Clinical and Autonomic Effects of Mind-Body Exercise in COPD

描述(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，是美国第四大主要死亡原因。尽管进行了药物和手术治疗，但慢性阻塞性肺病继续导致相当大的发病率和死亡率，是前十大疾病中发病率继续上升的唯一一种重大疾病。需要新的和廉价的干预措施，以改善症状、与健康相关的生活质量、功能能力，并有可能改变疾病的进展。太极是一种流行的身心锻炼，它将温和的身体活动、自我意识和放松与缓慢的身心呼吸结合在一起。它可能特别适合患有COPD的非条件个人，他们患有有限的运动耐量和运动时呼吸短促，它集成了与COPD管理相关的多个组成部分，包括低强度有氧运动、压力管理和缓慢的心身呼吸训练。在这项应用中，我们提出了一项三臂随机对照试验(N=102)，以评估太极锻炼(包括心身呼吸)与坐着的心身呼吸(全面太极计划的一个孤立的关键组成部分)与教育控制的益处。这一设计将使我们能够检查每一种心身干预对COPD临床结果的个别疗效，但也将允许两种干预措施之间的临床和生理比较，提供对心身疗法的组成部分和机制的洞察。COPD(全球阻塞性肺疾病1-3期，有呼吸困难症状)患者将从门诊、初级保健和肺部诊所招募。我们的主要目标将是研究太极和身心呼吸对这一人群的生活质量和运动能力的影响。二级目标将进一步探讨对临床症状、心理社会指标、心肺功能、力量和柔韧性、全身炎症生物标志物和自主神经活动的影响。我们建议的研究结果将有助于指导COPD的临床治疗，并促进我们对心身运动和缓慢的心身呼吸的作用的机械理解。

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 mortality and is the only major disease among the top ten that continues to increase in prevalence. Novel and inexpensive interventions that can improve symptoms, health-related quality-of-life, functional capacity, and potentially modify disease progression are needed. Tai chi is a popular mind-body exercise that combines gentle physical activity, self awareness, and relaxation with slow mind-body breathing. It may be particularly suited to deconditioned individuals with COPD, who suffer from limited exercise tolerance and shortness of breath on exertion, and it integrates multiple components relevant to COPD management, including low-intensity aerobic exercise, stress management and slow mind-body breathing training. In this application, we propose a 3-arm randomized controlled trial (N=102) to evaluate the benefits of tai chi exercise (which includes mind-body breathing) versus seated mind-body breathing alone (an isolated, key component of the comprehensive tai chi program) versus education control. This design will allow us to examine the individual efficacy of each mind-body intervention on clinical outcomes in COPD, but will also allow clinical and physiological comparisons between the two interventions, providing insight into the components and mechanisms of mind-body therapies. Patients with COPD (Global Obstructive Lung Disease stages 1-3 with symptoms of dyspnea) will be recruited from outpatient primary care and pulmonary clinics. Our primary aim will be to examine the effects of tai chi and mind-body breathing on quality-of-life and exercise capacity in this population. Secondary aims will further explore the effects on clinical symptoms, psychosocial indices, cardiopulmonary function, strength and flexibility, biomarkers of systemic inflammation, and autonomic activity. The results of our proposed research will help inform clinical treatment of COPD, and further our mechanistic understanding of mind-body exercises and the role of slow, mind-body breathing.