Nurse Managed: Sequential Resistance then Aerobic Training in COPD

描述（由申请人提供）：患有慢性阻塞性肺病（COPD）的人骨骼肌的力量和耐力下降，导致过早残疾。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。但患有严重至非常严重疾病的人通常难以实现更高强度的有氧运动训练。阻力训练可以提高肌肉力量，因此人们只用总力量的一小部分进行有氧训练。这可以使这些人以更少的感知努力以更高的有氧强度进行训练。这项研究提出了一种新的肺康复方法。与典型的临床实践同时进行有氧运动和阻力运动训练不同，我们将采用循序渐进的方法，让慢性阻塞性肺病受试者接受 8 周的下半身阻力训练，然后进行 8 周的有氧运动训练。该研究探讨了有氧训练之前进行较低的身体阻力训练是否比单独有氧训练或同时有氧加阻力训练更能带来功能状态的改善。在这项实验研究中，138 名重度/极重度 COPD 患者将被随机分入 3 个护士管理的训练组中的 1 个：1. 顺序训练组，包括 8 周的阻力训练，然后是 8 周的有氧运动训练（S-RAT，阻力和有氧训练依次进行），2. 对照组，包括 8 周的“假”训练，然后是 8 周的同步有氧训练加阻力训练（Control-C-RAT，Control-C-RAT，阻力和有氧训练同时进行），以及 3. 对照组包括 8 周的“假”训练，然后是 8 周的有氧训练（Control-AT，单独有氧训练）。 Control-C-RAT 组控制运动训练（有氧训练加阻力训练）的总剂量，并提供肺康复的常用方法，例如肺康复。同时采用培训方式。 Control-AT 小组控制与研究人员的接触量并提供“护理标准”，例如有氧训练。将在研究开始时、第 8 周后和第 16 周后评估以下因变量：1. 有氧运动表现，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颖的肺康复方法：在开始有氧运动训练之前进行下半身阻力训练，以最大限度地改善运动耐量、症状和身体活动的功能表现。临床医生将利用这些知识为慢性阻塞性肺病患者（尤其是更严重的残疾人）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.