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

描述(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，是美国第四大主要死亡原因。尽管进行了药物治疗和手术治疗，但COPD的发病率仍然很高，患者存在运动耐受和体力活动减少，这些都是导致病情恶化、住院和死亡的独立危险因素。肺康复(PR)已被证明可以改善呼吸困难的症状，改善与健康相关的生活质量，运动能力和国家指南现在建议所有COPD患者参与此类计划。不幸的是，最初康复后的长期锻炼依从性非常差，很明显，如果患者不继续锻炼，在PR期间获得的好处会迅速减少。仍然迫切需要新的干预措施，既可以维持PR后定期锻炼的好处，又可以促进COPD患者在康复后的长期锻炼坚持和锻炼自我效能。太极是一种流行的身心健康运动，它结合了中低强度的身体活动、自我意识、放松和冥想的慢呼吸。它可能特别适合患有运动耐量有限和呼吸困难的慢性阻塞性肺病患者。重要的是，太极拳运动综合了PR(有氧运动、上肢和下肢训练、呼吸和压力管理)的几个关键要素，成为一项相对低成本和可获得的活动。对不同人群的研究表明，太极可以提高运动能力、生活质量，并提高运动自我效能；与传统运动方式相比，坚持太极可能是有利的。在这项应用中，我们提出了一项针对COPD患者(N=126)的三臂随机对照试验，以评估六个月的太极锻炼与集体步行的益处，以及在完成标准的、有监督的PR后保持临床改善的自我锻炼(标准护理)的一般建议。我们的主要目标将是调查太极能否在PR后三个月和六个月保持运动能力的增长。次级目标将检查生活质量、呼吸困难、情绪、日常生活活动，以及锻炼自我效能、干预坚持和总体活动。长期跟踪评估将在1年内进行。拟议项目的结果有可能通过提供一种新的战略来改变COPD患者的临床护理，该战略可能会大幅扩大PR的好处，并促进这一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.