[Therapeutic effects of physical training in patients with chronic respiratory insufficiency]

The therapeutic benefits of physical training for patients with chronic respiratory insufficiency must be assessed on the clinical, physiopathological and sociopsychological planes. As far as the clinical state is concerned, one observes a reduction of dyspnea and of the frequency of hospitalizations and an increase in the level of daily activity. On the physiopathological point of view, one observes an increase in the maximal capacity of exercise ranging from 1 to 33% resulting mostly from a better peripheral oxygen extraction. Pulmonary function is little modified on the spirographic level; however, one observes an improvement of blood gases at rest which seems to result from better alveolar ventilation. No systematic change in the circulatory variables is reported, except for a reduction of the PPA at rest. About the psychological factors, one observes a reduction of anxiety and an increase in motivation to perform muscular exercise. These results are difficult to obtain and often require a long rehabilitation. Socially, numerous obstacles are encountered to a social reinstatement : a relatively advanced age, a disadvantaged social environment, a low cultural level and an affectively weak surrounding. The solution to these different problems must be sought for each individual and the rehabilitation must be pursued continually; this often necessitates the hospitalization of the patient in a rehabilitation institute. On the basis of these studies, it seems certain that physical training is beneficial to patients with chronic respiratory insufficiency. However different programmes should be proposed for patients in an advanced or intial stage of their illness.