Astımlı hastalarda aerobik egzersizlerinin ve solunum rehabilitasyonun etkileri

Abstract

12. ÖZET Çalışmamızda İstanbul Tıp Fakültesi Göğüs Hastalıkları ABD polikliniğine bağlı astım tanısı konmuş rutin kontrollere gelen 30 stabil astımlı hasta çalışmaya alındı. Yaş (29.1+10.8) yıl, boy (166.4+10.3) cm, kilo (62.2+12.1) kg ortalamaları olan onbeş kişilik gruba bisiklet ergometresi (MONARK 818-814E) ile sekiz hafta süre ile haftada 3 gün ve 1/2 saat ventilatuvar eşik düzeyinde egzersiz verildi. Yaş (26+9.61) yıl, boy (164.5+10.1) cm, 63.4+12.8) kg ortalamaları olan ikinci onbeş kişilik gruba bisiklet ergometreleri ile aerobik egzersizi verilirken aynı zamanda solunum rehabilitasyonu sekiz hafta süreyle uygulandı. Hastalarımızı çalışmaya almadan öcen fizik muayeneleri yapıldı. Kap i İler kandan alınan örnekle kan parametrelerine bakıldı. İstirahat EKG'leri ARS-EKG- 1 2K kompütirize cihazıyla değerlendirilerek risk faktörü taşıyan hastalar belirlenmeye çalışıldı. Solunum fonksiyon testleri Sensor Medics 2400 pulmonary function labrotory system cihazıyla bakıldı. So.unum fonksiyon testlerinden sonra hastalarımıza egzersiz testi Bruce protoküne göre breath by breath yöntemiyle yapılırken metabolik ölçümleri Sensor medics 2900c metabolic measurement system kompütirize cihazıyla ölçülerek yazılı kayda alındı. Egzersiz testi esnasında kardiolojik değişiklikleri QS0OO model monitör yardımıyla takip edildi. 3 dakika istirahat takip edildikten sonra test bitirildi. Hastaların anaeorobik eşik düzeyleri Wassermann'in kompürize programı ile belirlendi. Hastalarımıza test günü en az altı saat öncesine kadar ilaç almamaları söylendi. Sekiz haftalık programı aerobik egzersiz grubu %95 devamlılık oranı ile bitirdikten bu oran rehabilitasyon grubunda %87.9 idi. Aynı testler çalışma sonrası tekrarlanarak sonuçlar istatistiksel olarak student-t testine göre değerlendirildi. Çalışma sonrası her iki gruptaki metabolik parametrelerinde ve solunum fonksiyon testlerinde anlamlı değişiklik gözlenmiştir. Ancak gruplar arasında anlamlı fark gözlenmez iken solunum rehabilitasyonu uygulanan ikinci grupta göğüs çevre ölçümlerinde ve MVV değerlerinin rehabilitasyon grubu lehine anlamlı fark bulunmuştur. Hastalarımızın kan parametrelerinde çalışma sonrası anlamlı bir değişiklik görülmezken parametrelerinde çalışma sonrası anlamlı bir değişiklik görülmezken astına patogenezinde rol oynayan eozinofıl düzeyinde değişiklik her iki grupta da görülmemiştir. Sonuç olarak astımlı hastalarda egzersizin süresi, şiddeti ve sıklığı iyi belirlenmek suretiyle solunum fonksiyonlarına ve metabolik parametlerine müspet etkisi olacaktır, astımlı hastalar egzersizden kaçınmak yerine psikolojik destek ve kendine güven kazanması açısından mutlaka bu programlara alınmalıdır. Astımlı hastalarda, medikal tedavi eğitim, aerobik egzersizler ve solunum reabilitasyonu bir bütün içinde verilmesi bu hastalardaki fonksiyonel iyileşmeye önemli müspet etkisi olacaktır. 107

