Upper Body Strength Training in COPD

描述（由申请人提供）：中重度慢性患者

DESCRIPTION (provided by applicant): People with moderate to severe chronic obstructive pulmonary disease (COPD) experience intense symptoms of dyspnea when they use their arms and shoulders. To control the dyspnea people avoid the use of their upper extremities and ultimately experience a significant loss of upper body (UB) strength and a decrease in functional performance, reflected by a decrease in the level of activities performed on a daily basis. The purpose of this research is to examine the effects of UB strength training with a self-efficacy intervention to enhance adherence. This is an experimental study with random assignment of subjects to one experimental and two control groups: (a) UB strength training with self-efficacy intervention (experimental), (b) UB strength training with health education (control 1) and (c) armchair fitness exercises with health education (control 2). The interventions are four months in duration with three booster sessions scheduled during a 12 month follow up period. Each subject will be studied for a total of 16 months. The primary specific aims are to compare the short (4 months) and long term (12 months after termination of structured training) effects of the above interventions in terms of the following dependent variables: UB strength (one-repetition maximum), dyspnea during physical activities (Chronic Respiratory Disease Questionnaire) and functional performance (Functional Performance Inventory). Secondary aims are to examine the effects in terms of inspiratory muscle strength, exercise-related self-efficacy, and adherence to UB strength training. Additionally dual energy x-ray absorptiometry will be used to document changes in UB muscle mass (fat free soft tissue). Dual accelerometers (arm and waist) will be used to verify self-report of exercise adherence at home during the 12 months follow-up. The sample will be 120 people with moderate to severe COPD who experience dyspnea with UB activities, 40 per group. Researchers performing strength tests will be blinded to group assignment. This research is innovative in that it examines the effects of a comprehensive upper body strength training with weight lifting (8 exercises) and combines it with a theory-based self-efficacy intervention to promote adherence to training. This is important because people with COPD experience exacerbations that adversely affect adherence. Previous research in this area does not address the effect of multiple weight lifting exercises and long-term adherence.