中重度慢性阻塞性肺疾病患者无氧阈和高强度肺康复运动方案的比较

目的 比较无氧阈和高强度肺康复运动方案在中重度COPD患者中的效果.方法 2006年3月至12月在广州呼吸疾病研究所门诊就诊的中重度COPD患者54例入组,13例脱落.随机分为无氧阈组(15例)、高强度组(17例),另设对照组(9例).无氧阈组以无氧阈为运动强度,高强度组以最大可耐受的运动强度,进行12周(每周2次)的康复计划.康复前后分别测静态肺功能、心肺运动试验,记录心肺运动试验中每分钟呼吸困难(Borg)指数.采用SPSS 12.0软件进行统计学处理,受试者一般情况以x±s表示,均数两两比较采用独立样本t检验,试验前后总体均数比较采用配对t检验,两组以上均数比较采用单因素方差分析,率的比较采用Fisher精确概率法,非参数指标(如Borg指数)采用非参数Wilcoxon或Mann-Whitney u检验.结果 无氧阈组和高强度组康复后的峰值摄氧量占预计值%分别为(69±14)%和(79±13)%,明显高于康复前的(61±11)%和(72±12)%;康复后无氧阈组的峰值摄氧量占预计值%提高(14±17)%,高强度组提高(12±13)%,两组的改善程度无明显差别.高强度组康复后的无氧阈占预计值%为(42±9)%,明显高于康复前的(38±8)%.在56 W运动强度时,高强度组康复后的分钟通气量为(33±5)L/min,比康复前的(36±4)L/min明显下降(t=6.167,P<0.01);康复后的呼吸频率为(31±3)次/min,比康复前的(32±1)次/min明显下降(t=2.876,P<0.05);康复后的潮气量为(1.3±0.3)L,比康复前的(1.2±0.3)L明显升高(t=2.587,P<0.05).无氧阈组和高强度组康复后的心率分别为(109±39)次/min和(110±25)次/min,比康复前的(116±39)次/min和(114±42)次/min明显下降;康复后的氧脉分别为(10.4±4.0)ml/次和(9.0±3.2)ml/次,比康复前的(9.6±3.7)ml/次和(8.5±4.3)ml/次明显升高.无氧阈组和高强度组康复后的单位摄氧量下Borg指数分别由8.6±3.2和6.5±2.6下降到7.4±2.5和5.6±2.4,均得到明显改善,但改善程度无明显差别.结论 无氧阈和高强度的肺康复方案均可改善运动能力和呼吸困难症状,且改善程度相似,但高强度方案可额外改善无氧阈和通气形式.     

体外膈肌起搏对稳定期COPD患者心肺功能及生活质量的影响

目的:观察体外膈肌起搏对稳定期慢性阻塞性肺疾病(COPD)患者心肺功能及生活质量的影响。方法:本研究为病例对照研究。采用单纯随机抽样法,选取2019年1月至2021年4月在昆山市康复医院心肺康复科及呼吸内科就诊的稳定期COPD患者68例,采用随机数字表法分成观察组和对照组,每组34例。2组患者均进行为期12周的COPD...     

Effects of high-intensity exercise training in a pulmonary rehabilitation programme for patients with chronic obstructive pulmonary disease

