Clinical and Autonomic Effects of Mind-Body Exercise in COPD

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。尽管有药物和手术治疗，慢性阻塞性肺病仍然引起相当大的发病率和死亡率，并且是十大疾病中唯一一个患病率持续增加的主要疾病。我们需要能够改善症状、健康相关生活质量、功能能力并可能改变疾病进展的新型廉价干预措施。太极拳是一种流行的身心运动，结合了温和的身体活动，自我意识，放松和缓慢的身心呼吸。它可能特别适合患有慢性阻塞性肺病的人，他们的运动耐受性有限，运动时呼吸短促，它整合了与慢性阻塞性肺病管理相关的多个组成部分，包括低强度有氧运动、压力管理和缓慢的身心呼吸训练。在本应用中，我们提出了一项三组随机对照试验（N=102），以评估太极拳运动（包括身心呼吸）与静坐身心呼吸（综合太极拳计划的一个孤立的关键组成部分）与教育控制的益处。这种设计将使我们能够检查每种身心干预对慢性阻塞性肺病临床结果的个体疗效，但也将允许在两种干预之间进行临床和生理比较，从而深入了解身心治疗的组成部分和机制。COPD（全球阻塞性肺疾病1-3期，伴有呼吸困难症状）患者将从门诊初级保健和肺病诊所招募。我们的主要目的是研究太极拳和身心呼吸对这一人群的生活质量和运动能力的影响。次要目的将进一步探讨对临床症状、社会心理指标、心肺功能、力量和柔韧性、全身炎症的生物标志物和自主神经活动的影响。我们提出的研究结果将有助于为慢性阻塞性肺病的临床治疗提供信息，并进一步加深我们对身心锻炼和缓慢身心呼吸作用的机制理解。

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 mortality and is the only major disease among the top ten that continues to increase in prevalence. Novel and inexpensive interventions that can improve symptoms, health-related quality-of-life, functional capacity, and potentially modify disease progression are needed. Tai chi is a popular mind-body exercise that combines gentle physical activity, self awareness, and relaxation with slow mind-body breathing. It may be particularly suited to deconditioned individuals with COPD, who suffer from limited exercise tolerance and shortness of breath on exertion, and it integrates multiple components relevant to COPD management, including low-intensity aerobic exercise, stress management and slow mind-body breathing training. In this application, we propose a 3-arm randomized controlled trial (N=102) to evaluate the benefits of tai chi exercise (which includes mind-body breathing) versus seated mind-body breathing alone (an isolated, key component of the comprehensive tai chi program) versus education control. This design will allow us to examine the individual efficacy of each mind-body intervention on clinical outcomes in COPD, but will also allow clinical and physiological comparisons between the two interventions, providing insight into the components and mechanisms of mind-body therapies. Patients with COPD (Global Obstructive Lung Disease stages 1-3 with symptoms of dyspnea) will be recruited from outpatient primary care and pulmonary clinics. Our primary aim will be to examine the effects of tai chi and mind-body breathing on quality-of-life and exercise capacity in this population. Secondary aims will further explore the effects on clinical symptoms, psychosocial indices, cardiopulmonary function, strength and flexibility, biomarkers of systemic inflammation, and autonomic activity. The results of our proposed research will help inform clinical treatment of COPD, and further our mechanistic understanding of mind-body exercises and the role of slow, mind-body breathing. PUBLIC HEALTH RELEVANCE: Chronic obstructive pulmonary disease (COPD) is a major public health problem and is the fourth leading cause of death in the United States. This proposed study examines tai chi, a promising mind- body exercise, and one of its key components, slow mind-body breathing, that may be particularly relevant and beneficial to patients with COPD. The results of this study will help inform clinical treatment of COPD, and further our mechanistic understanding of mind-body therapies in general and the role of slow mind-body breathing.