Tai Chi after Pulmonary Rehabilitation in Patients with COPD: A Randomized Trial

描述（由申请人提供）：慢性阻塞性肺疾病（COPD）是一个主要的公共卫生问题，是美国第四大死亡原因。尽管进行了药物和手术治疗，COPD仍然导致相当大的发病率，患者遭受运动不耐受和体力活动减少，这是加重、住院和死亡的独立危险因素。和运动能力，国家指南现在建议所有COPD患者参加这些项目。不幸的是，初始康复后的长期运动坚持性非常差，很明显，如果患者不继续运动，PR期间获得的益处会迅速减少。仍然迫切需要新的干预措施，可以维持PR后定期运动的益处，以及促进COPD患者康复后长期运动依从性和运动自我效能。 太极拳是一种流行的身心运动，它结合了中低强度的身体活动，自我意识，放松和冥想式的缓慢呼吸。它可能特别适合于患有COPD的去适应个体，这些个体患有有限的运动耐量和呼吸困难。重要的是，太极拳运动将PR的几个关键要素（有氧运动，上肢和下肢训练，呼吸和压力管理）综合成一个相对低成本和可获得的活动。对不同人群的研究表明，太极拳可以提高运动能力，生活质量，促进运动自我效能;与传统的运动方式相比，坚持可能是有利的。 在本申请中，我们提出了一项在COPD患者（N=126）中进行的三组随机对照试验，以评估6个月太极拳运动与团体步行相比以及自我锻炼的一般建议的益处（标准治疗）在完成标准治疗后保持临床改善，我们的主要目的是调查太极拳是否可以在PR后三个月和六个月保持运动能力的增加。次要目的是检查生活质量，呼吸困难，情绪，日常生活活动，以及运动自我效能，干预坚持性和整体活动。将在1年时进行长期随访评估。拟议项目的结果有可能通过提供一种新的策略来改变COPD患者的临床护理，该策略可能会大大延长PR的益处，并促进该人群的持续体力活动。

DESCRIPTION (provided by applicant): Chronic obstructive pulmonary disease (COPD) is a major public health problem and is the fourth leading cause of death in the United States. Despite pharmacologic and surgical therapy, COPD continues to cause considerable morbidity, and patients suffer from exercise intolerance and decreased physical activity, which are independent risk factors for exacerbations, hospitalizations, and mortality.Pulmonary rehabilitation (PR) has been shown to improve symptoms of dyspnea, health-related quality of life, and exercise capacity and national guidelines now recommend that all patients with COPD participate in such programs. Unfortunately, long-term exercise adherence after initial rehabilitation is very poor, and it is clear that benefits gained during PR diminish rapidly if patients do not continue to exercise. There remains a critical need for novel interventions that may sustain the benefits of regular exercise after PR, as well as promote long-term exercise adherence and exercise self-efficacy in the post-rehabilitation period in patients with COPD. Tai chi is a popular mind-body exercise that incorporates low-moderate intensity physical activity, self awareness, relaxation, and meditative slow breathing. It may be particularly suited to deconditioned individuals with COPD who suffer from limited exercise tolerance and dyspnea. Importantly, tai chi exercise comprehensively integrates several key elements of PR (aerobic exercise, upper and lower extremity training, breathing, and stress management) into one relatively low-cost and accessible activity. Studies in varied populations have suggested that tai chi can improve exercise capacity, quality of life, and promote exercise self-efficacy; and that adherence may be favorable when compared to conventional exercise modalities. In this application, we propose a three-arm randomized controlled trial in patients with COPD (N=126) to evaluate the benefits of six months of tai chi exercise, versus group walking, versus general recommendations for self-exercise (standard care) in maintaining clinical improvements after the completion of standard, supervised PR. Our primary aim will be to investigate whether tai chi can maintain gains in exercise capacity three and six months after PR. Secondary aims will examine quality of life, dyspnea, mood, activites of daily living, as well as exercise self-efficacy, intervention adherence and overall activity. Long-term follow-up assessment will be conducted at 1 year. The results of the proposed project have the potential to transform the clinical care of patients with COPD by providing a new strategy that may substantially extend the benefits of PR and promote continued physical activity in this population.