chronic respiratory tract inflammation. Dyspnea, fatigue, exercise intolerance, decreased physical activity and a decline in the quality of life are included among its clinical symptoms. Patients with COPD frequently present with muscle dysfunction, limitation of activities of daily living and sleep and emotion disorders, as well as a worsening of balance in some cases. Exercise training is expected to improve these clinical conditions and symptoms of patients with COPD, thereby improving the long-term outcome. Upper limb training is included as a component of such programs, and additional intervention (oxygen prescription or noninvasive positive pressure ventilation) in combination with endurance training regimens has been attempted. The purpose of this review is to reference the physical responses during upper limb movement/ activity and to describe the expected effects, both acute and long-term, and evidence of the efficacy of upper limb training and endurance training with additional intervention in patients with COPD. Several unresolved or new issues were recognized in our overview of papers regarding the respective interventions up through 2017. The accumulation of further evidence in future studies in this field is important.
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