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，这是导致过早残疾的原因。肺康复，特别是有氧运动训练，是公认的提高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，所以人们在有氧训练中只使用较小比例的总力量。这可以使这些人以更低的体力进行更高的有氧强度训练。这项研究提出了一种新的肺康复方法。COPD患者将接受8周的下半身阻力训练，然后再接受8周的有氧运动训练，而不是像典型的临床实践那样同时进行有氧运动和阻力运动训练。这项研究考察了在有氧训练之前进行较低的身体阻力训练是否与单独进行有氧训练或同时进行有氧加阻力训练相比，功能状态的改善更大。在这项实验研究中，138名重度/特重型COPD患者将被随机分成3个由护士管理的训练组：1.序贯训练组，由8周的抗阻训练和8周的有氧运动训练(S，依次进行抗阻和有氧训练)组成；2.对照组，由8周的假训练和8周的同时进行的有氧训练+耐力训练(Control-C-大鼠，抗阻和有氧训练同时进行)组成；3.对照组，包括8周的‘假’训练和8周的有氧训练(Control-AT，仅进行有氧训练)。对照-C-大鼠组控制运动训练的总剂量(有氧训练和阻力训练)，并提供通常的肺康复方法，例如同时使用各种训练方式。Control-AT小组控制与研究人员的接触数量，并提供“护理标准”，例如有氧训练。以下相关变量将在研究开始时、8周后和16周后进行评估：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较低的身体阻力训练，以最大限度地改善运动耐量、症状和体力活动的功能表现。临床医生将利用这些知识为COPD患者，特别是更严重的残疾人设计肺康复计划。

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.