SONUÇ VE ÖNER LER

KOAH kal hava k tlamas ile karekterize, ilerleyici bir hastal kt r. KOAH’ta optimal medikal tedaviye ra men solunum fonksiyonlar ndaki bozulma genellikle kal r. Bu hastalarda görülen ve hava yolu obstrüksiyonu kadar önemli olan bir di er fonksiyonel bozukluk ise dinamik hiperinflasyondur. Hiperinflasyon egzersizde k tlamaya ve egzersizin erken sonlanmas na neden olmaktad r. (Troosters ve ark 2005)

KOAH hastalar nda görülen egzersiz kapasitesindeki azalma progresiftir. Bunun en önemli nedeni kas iskelet sisteminin tutulmas sonucu geli en kas güçsüzlü üdür. (Gosselink ve ark 1996) Bu hastalarda görülen kas güçsüzlü ü önemlidir; çünkü semptomlar n kötüle mesi, ya am kalitesinin azalmas , egzersiz kapasitesinin azalmas , ya am süresinin azalmas ve ilaç tüketiminin artmas gibi faktörlerle ili kili bulunmu tur. (Agusti ve ark 2003)

Hastal k ilerledikçe hastalar n klinik durumu tam bir k r döngüye dönü mektedir. Dispne, hareketsizlik, kas güçsüzlü ü birbirini olumsuz etkilemekte, ya am kalitesi sürekli azalmakta ve alevlenmeler bu klinik gidi i daha da kötüle tirmektedir.

Pulmoner rehabilitasyon KOAH hastalar na hastal n evresinden ba ms z olarak önerilen bir tedavi yöntemidir. Alt ekstremite a rl kl uygulanan aerobik egzersiz program pulmoner rehabilitasyonun en önemli bile enidir. Pulmoner rehabilitasyonun hastalara 6 ile 12 hafta aras nda uygulanmas önerilmektedir.

Biz de çal mam zda ayaktan haftada 3 gün, 8 hafta, toplam 24 seans orta ve yüksek yo unluklu aerobik egzersiz program uygulanarak pulmoner rehabilitasyon alm hastalar n dosyalar inceledik. Hastalar n dispne, fiziksel fonksiyonlar, solunum fonksiyonlar ve ya am kalitesi de erlerini egzersiz öncesi ve sonras kar la rd k. Hemen hemen tüm parametrelerde anlaml de iklikler gözlemledik. Hastalar n çok az bir k sm 8 hafta içinde yüksek yo unluklu program tolere edip çal abilmi ti.

KOAH hastalar nda endurans kazan sa kl insanlara göre daha geç olmaktad r. KOAH hastalar aerobik egzersiz program ndan çok fayda görmektedir. Bu hastalar n kazan mlar 6-12 ay aras nda sürmektedir. Aerobik egzersiz program n süresi artt kça bu kazan mlar n süreside artmaktad r. KOAH hastalar na yönelik planlanan yüksek yo unluklu aerobik egzersiz program n süresinin 8 haftadan daha uzun olmas önerilir.

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ÖZET T.C.

SELÇUK ÜN VERS TES TIP FAKÜLTES

Kronik Obstrüktif Akci er Hastal (KOAH) Olan Hastalarda Aerobik Egzersiz Program n Ya am kalitesi, Dispne, Fiziksel Fonksiyonlar ve Solunum Fonksiyonlar na Etkinli i

brahim Tu rul TA PINAR” Fiziksel T p ve Rehabilitasyon Anabilim Dal

TIPTA UZMANLIK TEZ / Konya, 2014

Kronik Obstrtrüktif Akci er Hastal (KOAH); kal hava ak k tlamas ile karakterize, yayg n, önlenebilir ve tedavi edilebilir bir hastal kt r. Egzersiz ve aktivite k tlanmas KOAH’ n karekteristik bulgusudur. Egzersiz intolerans KOAH’ n en rahats z edici belirtilerinden biridir. skelet kas disfonksiyonu egzersiz intolerans n geli iminde önemli rol oynar. Pulmoner rehabilitasyon KOAH’l hastalara önerilmektedir. Egzersiz e itimi KOAH’l hastalarda pulmoner rehabilitasyonun ana ö esidir ve egzersiz kapasitesini art r. Pulmoner rehabilitasyon program n süresi en az 6 hafta olmal r.

Çal mam zda, KOAH tan ile ayaktan pulmoner rehabilitasyon alan 30 hastan n verileri retrospektif olarak incelendi. Hastalara orta (KHR %60) ve yüksek (KHR %70) yo unluklu aerobik egzersiz program haftada 3 gün ve 8 hafta uyguland . Solunum fonksiyonlar , alt dakika yürüme testi (6DYT), dispne (mMRC dispne skalas ) ve ya am kalitesi (SGRQ) testleri 8 haftal k rehabilitasyon program öncesi ve sonras hastalar n dosyalar ndan elde edildi.

Rehabilitasyon program ndan sonra, solunum fonksiyon testlerinde (SFT), alt dakika yürüme testinde (6DYT), ya am kalitesinde (SGRQ) (semptom, aktivite, etki alt skoru ve toplam skor) ve mMRC dispne skalas nda (p <0.05) anlaml geli meler gözlenmi tir.

Orta ve yüksek yo unluklu aerobik egzersiz program KOAH'l hastalarda fonksiyonel kapasite, dayan kl k, nefes darl ve ya am kalitesini art r. KOAH hastalar na yönelik planlanan yüksek yo unluklu aerobik egzersiz program n süresinin 8 haftadan daha uzun olmas önerilir.

SUMMARY

The Effects of Aerobic Exercise on Quality of Life, Dysphnea, Physical Function and Pulmonary Function Tests in Patients with COPD

Chronic obstructive pulmonary disease (COPD), a common preventable and treatable disease, is characterized by persistent airflow limitation. Exercise and activity limitation are characteristic features of chronic obstructive pulmonary disease (COPD). Exercise intolerance is one of the most troubling manifestations of COPD. Skeletal muscle dysfunction plays a major role in the development of exercise intolerance. Pulmonary Rehabilitation is recommended for patients with COPD. Exercise training, a core component of pulmonary rehabilitation and improves the exercise capacity of patients with COPD. The duration of the pulmonary rehabilitation program should be at least 6 weeks.

n our study, data from 30 patients who get outpatients pulmonary rehabilitation with COPD diagnosis were analyzed retrospectively. Moderate (HRR 60%) and high (HRR 70%) intensity aerobic exercise program 3 days a week and 8 weeks were performed to patients. Pulmonary functions, six minute walk test (6MWT), dyspnea (mMRC dyspnea scale) and quality of life (SGRQ) tests before and after an 8-week rehabilitation program were obtained from patients’ medical records.

After the rehabilitation program, a significant improvement in pulmonary function tests (PFT), six minute walk test (6MWT), quality of life (SGRQ) (symptom, activity, impact subscale and the total score), and mMRC dyspnea scale (p<0.05) was observed.

Moderate and high intensity aerobic exercise program improves functional capacity, endurance, dyspnea, and quality of life in patients with COPD. The duration of the planned high intensity aerobic exercise program for patients with COPD is recommended that longer than 8 weeks.