324 日本呼吸ケア リハビリテーション学会誌第 22 巻第 3 号 7 CO V 4 E 運動療法の強度と運動処方 FrequencyIntensity TimeTypeFITT 1, , 5 COPD 15 high-intensity low
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1 2012 年 12 月 323 ワークショップ Ⅰ 運動処方と運動療法の実際 要旨 COPD COPD 運動療法のエビデンス ACCP/AACVPR GOLD ACCP/AACVPR GOLD A 2007 ACCP/ AACVPR 2B B 5 5, GOLD B 4 における運動耐容能の低下と運動療法 COPD 4, 6
2 324 日本呼吸ケア リハビリテーション学会誌第 22 巻第 3 号 7 CO V 4 E 運動療法の強度と運動処方 FrequencyIntensity TimeTypeFITT 1, , 5 COPD 15 high-intensity low-intensity 1, 2 V 4 O 2 max V 4 O 2 max , 2 V 4 O 2 max 1, 2 V 4 O 2 max 1, 2 15 Mahler 16, 17 TDR; Target Dyspnea Rating; < 足を前後に > < 足を左右に > < 座ったままでの歩行 > 図 1 18 < 膝の伸展 >
3 2012 年 12 月 325 V 4 O TDR , 19 TDR COPD 18, 19 COPD QOL ACCP/AACVPR 5 1A 4 14, 20 図 2 19 図 3 19
4 326 日本呼吸ケア リハビリテーション学会誌 図4 第 22 巻 第 3 号 低強度運動療法の実際 文献 19 より改変引用 院内で 在宅で 図6 図5 上肢筋トレーニング 上 と下肢筋トレーニング 下 文 献 15 より改変引用 低強度運動療法としての歩行 文献 15 より改変引用 レーニングの併用あるいは歩行にかかわる筋群トレーニ ングの有用性がエビデンス 1A と高く評価されており 今後 COPD においても上肢および下肢筋力トレーニ ングを積極的に取り入れることが望ましいと考えられる 図 5 6, 20
5 2012 年 12 月 327 PImax 6MWD, 12MWD CRQ 図 持久力トレーニングと筋力トレーニング 1, 2, , 20 15, 16 1, 2
6 328 日本呼吸ケア リハビリテーション学会誌第 22 巻第 3 号 QOL CRQchronic respiratory questionnaire 23 COPD QOL COPD COPD PImax6 6MWD QOLCRQ 7 26, 27 25, 26, 28 おわりに 2931 Prescription and practice of exercise therapy Takanobu Shioya 1 Masahiro Satake 1 Atsuyoshi Kawagoshi 2 Keiyu Sugawara 2 Hitomi Takahashi 2 Mitsunobu Homma 3 1 Department of Physical Therapy, Akita University Graduate School of Health Sciences 2 Department of Rehabilitation, 3 Department of Pulmonary Medicine, Akita City General Hospital 文献 1 / / // / ACCP/AACVPR Pulmonary Rehabilitation Guidelines Panel. Pulmonar y Rehabilitation. Joint ACCP/AACVPR evidence based guidelines. Chest, 112: , http://www. goldcopd. com Ries, A.L., Bauldoff, G.S., Carlin, B.W., et al: Pulmonary Rehabilitation. Joint ACCP/AACVPR Evidence-Based Clinical Practical Guidelines. Chest, 131: 4S 42S, COPD 3 COPD A statement of the American Thoracic Society and European Respiratory Society. Skeltal muscle dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 159: 1s 40s, Maltais, F., Simard, A.A., Simard, C., et al: Oxidative capacity of the skeletal muscle and lactic acid kinetics during exercise in normal subjects and in patients with COPD. Am J Respir Crit Care Med, 153: , Rabinovich, R.A., Ardite, E., Troosters, T., et al: Reduced muscle redox capacity after endurance training in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 164: , Decramer, M., debock, V., Dom, R.: Functional and histologic picture of steroid-induced myopathy in chronic obstructive pulmonary disease. Am J respire Crit Care Med 153: , Sullivan, M.J., Green, H.J., Cobb, F.R.: Skeltal muscle biochemistry and histology in ambulatory patients with long term heart
