Reducing Dynamic Hyperinflation through Breathing Retraining

通过呼吸再训练减少动态恶性通货膨胀

• 批准号: 7748064
• 负责人: Eileen G Collins
• 金额: --
• 依托单位: EDWARD HINES JR VA HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7748064
• 关键词: Abdomen; Activities of Daily Living; Address; Affect; American; Area; Auditory; Behavioral; Blood; Blood flow; Breathing; Cardiac Output; Cardiovascular system; Caring; Cause of Death; Chest; Chronic; Chronic Obstructive Airway Disease; Complex; Computers; Contracts; Control Groups; Critical Care; Data; Data Analyses; Development; Dyspnea; Educational process of instructing; Enrollment; Environmental Risk Factor; Environmental air flow; Ergometry; Exercise; Exercise stress test; Exhalation; Fatigue; Feedback; Functional disorder; Gases; General Population; Goals; Grant Review; Health; Helium; Hospitalization; Hospitals; Human Resources; Impairment; Individual; Inspiratory Capacity; Intention; Intervention; Intervention Studies; Investigation; Journals; Knowledge; Leg; Life; Limb structure; Lip structure; Living Wills; Lung; Lung Compliance; Lung diseases; Measurement; Measures; Mechanics; Medicine; Methodology; Methods; Modeling; Muscle; Muscle Fibers; Muscle function; Muscular Atrophy; Nose; Nurses; Office Visits; Oxygen; Oxygen Therapy Care; Patient Education; Patients; Pattern; Perception; Performance; Peripheral; Physical Function; Physical activity; Physicians; Physiological; Positive-Pressure Respiration; Press Releases; Publications; Publishing; Pulmonary function tests; Randomized; Randomized Controlled Clinical Trials; Recruitment Activity; Regression Analysis; Rehabilitation therapy; Reporting; Research; Research Personnel; Resistance; Respiratory Diaphragm; Respiratory Muscles; Respiratory System; Sampling; Sampling Studies; Societies; Specific qualifier value; Stress; Symptoms; System; Techniques; Technology; Testing; Theft; Time; Training; Treadmill Tests; United States; Veterans; Visit; Visual; Walking; Work; Workload; abstracting; auditory feedback; base; clinical practice; compare effectiveness; computer program; coping; cost effectiveness; density; disability; electric impedance; experience; follow-up; health administration; improved; innovation; lung volume; meetings; muscle form; muscle strength; news; novel; pressure; primary outcome; programs; prototype; psychologic; public health relevance; quadriceps muscle; respiratory; response; rib bone structure; social; standard of care; success; user-friendly; visual feedback

