[Impact of exercise, sport and rehabilitation therapy in asthma and COPD]

Patients with chronic obstructive pulmonary disease (COPD) and Asthma share increased physical inactivity as a characteristic and risk factor for the aggravation of their symptoms and marker of their health condition, respectively. Physical inactivity may be objectively measured by means of accelerometry superior to questionnaires. Physical inactivity is the reason for a reduced endurance capacity and a reduction of strength with concomitant decrease of skeletal muscle mass aggravating inflammation as a common pathophysiologic soil. Endurance training is recommended in the form of continuous and interval training having similar effects on endurance capacity executed on either a bike or as walking in patients with COPD und Asthma. Walking inherits the potential additional benefit of a reduction of fall risk which needs additional scientific evidence. This holds true especially for elderly subjects. Strength training is important because of the frequently atrophied skeletal musculature, which triggers the increase of the exercise-induced ventilation by early lactate acidosis and thereby aggravates dyspnea during exercise. An important aspect of therapy is the maintenance of the individualized training after discharge from hospital in the domestic environment taking into consideration training facilities, encounter groups and social circumstances. The objective measurement of physical activity has the potential to guide and control therapy. Because of the frequently present cardio-metabolic comorbidities the assessment of the exercise capacity as well an evaluation of nutrition should be included into a holistic therapeutical approach. An optimized bronchospasmolytic and anti-inflammatory therapy is the basis for a sufficient response to exercise training. In patients with asthma, a warm-up phase of at least 15 min prior to exercise is recommended. Redundant fear of exercise-induced attacks of asthma shall be avoided by doing so. If necessary, additional psychological support should be given.