Ciddi kronik obstr?ktif akci?er hastal??? olan olgularda n?romusk?ler elektriksel stim?lasyonu ve
endurans e?itim etkinli?inin kar??la?t?r?lmas?

Dicle KAYMAZ1, P?nar ERG?N2, Ebru DEM?RC?1, Ne?e DEM?R1


1 Ankara Atat?rk G???s Hastal?klar? ve G???s Cerrahisi E?itim ve Ara?t?rma Hastanesi, Pulmoner Rehabilitasyon ve

Evde Sa?l?k Hizmet Sunum Merkezi, Ankara, T?rkiye

1 Department of Pulmonary Rehabilitation and Home Care Center, Ataturk Chest Diseases and Thoracic Surgery Training and

Research Hospital, Ankara, Turkey

2 Kafkas ?niversitesi T?p Fak?ltesi, G???s Hastal?klar? Anabilim Dal?, G???s Hastal?klar?, Kars, T?rkiye

2 Department of Pulmonary Medicine, Kafkas University School of Medicine, Kars, Turkey

?ZET

Ciddi kronik obstr?ktif akci?er hastal??? olan olgularda n?romusk?ler elektriksel stim?lasyonu ve endurans e?itim etkinli?inin kar??la?t?r?lmas?

Giri?: Ciddi hastal?k ve kas disfonksiyonu nedeniyle egzersiz e?itimine aktif kat?lamayan KOAH'l? olgularda periferik kaslar?n elektriksel stim?lasyonu bir tedavi stratejisi olarak pulmoner rehabilitasyon (PR) programlar?nda ba?ar?yla kullan?labilecek metodtur.

Materyal ve Metod: Nonrandomize kontroll? g?zlemsel ?al??maya ileri evre KOAH'? olan 50 olgu al?nd?. Olgular?n 27'sine endurans e?itimi, 23'?ne ise n?romusk?ler elektriksel stim?lasyon (NMES) uygulanmak ?zere iki gruba ayr?ld?lar. PR program? ?ncesi ve sonras?nda olgular?n nefes darl??? MRC ile, egzersiz kapasitesi artan h?zda mekik y?r?me testi (AHMYT) ile, periferik kas g?c? manuel kas testi ile ya?am kalitesi SGRQ anketi ile, psikolojik durumlar? HAD skalas? ile v?cut kompozisyonu ise bioelektriksel impedans y?ntemi ile de?erlendirildi.

Bulgular: Her iki grupta da pulmoner rehabilitasyon program? sonras? MRC'de azalma (p< 0.001) AHMYT mesafesi ve endurans s?resinde art?? (p< 0.001) saptan?rken, endurans e?itimi uygulanan grupta SGRQ anketinin t?m alt ba?l?klar?nda ve HAD skorlar?nda azalma, NMES uygulanan grupta ise SGRQ anketinin semptom skoru hari? di?er t?m alt ba?l?klar?nda ve total skorunda, HAD skorlar?nda iyile?me saptand?. PR program? sonras? NMES ve endurans e?itim etkinlikleri aras?nda t?m parametrelerdeki kazan?mlar?n benzer d?zeylerde oldu?u g?r?ld?.

Sonu?: ?leri evre KOAH'da n?romusk?ler elektriksel stim?lasyon PR programlar?nda periferik kas e?itiminde kullan?labilecek etkin bir yakla??md?r.

Anahtar kelimeler: KOAH, dispne, pulmoner rehabilitasyon

SUMMARY

Comparison of the effects of neuromuscular electrical stimulation and endurance training in patients with severe chronic obstructive pulmonary disease

Introduction: In severely disabled patients who are not capable of following formal pulmonary rehabilitation (PR) and/or tolerating higher training intensities, neuromuscular electrical stimulation (NMES) has been successfully utilized as a localized training method.

Materials and Methods: In this non-randomized controlled observational study 50 patients with severe chronic obstructive pulmonary disease (COPD), who were allocated into two groups. Endurance training group (ET) (n= 27) and NMES group (n= 23). To compare the effects of NMES and ET on health-related quality of life (HRQOL), exercise capacity, muscle strength, dyspnea, psychological status, and body composition in patients with severe COPD. Before and after PR program, the study parameters were assessed using the Medical Research Council (MRC) scale, incremental and endurance shuttle walking tests (ISWT, ESWT), manual muscle testing (MMT), the St. George's Respiratory Questionnaire (SGRQ), bioelectrical impedance analysis, and the Hospital Anxiety and Depression Scale (HADS).

Results: After the PR program, walking distance and endurance time significantly increased in both groups (p< 0.001 for each), whereas the MRC scores of both groups significantly decreased (p< 0.001 for each). In the ET group, significant decreases were noted in all domains of SGRQ and HADS. In the NMES group, significant improvements were observed in the HADS scores and in all SGRQ domain except symptom domain. No significant differences were observed between the NMES and ET groups regarding the changes from baseline to after PR program in walking distance (p= 0.140), endurance time (p= 0.376), the MRC (p= 0.540), HRQOL (p> 0.05) and HADS (p> 0.05) scores, body-mass index (BMI) (p= 0.49), fat-free mass (FFM) (p= 0.50) and fat-free mass index (FFMI) (p= 0.94).

Conclusion: NMES can be used as an effective treatment strategy in PR programs for peripheral muscle training in patients with severe COPD.

Key words: COPD, dyspnea, pulmonary rehabilitation

Geli? Tarihi/Received: 09.07.2014 • Kabul Edili? Tarihi/Accepted: 11.12.2014

Yaz??ma Adresi (Address for Correspondence)

Dr. Dicle KAYMAZ

Ankara Atat?rk G???s Hastal?klar? ve

G???s Cerrahisi E?itim ve Ara?t?rma Hastanesi,

Pulmoner Rehabilitasyon ve

Evde Sa?l?k Hizmet Sunum Merkezi,

ANKARA - TURKEY

e-mail: dicleyilmaz@hotmail.com