BACKGROUND AND OBJECTIVES: The benefits of pulmonary rehabilitation for patients with COPD depend on the intensity of training. Traditional pulmonary rehabilitation programmes (PRPs) do not consistently achieve high-intensity training and have variable training effects. This study examined the effects of high-intensity exercise training on cardiac and pulmonary function in COPD patients. METHODS: Patients with COPD participated in a 6-week, cardiopulmonary exercise test-based PRP. Spirometry, 6-min walking distance and cardiopulmonary exercise test were used to evaluate cardiopulmonary function, respiratory muscle strength and endurance at rest, during exercise and before and after the programme. Patients were encouraged to complete high-intensity exercise with a targeted training intensity of at least 75% maximum oxygen uptake (VO(2)). RESULTS: Thirty-four COPD patients were enrolled into the study; 16 completed the high-intensity training, 18 did not. At the end of the 12-session PRP, submaximal exercise capacity (6-min walking distance, 461.8 +/- 77.2-502.7 +/- 66.9 m, P < 0.001) improved in both the patients who completed high-intensity training and those who did not. Only the patients who completed high-intensity training had significant improvements in FVC (2.47 +/- 0.70-2.70 +/- 0.62 L, P = 0.024) at rest, maximal exercise capacity (peak VO(2), 1001.6 +/- 286.4-1116.1 +/- 320.4 mL/min, P = 0.020) and work efficiency (7.3 +/- 1.4-8.4 +/- 1.8 mL/min/watt, P = 0.026). There was no statistically significant difference between the two groups in the change in the physiological parameters before and after exercise. CONCLUSIONS: Exercise training in a PRP improved submaximal exercise capacity. Only patients who completed high-intensity exercise training showed improvements in maximal exercise capacity, FVC and work efficiency.     

Effects of 3-week Outpatient Pulmonary Rehabilitation on Exercise Capacity, Dyspnea, and Quality of Life in COPD

The effects of intensive 3-week outpatient pulmonary rehabilitation (PR) on exercise capacity, dyspnea, and health-related quality of life (HRQL) were investigated in patients with COPD. Two hundred ten patients with COPD (mean FEV₁ = 54%pred) underwent PR consisting of exercise training, patient and psychosocial education, breathing and relaxation therapy, nutrition counseling, and smoking cessation support. Before and after PR, exercise capacity was assessed with 6-min walking tests (6MWT) and constant cycle ergometer exercise (CEE). Dyspnea was measured after 6MWTs with a Borg scale and after PR with the Transition Dyspnoea Index (TDI). HRQL was examined with the Medical Outcomes Study Short Form 36 (SF-36). Results showed improvements in the 6MWT (+39 m, p < 0.001) and CEE (+241 W × min, p < 0.001) after PR, paralleled by decreased dyspnea during the 6MWT (−0.5, p < 0.001) and during activities (TDI score = 3.6). Increases in all SF-36 subscales reflected improved HRQL after PR (p < 0.001). No gender differences were found. Patients with milder versus more severe COPD improved similarly in most outcomes. Regression analyses revealed that TDI scores were the most important predictor of improvements in HRQL. The results suggest that intensive 3-week outpatient PR is associated with improvements in exercise capacity, dyspnea, and HRQL in male and female patients with COPD irrespective of COPD severity. Reduced dyspnea during activities contributed the most to improvements in HRQL.     

Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation

The European Society of Cardiology heart failure guidelines firmly recommend regular physical activity and structured exercise training (ET), but this recommendation is still poorly implemented in daily clinical practice outside specialized centres and in the real world of heart failure clinics. In reality, exercise intolerance can be successfully tackled by applying ET. We need to encourage the mindset that breathlessness may be evidence of signalling between the periphery and central haemodynamic performance and regular physical activity may ultimately bring about favourable changes in myocardial function, symptoms, functional capacity, and increased hospitalization-free life span and probably survival. In this position paper, we provide practical advice for the application of exercise in heart failure and how to overcome traditional barriers, based on the current scientific and clinical knowledge supporting the beneficial effect of this intervention.     

Improvement of physical activity in chronic obstructive pulmonary disease by pulmonary rehabilitation and pharmacological treatment

