Ausdauertraining bei chronischen MSK-Schmerzen: Ein oft vergessener Therapiepfeiler?

Hintergründe

Klassischerweise konzentrieren sich unsere trainingstherapeutischen Ansätze bei muskuloskelettalen Beschwerden stark auf eine Muskelkräftigung bzw. eine koordinative Verbesserung im betroffenen Bereich.1 Ein strukturiertes Ausdauertraining, das der Patient in Eigenregie durchführen kann, ist aber gerade bei chronischen Schmerzpatienten ein häufig vergessener Therapiepfeiler. Eine aktuelle RCT zeigt beispielsweise für chronische Nackenschmerzpatienten, dass ein zusätzliches selbstständig durchgeführtes Walking- oder Cycling-Programm über min. 30 min., 2x/Woche, zu deutlich besseren Ergebnissen im Vergleich zu einem alleinigen Dehnungs-/Kräftigungsprogramm führt, gerade auch in längerfristiger Hinsicht.4

Die irische SWIFT-Studie kam zu dem Ergebnis, dass ein individualisiertes Walking-Programm bei chronischen Rückenschmerzpatienten nicht schlechter als eine übliche PT-Behandlung oder ein intensives Gruppentraining wirkt.5

Zudem betonen u.a. die aktuellen Bewegungsempfehlungen der WHO13 die wichtige Rolle eines Ausdauertrainings (in Kombination mit einem Krafttraining) für die menschliche Gesundheit.  Gerade chronische Schmerzpatienten sind häufig inaktiver12, besitzen ein höheres Mortalitätsrisiko7,8 und weisen Komorbiditäten auf 6,9,10,11 , sodass uns hier als „die Stimme aktiver Behandlungsansätze“ auch im Sinne der Förderung von mehr genereller körperliche Aktivität (physical activity promotion) eine wichtige Aufgabe zukommt.14,15

ZEIT ALSO, DIE MÖGLICHEN EFFEKTE VON AUSDAUERTRAINING BEI SCHMERZPATIENTEN GENAUER ZU BETRACHTEN…

ES GIBT EVIDENZ DAFÜR, DASS AEROBES TRAINING DIE FOLGENDEN EFFEKTE HAT….

  • Verbesserung des Schlafes27,28,2930
  • Verbesserung der Alltagsmotorik39
  • Verbesserung der Gedächtnisfunktion40,41,65
  • Normalisierung von Cortisolveränderungen66
  • Verbesserung der Funktion des Immunsystems33,43,52, 54,55,67
  • Verbesserung der kardiopulmonalen Fitness & – Gesundheit68,69
  • Reduktion des Verlusts an grauer Substanz und Verbesserung der Gehirngesundheit 31,70
  • Aerobes Training an sich trägt dazu bei, Schmerzen zu lindern, was zu einer sofortigen Hypoalgesie nach dem Training führen kann.19, 20,21,23,24,25,26,71,72
  • Verringerung chronischer Entzündungen43,73,74,75
  • Verminderung von Ängsten76-78
  • Reduktion von Depressionssymptomen und Verbesserung der Stimmung 21.56-59,60,61,71
  • Ausdauertraining ist in dieser Hinsicht genauso wirksam wie Antidepressiva. 81,82
  • Verringerung der Sensitivität des Nervensystems mit neuroprotektiver und neuroregenerativer Wirkung bei Neuropathien 64,79, 80
  • Verbesserung der  Lebensqualität83,84
  • Reduktion von Fatigue85
  • Wichtig für die Prävention86  bzw. Therapie 87 von min. 35 bzw. 26 Erkrankungen und pathologischen Zuständen.

Welche Belastungsparameter kann man im Ausdauertraining von chronischen Schmerzpatienten nutzen?

In Anlehnung an Leitlinien der WHO13 bzw. des ACSM88 empfehlen Booth et al.3 in einem pragmatischen Ansatz nach dem FITT-Prinzip folgende Belastungsparameter und Progressionsstrategien bei Patienten mit chronischen MSK-Beschwerden…

Aerobes TrainingIntensität entsprechend der Herzfrequenzbereiche: Geringe Intensität: 40-<64% der HF max bzw. 30-39% der HF-R Moderate Intensität: 64-76% der HF max bzw. 40-59% der HF-R Hohe Intensität: 77-95% der HF max bzw. 60-89% der HF-R
Frequenz? 2 Einheiten/Woche; ? 6 Wochen
IntensitätGeringe Intensität (RPE 8–11) bis moderate Intensität (RPE 12–13). Hohe Intensität (RPE 14–17) als Ziel bei Belastungen  mit hohen Anforderungen in Beruf,  Sport oder Hobby
Zeit20–60 min und <20 min bei Belastungsintoleranz. Wähle evtl. kürzere Intervalle  mit Unterbrechung durch andere Trainingsmodalitäten( z.B:  3 × 7 min Gehen mit Krafttraining in der Pause)
HF-R: Herzfrequenzreserve=max. Herzfrequenz (Hfmax.) – Ruheherzfrequenz
Aerobes TrainingIntensität entsprechend der Herzfrequenzbereiche: Geringe Intensität: 40-<57% der HF max bzw. 30-39% der HF-R Moderate Intensität: 64-76% der HF max bzw. 40-59% der HF-R Hohe Intensität: 77-95% der HF max bzw. 60-89% der HF-R
ArtBewegungsformen, die kontinuierliche und rhythmische Aktivitäten beinhalten, und die Hauptmuskelgruppen beanspruchen, allerdings die Symptome nicht exazerbieren (z.B. Walking, Joggen, Schwimmen, Tanzen usw.)
ProgressionBeginn mit einem subjektiven Belastungsempfinden von RPE 8-10 bis RPE 11-13, wenn die Toleranz zunimmt; RPE ?14 für hochintensives Training (s. nächste Slide). Erhöhe die Dauer vor der Intensität (z.B. beim Gehen auf dem Laufband die Dauer und die Gehgeschwindigkeit vor der Steigung)
HF-R: Herzfrequenzreserve=max. Herzfrequenz (Hfmax.) – Ruheherzfrequenz

Trainingssteuerung – RPE-Skala,

WertSubjektiv
6Keine Anstrengung
7Extrem leicht
8
9Sehr leicht
10
11Leicht
12
13Etwas schwer
14
15schwer
16
17Sehr schwer
18
19Extrem schwer
20Maximale Ausbelastung

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