Nurse Managed: Sequential Resistance then Aerobic Training in COPD

描述（由申请人提供）：慢性阻塞性肺疾病（COPD）患者的骨骼肌力量和耐力下降，导致过早残疾。肺康复，特别是有氧运动训练，是公认的改善功能能力和减轻痛苦症状的方法。但是患有严重到非常严重疾病的人通常很难达到更高强度的有氧运动训练。阻力训练可以提高肌肉力量，因此人们使用有氧训练的总力量的一小部分。这可以使这些人在更高的有氧强度下训练，而感知到的努力更少。本研究提出了一种新的方法，肺康复。将采用序贯方法，而不是同时进行有氧运动和阻力运动（这是典型的临床实践），COPD受试者将接受8周的阻力训练，重点是下半身，然后进行8周的有氧运动训练。该研究探讨了有氧训练前的下半身阻力训练是否比单独的有氧训练或同时进行有氧训练加阻力训练与功能状态的更大收益相关。在这项实验性研究中，138名重度/极重度COPD患者将被随机分配到3个护士管理的培训组之一：1.序贯训练组，包括8周的阻力训练，随后是8周的有氧运动训练（S-RAT，阻力和有氧训练序贯进行），2.对照组，包括8周的“假”训练，随后8周的同时有氧训练加阻力训练（Control-C-RAT，阻力和有氧训练同时进行），和3.对照组包括8周的“假”训练，随后是8周的有氧训练（对照-AT，单独的有氧训练）。Control-C-RAT组控制运动训练（有氧训练加阻力训练）的总剂量，并提供肺康复的常用方法，例如同时采用训练方式。Control-AT组控制与研究人员的接触量，并提供“标准护理”，例如有氧训练。将在研究入组时、第8周后和第16周后评估以下因变量：1.有氧运动能力，2.外周肌肉质量，力量，耐力，3。呼吸困难和疲劳的症状，4。功能状态该计划采用了一种新的肺康复方法：在开始有氧运动训练之前进行下体阻力训练，以最大限度地改善运动耐受力，症状和身体活动的功能表现。这些知识将被临床医生用于设计COPD患者的肺康复计划，特别是更严重的残疾人。

DESCRIPTION (provided by applicant): People with chronic obstructive pulmonary disease (COPD) experience decreased strength and endurance of the skeletal muscles which contributes to premature disability. Pulmonary rehabilitation, in particular aerobic exercise training, is a recognized approach for improving functional capacity and lessening distressing symptoms. But people with severe to very severe disease often have difficulty achieving higher intensities of aerobic exercise training. Resistance training can improve muscular strength so people use a smaller fraction of their total strength with aerobic training. This could enable these people to train at a higher aerobic intensity with less perceived effort. This study proposes a novel approach to pulmonary rehabilitation. Rather than concurrently train people with both aerobic and resistance exercise which is typical clinical practice, a sequential approach will be employed whereby COPD subjects will receive 8 weeks of resistance training focused on the lower body, followed by 8 weeks of aerobic exercise training. The study examines whether lower body resistance training prior to aerobic training is associated with greater gains in functional status than aerobic training alone or concurrent aerobic plus resistance training. In this experimental study 138 people with severe/very severe COPD will be randomized to 1 of 3 nurse-managed training groups: 1. a sequential training group comprised of 8 weeks of resistance training followed by 8 weeks of aerobic exercise training {S-RAT, resistance and aerobic training conducted sequentially), 2. a control group comprised of 8 weeks of 'sham' training followed by 8 weeks of concurrent aerobic training plus resistance training (Control-C-RAT, resistance and aerobic training conducted concurrently), and 3. a control group comprised of 8 weeks of 'sham' training followed by 8 weeks of aerobic training (Control-AT, aerobic training alone). The Control-C-RAT group controls for the total dose of exercise training (aerobic training plus resistance training) and provides the usual approach to pulmonary rehabilitation, e.g. concurrent employment of training modalities. The Control-AT group controls for the amount of contact with research staff and provides the 'standard of care', e.g. aerobic training. The following dependent variables will be assessed at study entry, after week 8, and after week 16: 1. aerobic exercise performance, 2. peripheral muscle mass, strength, endurance, 3. symptoms of breathlessness and fatigue, 4. functional status. This program employs a novel approach to pulmonary rehabilitation: lower body resistance training prior to initiating aerobic exercise training in order to maximize improvements in exercise tolerance, symptoms, and functional performance of physical activities. This knowledge will be used by clinicians in designing pulmonary rehabilitation programs for people with COPD, especially more severely disabled people.