Physical activity (PA) is defined as bodily movement produced by skeletal muscles with energy expenditure beyond resting levels. PA is closely related to reduced morbidity and mortality in chronic obstructive pulmonary disease (COPD). Self-report questionnaires are often subject to recall bias, correlating poorly with objectively qualified PA, and do not provide an accurate estimate of free-living energy expenditure. PA may be objectively evaluated by newly developed tri-axial accelerometers by quantifying steps or body movements over a period of time. Low-intensity, home-based pulmonary rehabilitation (PR) using pedometer feedback improves PA. Improvement in physiological factors correlates with increased walking time in stable elderly COPD patients.This review focuses on the effects of PR and pharmacological treatment on PA in COPD patients. We selected 32 studies from our literature search evaluating the effects of PR and 11 studies examining the effects of pharmacological treatment on PA. Findings in both categories were inconsistent. Nineteen studies showed a positive effect with PR whereas 13 showed no effect. Eight studies showed a positive effect, while three revealed no effect from pharmacological intervention. As both interventions increase exercise capacity without a consistent effect on PA, counseling with behavioral changes may be necessary to achieve a significant and lasting increase in PA. Changing PA behavior in COPD patients requires an interdisciplinary approach involving specialists in respiratory medicine, rehabilitation, social, and behavioral sciences. Future research in this area is warranted to advance our knowledge in this area, specifically with regard to the interaction of pharmacological and non-pharmacological interventions.     

Emergency Admissions for COPD in an Urban Population: The Role of Population and Primary Care Factors

COPD is a major cause of emergency admissions worldwide. In many countries the majority of COPD care is provided by primary care teams. This study examined variation between primary care teams in rates of COPD admission and assessed the role of prevalence, deprivation, practice performance, and general practitioner (GP) and nurse supply on risk of COPD admission. Retrospective observational study of National Health Service admissions for COPD of patients registered with London general practices over four years (2006–2009). We sought associations using negative binomial regression between COPD admissions and population factors, practice organization and practice performance. Trends in rates of COPD admissions across London were stable between 2006 and 2009. COPD admission rates varied substantially between practices (2006/7: median 13.68/10,000 population (IQR 7.83–22.70)), with almost a 3-fold difference across the interquartile range each year. Practice characteristics varied to a similar extent. Variation in practice COPD admission rates was associated with diagnosed prevalence of COPD (Rate Ratio 2.06, 95% CI 1.84–2.3) and increasing levels of deprivation (RR 1.01, 1.006–1.01). Other practice characteristics, including GP and nurse supply, and practice performance scores were not predictive of practice level COPD admission rates, when controlling for COPD prevalence and socio-economic status. Main predictors of variation in rates of COPD admissions were prevalence of diagnosed COPD and socioeconomic status. The absence of evidence that variation in primary care services for COPD was associated with rates of COPD admission emphasizes the importance of primary prevention of COPD if COPD admission rates are to fall.     

性别差异对中重度慢性阻塞性肺疾病患者运动耐力的影响

目的 比较中重度慢性阻塞性肺疾病(COPD)患者运动耐力的性别差异.方法 本研究对151例中、重度COPD患者的肺功能(PFT)和功率递增心肺运动试验(CPET)结果进行了分析.将患者分为Ⅱ级COPD组和Ⅲ级COPD组.并选择43例年龄、性别、身高、体质量相匹配的正常人作为对照组.本研究测定第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、峰值运动功率(Peak Load)、峰值摄氧量(Peak (V)O2)、峰值心率(Peak HR)、峰值氧脉搏(Peak(V)O2/HR)、最大分钟通气量(M(V)E)、气促指数(M(V)E/MVV)等指标.本研究分别在不同COPD分级和性别之间分析比较了上述指标的差异.结果 Ⅱ级COPD组和Ⅲ级COPD组的女性患者的Peak (V)O2实/预％和Peak (V)O2/HR实/预％较同组男性更高(P值均＜0.05).Ⅲ级COPD男性患者的运动耐力较Ⅱ级有明显降低(P＜0.0001),然而,Ⅲ级、Ⅱ级COPD女性患者之间运动耐力差异无统计学意义(P=0.246).结论 在中、重度COPD患者中,男性运动耐力下降较女性更为严重,吸烟可能是造成这一差异的重要因素.     

