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

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，患者患有运动不耐受和体力活动减少，这是病情恶化、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、健康相关的生活质量和运动能力，国家指南现在建议所有COPD患者参加这样的项目。不幸的是，最初康复后的长期运动坚持性非常差，很明显，如果患者不继续运动，PR期间获得的益处会迅速减少。目前迫切需要新的干预措施，以维持PR后常规运动的益处，并促进COPD患者康复后长期坚持运动和运动自我效能感。太极拳是一种流行的身心运动，包括中低强度的身体活动、自我意识、放松和冥想式的缓慢呼吸。它可能特别适用于患有运动耐受性有限和呼吸困难的慢性阻塞性肺病患者。重要的是，太极拳运动全面整合了PR的几个关键要素（有氧运动、上肢和下肢训练、呼吸和压力管理），成为一个相对低成本和容易接受的活动。对不同人群的研究表明，太极拳可以提高运动能力，提高生活质量，促进运动自我效能；与传统的锻炼方式相比，这种坚持可能是有利的。在本申请中，我们建议在COPD患者中进行一项三组随机对照试验（N=126），以评估六个月的太极运动与团体步行相比，与自我运动（标准护理）的一般建议在完成标准治疗后保持临床改善的益处。我们的主要目的是调查太极拳在PR后3个月和6个月是否能保持运动能力的增长。次要目的是检查生活质量，呼吸困难，情绪，日常生活活动，以及运动自我效能感，干预依从性和整体活动。1年进行长期随访评估。拟议项目的结果有可能通过提供一种新的策略来改变COPD患者的临床护理，该策略可能会大大延长PR的益处并促进该人群的持续体育活动。

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.