The relationship between exercise capacity and different functional markers in pulmonary rehabilitation for COPD.
The relationship between exercise capacity and different functional markers in pulmonary rehabilitation for COPD.
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DOI：
10.2147/copd.s153525
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发表时间：
2018
影响因子：
2.8
通讯作者：
Varga JT
中科院分区：
文献类型：
--
作者：
Kerti M;Balogh Z;Kelemen K;Varga JT
肺力学、胸部运动学、代谢、外周肌和呼吸肌功能等功能参数与运动耐量水平的关系一直是一个有争议的话题。虽然先前的研究表明，肺部康复能够改善COPD患者的运动耐量，如6分钟步行测试（6MWT）的值所表达的那样，但上述每个参数对这种变化的贡献程度尚不清楚。探讨COPD肺康复后运动能力变化与其他功能指标的相关性，确定哪些参数与运动耐量的改善关系更密切。327例COPD患者（预测第一秒用力呼气量[FEV1]平均95% CI: 45%[25%-83%]，年龄：64[48-80]岁，BMI: 27 [13.5-40.4] kg/m2）参与本研究。30%的患者合并肺动脉高压。患者接受为期4周的肺部康复治疗，每次20-30分钟，每天2 - 3次。该计划包括胸壁伸展，控制呼吸练习，以及自行车和跑步机使用的个性化训练计划。测量6MWT、肺功能、胸壁扩张、握力、最大吸气压力、屏气时间。计算体重指数、气流阻塞、呼吸困难和运动能力（BODE-index）、体重指数[BMI]、FEV1、6MWT、改良医学研究呼吸困难量表评分和备选量表评分（BMI、FEV1、6MWT和COPD评估测试）。康复治疗导致患者6MWT的普遍改善（平均：360 [95% CI: 178-543 m] vs平均：420 [95% CI: 238-601 m]， p<0.05）。运动耐量的改善与复合bode指数（R2=−0.6）、替代量表（R2=−0.56）、呼吸困难评分（改良的医学研究呼吸困难量表R2=−0.54）和健康状况（COPD评估测试R2=−0.4,p<0.05）的变化最为密切相关。此外，运动耐量的改善被发现与吸气肺活量的改善中度相关（IVC, R2=0.34, p<0.05）。康复后IVC的变化与握力（R2=0.6）和胸部扩张（R2=0.48）有关。运动耐量的增强与IVC、bode指数和新的替代量表的变化相关。然而，综合评估需要考虑胸部运动学、外周肌和呼吸肌功能。
The relationship of functional parameters such as lung mechanics, chest kinematics, metabolism and peripheral and respiratory muscle function with the level of exercise tolerance remains a controversial subject. While it has been previously shown that pulmonary rehabilitation is capable of improving exercise tolerance in patients afflicted by COPD, as expressed by values of 6-minute walking test (6MWT), the degree of contribution to this change by each of the aforementioned parameters remains unclear. To investigate the correlation between changes in exercise capacity and other functional markers following pulmonary rehabilitation in COPD and to determine which parameters are more closely related to improvements of exercise tolerance. Three hundred and twenty-seven patients with COPD (with average, 95% CI for forced expiratory volume in the first second [FEV1]: 45% [25%–83%] predicted, age: 64 [48–80] years, and BMI: 27 [13.5–40.4] kg/m2) participated in this study. Thirty percent of the patients had pulmonary hypertension as comorbidity. Patients underwent a pulmonary rehabilitation program with 20–30 minutes sessions two to three times per day for 4 weeks. The program was composed of chest wall-stretching, controlled breathing exercises, and a personalized training schedule for cycling and treadmill use. Measurements of 6MWT, lung function, chest wall expansion, grip strength, maximal inspiratory pressure, and breath holding time were taken. The Body mass index, airflow Obstruction, Dyspnea and Exercise capacity (BODE-index), body mass index [BMI], FEV1, 6MWT, modified Medical Research Dyspnea Scale score, and an alternative scale score (for BMI, FEV1, 6MWT, and COPD Assessment Test) were calculated. Rehabilitation resulted in a generalized improvement in 6MWT among patients (average: 360 [95% CI: 178–543 m] vs average: 420 [95% CI: 238–601 m], p<0.05). Improvements in exercise tolerance were found to be most closely associated with changes in composite BODE-index (R2=−0.6), Alternative Scale (R2=−0.56), dyspnea score (modified Medical Research Dyspnea Scale R2=−0.54), and health status (COPD Assessment Test R2=−0.4, p<0.05). In addition, improvements in exercise tolerance were found to moderately correlate with improvements in inspiratory vital capacity (IVC, R2=0.34, p<0.05). Post-rehabilitation changes in IVC displayed a connection with grip strength (R2=0.6) and chest expansion (R2=0.48). Enhancements in exercise tolerance had correlation with changes in IVC, BODE-index, and the new Alternative Scale. However, comprehensive assessment needs to include considerations of chest kinematics and peripheral and respiratory muscle function as well.