Improving exercise capacity in chronic obstructive pulmonary disease patients through uphill walking

上坡步行提高慢性阻塞性肺疾病患者的运动能力

• 批准号: 9885096
• 负责人: DEBRA J ROMBERGER
• 金额: --
• 依托单位: OMAHA VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2021-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9885096
• 关键词: Address; Air; Applications Grants; Award; Biological Rhythm; Breathing; Cardiopulmonary; Cause of Death; Chronic Obstructive Airway Disease; Complex; Coupled; Coupling; Cross-Sectional Studies; Data; Discipline; Disease; Dyspnea; Effectiveness; Enrollment; Exercise; Exercise Test; Frequencies; Future; General Population; Goals; Health; Healthcare; High Prevalence; Human; Lung; Measures; Morbidity - disease rate; Outcome; Outcome Study; Oxygen; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Pattern; Performance; Physiological; Population; Positioning Attribute; Prevalence; Regimen; Rehabilitation Outcome; Rehabilitation therapy; Research; Risk; Sampling; Severity of illness; Space-Walks; Speed; Testing; Time; Training; Translating; United States; Veterans; Walking; Work; base; burden of illness; design; disability; effectiveness evaluation; exercise capacity; exercise intensity; exercise prescription; experience; improved; improved outcome; innovation; mortality; multidisciplinary; novel strategies; programs; pulmonary rehabilitation; recruit; respiratory; treadmill; uptake; walking speed

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality and presents an important healthcare problem, especially for Veterans. Prevalence of COPD in the Veteran population ranges from 33%-43%, a higher prevalence than among the general population of the United States. COPD patients experience diminished exercise capacity. A significant portion of this limitation in exercise capacity is due to dynamic hyperinflation and dyspnea. Humans demonstrate a coupled relationship between walking and breathing. Our preliminary data indicates that patients with COPD demonstrate an abnormal coupling pattern compared to those without COPD, using one stride for one breath, even at speeds outside of their self-selected walking pace. Current pulmonary rehabilitation relies on increasing intensity of exercise through accelerated walking. Based on coupling patterns in patients with COPD, increasing speed leads to an increase in respiratory rate, dynamic hyperinflation, and dyspnea, thus limiting exercise time. The goal of this proposed project is to investigate, in Veteran COPD patients, the effect of walking faster vs. walking on a slope on dynamic hyperinflation and dyspnea, oxygen uptake and dead space, and walking and breathing coupling. We hypothesize that walking on a slope will alter breathing and walking coupling, lower respiratory rates, and reduce dynamic hyperinflation and associated dyspnea. We predict that walking on a slope will permit an increase in oxygen uptake and a decrease in dead space in patients with COPD as compared to accelerated walking speeds. These hypotheses will be tested through three aims: 1) Identify differences in dynamic hyperinflation and dyspnea; 2) Compare differences in respiratory rate, oxygen uptake, and lung dead space; 3) Determine the complexity of walking and breathing coupling ratios. In this cross-sectional study, Veterans with COPD will be recruited and screened using a cardiopulmonary exercise test. A total of 25 eligible Veterans will be enrolled through stratified sampling of disease severity. The time course of work rate will be calculated from the cardiopulmonary exercise test. The speed and slope that corresponds to 70%-80% of peak work rate will be used. An additional constant work rate test will be given using increases in speed with a level treadmill to determine the speed that elicits oxygen uptake comparable to the sloped walking test. Subjects will be asked to perform two experimental trials (walking faster vs. walking on a slope) at 70%-80% peak work rate. Measures of dynamic hyperinflation, dyspnea, oxygen uptake, dead space, and coupling will be recorded during all walking trials. Possible covariates will also be collected. We anticipate that dynamic hyperinflation and dyspnea will be reduced in patients with COPD due to slower walking and slower respiratory rates during sloped walking as compared to faster level walking. It is expected that this will be influenced by the complexity in breathing and walking coupling ratios. Our multidisciplinary team will provide combined expertise from several disciplines and is uniquely qualified to complete the aims proposed. Results from this feasibility and acceptability study will set the stage for a rigorous, well-powered, full Merit award outcome study evaluating the effectiveness of a slope-based training regimen as part of rehabilitation.

慢性阻塞性肺疾病（COPD）是发病率和死亡率的主要原因，并呈现出严重的疾病和疾病