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1 Inspanningstraining bij ernstig COPD: minder hard trainen geeft meer effect. Dr. Peter Klijn Klinisch inspanningsfysioloog Bewegingswetenschapper Disclosure belangen spreker (potentiële) Belangenverstrengeling Geen

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3 Skinner et al., the HERITAGE Family Study. J Appl Physiol 90 (5) 2001 Skinner et al., the HERITAGE Family Study. J Appl Physiol 90 (5) 2001 Hubal et al., Variability in muscle size and strength Med Sci Sports Exerc

4 Davidsen et al., High responders to resistance training. J Appl Physiol Non-responders Hubal et al., Variability in muscle size and strength Med Sci Sports Exerc

5 Traditional endurance and progressive resistance training Bernard et al 1999 Endurance 80% Wpeak (HI) Strength 60-80% 1-RM; 2-3 x (8-10) reps >10 reps / set increase in load Ortega et al 2002 Endurance 70% Wpeak Strength 70-85% 1-RM; 4 x (6-8) reps; 1-RM every 2-wks Combined 70% Wpeak / 70-85% 1-RM; 2 x (6-8) reps Spruit et al 2002 Endurance 30-75% Wpeak; 10->25 min 60% 6MWD speed ; 10->20 min Strength 70% 1-RM; 3 x 8 reps 2min walk 60% 6MWD speed Mador et al 2004 Endurance Cycling: 50% Wpeak; 20 min 10% increase workload Walking: mph Combined Cycling: 50% Wpeak; 20 min Walking: mph Strength: 60% 1-RM; 1-> 3 sets x 10 reps 3 sets without difficulty 5lb increase Optimal intensity and type of leg exercise training for people with chronic obstructive pulmonary disease (Review) Zainuldin R, Mackey MG, Alison JA; 2011, Issue 11

6 Needs analysis An assessment of factors that determine the specific training program appropriate for an individual. Physiological requirements Biomechanical requirements Individual deficiencies Nonlinear exercise training in advanced COPD is superior to traditional exercise training: a randomized trial. Peter Klijn, Anton van Keimpema, Monique Legemaat, Rik Gosselink, and Henk van Stel. Inspanningstraining bij ernstige COPD. Minder hard trainen geeft meer effect. Peter Klijn, Monique Legemaat, Anton van Keimpema, Rik Gosselink, en Henk van Stel. Klijn et al; Am J Resp Crit Care Med 2013, 188(2); Klijn et al; Ned Tijdschr Geneesk 2013, 135(57).

7 VVMi < 16 kg/m 2 mannen VVMi <15 kg/m 2 vrouwen Randomisatie N=110 Stratificatie VVMi 16 kg/m 2 mannen VVMi 15 kg/m 2 vrouwen Randomisatie A1 A2 B1 B2 N=33 N=34 N=22 N=21 60±7.1jaar 61.3±5.8jaar 61.9±5.3jaar 61.3±6jaar FEV 1 %pred 30.6±9.2 FEV 1 %pred 32.7±9.7 FEV 1 %pred 34.6±9 FEV 1 %pred 31.2±9 FFMi (kg/m 2 ) 13.7±1.0 FFMi (kg/m 2 ) 13.9±1.0 FFMi (kg/m 2 ) 18.1±1.6 FFMi (kg/m 2 ) 17.4±1.6 Doel van de studie Onderzoek effecten van NLPE-training t.o.v. EPR op de sub-maximale fietsduur en ziektespecifieke kwaliteit van leven bij patienten met ernstig COPD. Endurance fietstest (CWT) 75% Wmax CRQ

8 Endurance and Progressive Resistance training loopband 10 min, 60% 6MWD speed 15 min, 70-80% 6MWD speed Fietsergometer 10 min, 30% W peak 25 min, 70-80% W peak chest press, pull down, leg press, leg extension 2 series, [8-10] herhalingen, 50% 1-RM 3 series, [8-10] herhalingen Progressie: 60-80% 1-RM Bernard et al 1999; Ortega et al 2002; Spruit et al 2002; Mador et al 2004 Progressive overload Klijn et al; Ned Tijdschr Geneesk 2013, 135(57).