DESCRIPTION (provided by applicant): Abstract Dynamic hyperinflation limits exercise duration in chronic obstructive pulmonary disease (COPD). To limit dynamic hyperinflation during exercise and thus improve exercise duration, we successfully developed a visual-auditory ventilation-feedback system. The system retrains patient's breathing pattern during exercise. The goal of the current proposal is to develop a user-friendly ventilation-feedback technique with a novel auditory feedback system. We reason that the proposed feedback system plus exercise training will be superior to exercise training alone while having the potential for an easier application into clinical practice. Hypotheses: The primary hypothesis is that the exercise duration of patients with moderate-to-severe COPD who successfully complete a 12-week program of breathing retraining plus exercise will be longer than that of patients who complete a 12-week program of treadmill exercise training alone. We also hypothesize that the primary predictor of improved exercise duration will be a reduction in dynamic hyperinflation and to a lesser extent, improvement in peripheral muscle function. Lastly, we hypothesize that dyspnea will be reduced in patients assigned to breathing retraining plus exercise when compared to exercise training alone. Methods: The proposed study is a randomized controlled clinical trial. 246 patients with moderate-to-severe COPD will be enrolled and randomized into breathing retraining plus exercise or exercise training alone. Both groups will receive 12-weeks of treadmill exercise training three times weekly. The breathing retraining plus exercise group will also receive auditory feedback to decrease respiratory rate and prolong exhalation. The goal of breathing retraining is to reduce exercise- induced dynamic hyperinflation. Follow-up testing will be completed at 6, 12, and 24 weeks. Testing will include a pulmonary function test, symptom-limited and constant workrate treadmill tests, six-minute walk, dyspnea measurements, testing of respiratory muscle strength and endurance, and quadriceps muscle endurance testing. Analysis: Measures of central tendency will be used to describe the study sample. A two-sample t-test (1 = 0.05) will be used to analyze changes from baseline to 12-weeks between the breathing retraining plus exercise group and exercise training alone group. In data analysis, intention-to-treat principles will be used. Since several measures will be taken on each patient, mixed-models analysis will be used to compare changes over time between the two groups. Multiple regression analysis will be employed to determine the predictors of improved exercise performance. PUBLIC HEALTH RELEVANCE: Relevance_Narrative Relevance to the VA. COPD is the fourth leading cause of death in the United States and the sixth most common chronic condition cited among veterans enrolled in the Veterans Health Administration. Over 16 million individuals in the United States are afflicted with COPD. As compared with the general population, patients with COPD are more likely to rate their health as poor, to report more limitations in daily activities, to visit their physician, to stay in the hospital and to report more disability days. More than 17 million office-visits and over 700,000 hospitalizations resulted from COPD. Innovative approaches to pulmonary rehabilitation of patients with COPD may be instrumental in modifying this cyclical pattern of increasing impairment leading to more hospitalizations and decreasing reserve to cope with the stress and strain of daily living.

描述（由申请人提供）： 动态过度充气限制了慢性阻塞性肺疾病（COPD）患者的运动时间。为了限制运动过程中的动态过度充气，从而提高运动持续时间，我们成功地开发了一个视听通气反馈系统。该系统在运动期间重新训练患者的呼吸模式。目前的建议的目标是开发一个用户友好的通气反馈技术与一个新的听觉反馈系统。我们的理由是，建议的反馈系统加上运动训练将优于上级运动训练单独，同时具有更容易应用到临床实践的潜力。假设：主要假设是，成功完成12周呼吸再训练加运动方案的中重度COPD患者的运动持续时间将长于仅完成12周跑步机运动训练方案的患者。我们还假设改善运动持续时间的主要预测因素是动态过度充气的减少，以及在较小程度上改善外周肌肉功能。最后，我们假设，与单纯运动训练相比，呼吸再训练加运动的患者呼吸困难会减少。方法：本研究为随机对照临床试验。将入组246例中重度COPD患者，并将其随机分配至呼吸再训练加运动或仅运动训练组。两组都将接受为期12周的跑步机运动训练，每周三次。呼吸再训练加锻炼组还将接收听觉反馈以降低呼吸速率并延长呼气。呼吸训练的目的是减少运动引起的动态过度充气。将在第6、12和24周完成随访试验。测试将包括肺功能测试，极限和恒定工作率跑步机测试，六分钟步行，呼吸困难测量，呼吸肌力量和耐力测试，以及股四头肌耐力测试。分析：将使用集中趋势指标描述研究样本。将使用双样本t检验（1 = 0.05）分析呼吸再训练加运动组与单纯运动训练组之间从基线至12周的变化。在数据分析中，将使用意向治疗原则。由于将对每例患者进行多项测量，因此将使用混合模型分析来比较两组之间随时间的变化。将采用多元回归分析来确定改善运动表现的预测因素。 公共卫生关系： 相关性_叙述与VA的相关性。COPD是美国第四大死亡原因，也是退伍军人健康管理局登记的退伍军人中第六大最常见的慢性病。在美国，超过1600万人患有COPD。与一般人群相比，COPD患者更可能将其健康状况评为较差，报告日常活动受到更多限制，去看医生，住院，并报告更多的残疾日。超过1700万次办公室就诊和超过70万次住院治疗是由COPD引起的。COPD患者肺康复的创新方法可能有助于改变这种增加损伤的周期性模式，导致更多的住院治疗和减少储备，以科普日常生活的压力和紧张。