Reducing Dynamic Hyperinflation through Breathing Retraining

摘要 动态高通胀限制慢性阻塞性肺疾病患者的运动时间 (COPD)。为了限制运动期间的动态恶性通货膨胀，从而延长运动持续时间， 我们成功地研制了一套视听换气反馈系统。系统重新训练 患者在运动过程中的呼吸模式。当前提案的目标是制定一项 用户友好的通风反馈技术与新颖的听觉反馈系统。我们推论 建议的反馈系统加上运动训练将优于运动训练 同时有可能更容易地应用到临床实践中。假设： 基本假设是中重度COPD患者的运动持续时间 成功完成为期12周的呼吸再训练和锻炼的人将是 比完成为期12周的跑步机运动训练的患者更长 独自一人。我们还假设，延长运动持续时间的主要预测因素将是 动态过度充气减少，外周肌肉改善程度较轻 功能。最后，我们假设呼吸困难患者的呼吸困难将会减少。 与单纯的运动训练相比，再训练加运动。方法：建议的 本研究为随机对照临床试验。246例中重度COPD患者将 被纳入并随机进入呼吸再训练加上运动或单独运动训练。 两组都将接受为期12周的跑步机运动训练，每周三次。这个 呼吸再训练加运动组也会收到听觉反馈来减少 呼吸频率和延长呼气。呼吸再训练的目的是减少运动-- 导致动态恶性通货膨胀。后续测试将在6周、12周和24周完成。 测试将包括肺功能测试、症状受限和恒定工作速度跑步机 测试，六分钟步行，呼吸困难测量，呼吸肌力量测试和 耐力和股四头肌肌肉耐力测试。分析：中央银行的措施 用倾向性来描述研究样本。将使用两样本t检验(？=0.05 分析呼吸再训练加运动之间从基线到12周的变化 运动组和单纯运动训练组。在数据分析中，意向治疗原则将是 使用。由于将对每个患者采取几项措施，因此将进行混合模型分析 用于比较两组之间随时间的变化。多元回归分析将 被用来确定提高运动成绩的预测因素。

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 (¿ = 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.