踏车锻炼对慢性阻塞性肺疾病患者吸气肺功能的影响及与运动能力改善的关系

目的 探讨踏车锻炼对慢性阻塞性肺疾病(COPD)患者吸气肺功能的影响及与运动能力改善的关系.方法 对12例中、重度COPD患者进行12周的下肢踏车运动训练.在运动训练前后分别进行常规肺通气功能、弥散功能、肺容积、最大用力吸气峰流速(PIF)、最大吸气压(MIP)、症状限制递增功率心肺运动试验和高强度恒定功率心肺运动试验.在高强度恒定功率运动中,每隔1 min记录受试者潮式呼吸流速-容积(TBFV)曲线.结果 踏车锻炼后COPD患者运动持续时间(T)(t=7.357,P＜0.001)和峰运动功率(WRpeak)(t=3.614,P＜0.05)显著增加;MIP(t=4.754,P＜0.001)和PIF(t=2.440,P＜0.05)显著增加;踏车锻炼后COPD患者在等时间点潮式呼吸吸气峰流速(t=-2.747,P＜0.05)和呼气峰流速(t=-4.487,P＜0.05)均较前显著下降,最大吸气流速储备较前显著增加(t=2.755,P＜0.05),最大呼气流速储备较前无显著变化(t=1.326,P＞0.05).受试者下肢踏车锻炼后MIP的增加(r=0.613,P＜0.05)、PIF的增加(r=0.497,P＜0.05)和等时间点最大吸气流速储备的增加(r=0.592,P＜0.05)分别与运动持续时间的增加呈显著正相关.结论 下肢运动训练可改善COPD患者吸气肺功能指标;运动训练后吸气肌肉力量、PIF和运动中吸气流速储备的增加可能是COPD患者运动能力改善的主要原因.

Abstract：

Objective To explore the effect of treadmill training on inspiratory function and its association with improvement of exercise capacity in patients with chronic obstructive pulmonary disease (COPD). Methods The 12 moderate to severe COPD patients were allocated to lower-limb exercise training for 12weeks. The routine tests of pulmonary ventilation function, diffusion function,lung volume, peak inspiratory flow (PIF), maximal inspiratory pressure (MIP), symptom-limited progressive cycle ergometer exercise tests and constant work rate exercise tests were administered before and after the training program. During the constant work rate exercise tests, tidal breathing flow volume (TBFV) curves were recorded every 1 mir. Results After treadmill training, the exercise duration (T) (t=7. 357, P＜0. 001), peak work rate (WRpeak) (t=3. 614, P＜0.05), MIP (t=4.754, P＜0. 001) and PIF (t=2. 440, P＜0. 05) increased significantly. The tidal PIF (t=- 2.747, P＜0.05) and peak expiratory flow (PEF) (t = - 4.487, P＜ 0.05 ) decreased significantly at isotime. Maxium inspiratory flow reserve (△FLOWinsp) (t = 2. 755, P ＜ 0. 05 ) increased significantly at isotime, and maxium expiratory flow reserve (△FLOWexp) (t = 1. 326, P ＞ 0.05)showed no significant changes; The△T were positively correlated with △MIP (r=0. 613, P＜0. 05),△PIF (r=0.497, P＜0.05) and △FLOWinsp (r=0.592, P＜0.05). Conclusions Lower limb exercise training improves inspiratory function of COPD patients. The improvement of exercise endurance in moderate to severe COPD patients after lower limb exercise training is due to increases of inspiratory muscle strength, maxium PIF and inspiratory flow reserve.     

Measurement of agreement on health-related quality of life changes in response to respiratory rehabilitation by patients and physicians--a prospective study

INTRODUCTION: To provide optimal care for patients with chronic obstructive pulmonary disease physicians need to understand if their patients benefit from an intervention. The objective of this study was to assess agreement between patients and physicians on health-related quality of life (HRQL) changes in response to respiratory rehabilitation and to explore sources for disagreement. METHODS: Sixty-one patients rated their health states on a validated preference-based instrument, the feeling thermometer (FT). In an analogous manner, the eight treating physicians rated the patients' health states on the FT. Patients and physicians were blinded to each other's ratings. We calculated intraclass correlation coefficients (ICC) to assess agreement between patients and physicians and used HRQL instruments and the 6-min walking test to assess the evaluative properties of the FT. RESULTS: We found moderate agreement at baseline (ICC 0.40, P = 0.018) and follow-up (ICC 0.49, P = 0.008) but large disagreement about change scores (ICC 0.02, P = 0.46). Patients' FTchange scores correlated well with change scores of the Chronic Respiratory Questionnaire, SF-36 and the Borg scale for dyspnoea whereas physicians' FT change scores correlated significantly with the change score of the 6- min walking test (r = 0.33). Physicians' ratings showed an inconsistent pattern for correlations with HRQL measures. CONCLUSIONS: There is large disagreement between patients and physicians on HRQL changes in response to respiratory rehabilitation. Investigators should assess whether the introduction of HRQL instruments into clinical practice raises the awareness of physicians towards HRQL and improves agreement with their patients.     