9 Endurance training Borg AH < 5: intensity increase Borg AH 5-6: intensity unchanged Borg AH 7 or HR approached maximum reached during CPET: intensity decrease Intensity also adjusted in the presence of adverse symptoms: general fatigue, chest or leg discomfort Maltais et al; Am J Resp Crit Care Med 1997 Basic Models of Periodization Linear Periodization Model Reverse linear periodization model Nonlinear (Undulating) Model of Periodization

10 Periodization Periodization Cycles Macrocycle Extended training period (1 year) Divided into different mesocycles Mesocycle Several weeks to months of training Divided into different microcycles Microcycle 5-10 days to 4 weeks tijd tijd

11 Needs analysis Physiological requirements Aerobic energy system Anaerobic energy system Leg endurance Leg strength Biomechanical requirements Knee and hip muscles Many submaximal contractions Individual deficiencies

12 Principle of orderly recruitment Cerny & Burton. Exercise physiology for health care professionals Serres et al., Chest 113(4), 1998 Mador et al., Am J Respir Crit Care Med 168(1) 2003 Van t Hul et al., Muscle Nerve 29(2) 2004 Janaudis-Ferreira et al., Respir Med 100(8) 2006 Beachle and Earle. Essentials of strength training and conditioning. 2008

13 Trainingsvariabelen Muscle action Number of repetitions Frequency Load increase Loading Repetition velocity Resistance training Mechanical work (ROM) volume Time-under-tension Rest periods Exercise order Exercise selection Adapted from: Crewther et al, Sports Med 2005; Bird et al, Sports Med 2005; Toigo & Boutellier, EJAP 2006; ACSM, Med Sci Sports Exerc 2009; Burd et al., J Physiol 2012 Niet-lineair geperiodiseerde training Volume Intensity Rest 1-3 x (3-10) min 60% W peak 1-3 min HI 4x4 min 80-90% W peak 3 min active rest 50%W peak (15-30) x 30 sec >95% W peak 30 sec 4-8 x (2-7)min 65-80% W peak 2-5 min 6-10 x (90-120)sec 85-95% W peak 1-3 min Compensation cycling following an anaerobic exercise session 1 x (5-10) min 50% W peak Klijn et al; Am J Resp Crit Care Med 2013, 188(2)

14 Hawley et al., Molecular responses to strength and endurance training: are they incompatible? Appl Physiol Nutr Metab; Nonlinear exercise training Energy system cycle training Resistance training repetition zones Goal Repetition range goal Aerobic 20 Muscular endurance Anaerobic Strength Klijn et al; Am J Resp Crit Care Med 2013, 188(2)

15 Monitoring Hoe kortademig / benauwd bent u op dit moment? 0 niet 0,5 heel heel licht 1 heel licht 2 licht 3 matig 4 matig erg 5 erg 6 7 heel erg 8 9 heel heel erg 10 maximaal Hoe vermoeid bent u op dit moment? 0 niet 0,5 heel heel licht 1 heel licht 2 licht 3 matig 4 matig erg 5 erg 6 7 heel erg 8 9 heel heel erg 10 maximaal Hoe zwaar vindt u deze oefening? 0 niet voelbaar 0,5 heel heel licht 1 heel licht 2 licht 3 matig 4 matig zwaar 5 zwaar 6 7 heel erg zwaar 8 9 heel heel erg zwaar 10 maximaal Cycle endurance (seconds) Cycle endurance (seconds) EPR-depleted NLPE-depleted Baseline 6 weeks 12 weeks Measurement Baseline Measurement 12 weeks EPR-nondepleted NLPE-nondepleted CWT EPR (n=55) NLPE (n=55) Verschil (95%BI) dyspneu 6,4 5,5-0,9 (-1,6 - -0,1) vermoeidheid benen 6,5 4,7-1,8 (-2,6 - -1,0) CRQ-score dyspneu +0,94 +1,90 0,96 (0,57 1,35) vermoeidheid +0,90 +1,64 0,74 (0,39 1,10) emoties +0,83 +1,32 0,48 (0,19 0,78) beheersing +0,87 +1,39 0,52 (0,21 0,84)

16 One size fits all Tailoring to the individual Training smart not just hard!