7 2012 年 12 月 329 failure. Circulation, 81: , Casaburi, R., Patessio, A., loli, F., et al: Reductions in exercise lactic acidosis and ventilation as a results of exercise training in patients with obstructive lung disease. Am Rev Respir Dis, 143: 918, Normandin, E.A., McCuster, C., Connors, M., et al: An evaluation of two approach to exercise conditioning in patients with COPD. Chest, 121: , Mahler, D.A., COPD COPD FRONTIER Horowitz, M.B., Littenberg, B., Mahler, D.A.: Dyspnea ratings for prescribing exercise intensity in patients with COPD. Chest, 109: , Takahashi, H., Sugawara, K., Satake, M., at al: Effects of low-intensity exercise training Chronic Obstructive Pulmonary Disease Sitting Calisthenicsin patients with stable chronic obstructive pulmonary disease. Jpn J Compr Rehabil Sci, 2: 5 12, COPD Geriatic Medicine Ries, A.L., Ellis, B., Hawkins, R.W.: Upper extremity exercise training in chronic obstructive pulmonary disease. Chest, 93: , Jones, N.L.: Physiology of exercise. In; Clinical Exercise Testing, 4th edition, W.B. Saunders, Philadelphia, Puhan, M.A., Schünemann, H.J., Frey, M., et al: How should COPD patients exercise during respiratory rehabilitation? Comparison of exercise modalities and intensities to treat skeletal muscle dysfunction. Thorax, 60: , Beauchamp, M.K., Nonoyama, M., Goldstein, R.S., et al: Interval versus continuous training in individuals with chronic obstructive pulmonary disease a systematic review. Thorax, 65: , Lötters, F., van Tol, B., Kwakkei, G., et al: Effects of controlled inspiratory muscle training in patients with COPD: a meta-analysis. Eur Respir J, 20: , Suppl199s COPD Sugawara, K., Takahashi, H., Kasai, C., et al: Effects of nutritional supplementation combined with low-intensity exercise in malnourished patients COPD. Respir Med, 104: , Sugawara, K., Takahashi, H., Kashiwagura, T., et al: Effects of anti-inflammatory nutritional supplementation with whey peptide and exercise therapy in patients COPD. Respir Med, 106: , Ferreira, I.M., Brooks, D., White, J., et al: Nutritional supplementation for stable chronic obstructive pulmonary disease. Cochrane Database of Systemic Reviews 2012, Issue 12. Art. No.: CD DOI: 10/ CD pub3.
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2012 年 12 月 271 第 22 回日本呼吸ケア リハビリテーション学会学術集会 ( 福井 ) 奨励賞 受賞報告 特発性肺線維症における呼吸困難感, 運動 耐容能,QOL を含む多面的評価の重要性 要旨 IPF QOL IPF modified MRC modified MRC 6 SpO 2 modified MRC IPF IPF 6 QOL IPF QOL は じ め に 24 11
運動負荷試験としての 6 分間歩行試験の特徴 和賀大 坂本はるか < 要約 > 6 分間歩行試験 (6-minute walk test; 6MWT) は,COPD 患者において, 一定の速度で歩く定量負荷試験であり, この歩行試験の負荷量は最大負荷量の約 90% に相当すると報告されている. そこ
運動負荷試験としての 6 分間歩行試験の特徴 和賀大 坂本はるか < 要約 > 6 分間歩行試験 (6-minute walk test; 6MWT) は,COPD 患者において, 一定の速度で歩く定量負荷試験であり, この歩行試験の負荷量は最大負荷量の約 90% に相当すると報告されている そこで, 6MWT は一定負荷試験であるか, 高負荷運動であるかを検証するため, 研究 1 は, 高齢者 22
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