13. SUMMARY Wc designed this study to evaluate the physiological effect of aerobic exercise and pulmonary rehabilitation on pulmonary function test and metabolic parameters. We studied 30 patients (10 males, 20 females) with stable asthma. At the time of the study asthmatics had not used any oral/paranteral steroids or had used for a short time of period until 3 months before the test. They were not asthma attacked ever before and there was a change not more than %5 in their pulmonary function test. The patients were assigned into two groups. The first group consisted of 10 females and 5 males (average age of the ones in aerobic exercise group is 29 ± 10.8 years; average weight of them is 62.2 ±12.1 kgs and average tallness of them is 166.4 ± 10.3 cms) The second group composed of 1 0 females and S males again, named as group B (average age of the ones in aerobic exercise and pulmonary rehabilitation group is 26 ± 9.61 years, average weight of them is 63.4 ± 12.8 kgs and average tallness of them is 164.5 ±10.1) Patients were asked to refrain from taking any drugs for 6 hours before testing. Before the testing, physical exemanitions were done. After blood parameters were assessed, rest ECG of them were taken. Their pulmonary ruction tests were performed at erect position by sensor medics 2400 Pulmonary Fuction Laboratory System while the incremental exercise tests were being loaded using the BRUCE protocale. The cardiologic changes were evaluated by Q5000 (QUINTON) Monitor. Simultaneously, metabolic parameters were analysed by the Sensor Medics 2900c Metabolic Measurement System with breath by breath methodology. Anaerobic threshold was determined by using the Wasserman Programme following the test. In group A, below the threshold level-which was detenu ined by the beyele ergometer (MONARK 814-818) - a 3 days per week for 8 week, 1/2 hours aerobic exercise programme was performed. Two patients were unable to complete the programme. The average attendance of group A has been %95. In group B, beyele ergometer & pulmonary rehabilitation (some breathing exercise, chest mobilisation exercise, upper extremeter isokinetik exercise, breath control and relaxation) were included. Three patients failed in completing the programme in this group. The attendance of this group was 87.9 %. The same tests were repeated following the 8 weeks work-out and findings were statistically evaluated. While, in both groups, a significant change occurs in pulmonary function test and FEV,, FEF %25/75, PEF, FEF %50, FEF 75-85 %, M VV and ERC parameters; in group A, changes in FVC and IC were statistically non-significant. FEV,/FVC being statistically significant in group A (p<0.01), this significance has not been observed in group B (p<0.50). There has been no statistically significant difference between the two groups. Observed increase in MVV of group A and group B were 16.1 % and 19.5 % respectively. The significant difference in terms of this parameter was in favour of the rehabilitation group (p<0.001). In maximal exercise test, the pre-test base line values of VE (ventilation) HR, VC02, V02/KG, RR (Respiratory Rate), were not statistically significantly different for both group at prior to and post to the work-out. In the same test, the augmentation in the MaxV02 in group A was 8.9 % (p<0.02), while this was 12.2 % (pO.OOl) in group B. There has been no statistically significant difference between the two groups though there has been a significant increase in MET, ENDURANS TIME, %MAX HR, VC02 in both groups. In group A the increase in VE-BTPS was recorded as 18.8 % being statistically significant (p<0.001). In group B this rate was 1 1.1 % (p<0.01). There has been significant changes in anaerobic threshold time (AT-Time), VE (p<0.05), V02/kg values (p<0.01). But there has not been a statistically significant difference between the groups. A meaningful change has not been recorded after the work in eozonofil level-which is important for pathogenesiz of asthmatics - in both groups. The measurements of chest circumference - which we obtained from three regions: Axilla, Epigastric & Subcostal - were statistically significant in group A (p<0.05) while this was (p<0.01) in group B. This could be related to the pulmonary rehabilitation that was induced. Consequently, it is quiet possible to have physiological changes via the aerobic exercises to be induced over asthmatics. The significance of the changes will be at higher levels by providing proper conditions for the tests and by inducing pulmonary rehabilitation on the asthmatics. 108