The efficacy and applicability of a pulmonary rehabilitation programme for patients with COPD in a secondary-care community hospital

Background and objective:   Pulmonary rehabilitation is known to have beneficial effects in COPD patients. This study aimed to assess the applicability and efficacy of a pulmonary rehabilitation programme in a community hospital lacking specialist pulmonary rehabilitation services.
Methods:   This randomized, controlled, prospective study included a total of 78 patients. Questionnaires were used to collect data on sociodemographic characteristics, respiratory function tests, the Modified Medical Research Council dyspnoea scale, 6MWD, the Short Form-36 (SF-36) quality of life scale, the Hospital Anxiety and Depression Scale (HADS) and the St George's Respiratory Questionnaire (SGRQ). The experimental group underwent a pulmonary rehabilitation programme while the control group did not participate. The first, second and third month measurements for all parameters were compared between the two groups.
Results:   No significant differences in pulmonary function tests or dyspnoea scale ( P  > 0.05) were observed between the two groups. Significant differences were observed in the 6MWD measurements at the third month ( P  < 0.05), as well as in the SF-36 quality of life scale, SGRQ and HADS measurements at the second and third months ( P  < 0.01).
Conclusions:   Short-term pulmonary rehabilitation had a positive impact on exercise capacity and quality of life of patients with COPD, irrespective of FEV₁. This study demonstrated the efficacy of a pulmonary rehabilitation programme in a secondary care hospital not staffed by a specialist pulmonary rehabilitation group.     

下肢等速肌力训练对中重度COPD患者运动能力和生活质量的影响

目的:观察下肢等速肌力训练对中重度慢性阻塞性肺疾病(COPD)患者生活质量和运动能力的影响。方法:随机对照研究。选取上海市浦东新区公利医院2017年3月至2019年3月COPD稳定期患者(Ⅱ、Ⅲ级)40例,采用随机数字表法分为对照组和运动组,每组20例。对照组给予常规药物治疗和疾病健康教育。运动组在对照组干预基础上行1...     

Identification of factors associated with a need for rehabilitation for patients over 65 years following admission to a general and vascular surgical service

Aim: To identify factors that predict admission to a rehabilitation hospital for patients over 65 years of age. Methods: This study reviewed the destinations of all patients over 65 years admitted to a Department of General and Vascular Surgery over 1 year to analyse factors associated with subsequent admission to a rehabilitation hospital. Data recorded included demographic characteristics, type of admission, length of stay at the primary hospital, operation, speciality type, previous admission to rehabilitation hospital, diagnoses and procedures. Results: Of the 2632 patients examined, 8.7% were subsequently admitted to a rehabilitation hospital. Multivariate analysis showed that previous admission to the rehabilitation hospital, increasing age, number of diagnoses and admission under vascular service were all independently associated with admission for rehabilitation. Conclusions: Factors associated with increased risk of requiring transfer to a rehabilitation hospital can be identified. This allows early recognition of at‐risk patients.     

Effects of diet and exercise on adipocytokine levels in patients with moderate to severe chronic kidney disease

Background and aimsObesity is a pro-inflammatory risk factor for progression of CKD and cardiovascular disease. We hypothesized that implementation of caloric restriction and endurance exercise would improve adipocytokine profiles in patients with moderate to severe CKD.Methods and resultsWe enrolled patients with moderate to severe CKD through a multi-center pilot randomized trial of diet and exercise in a 4-arm design (dietary restriction of 10%–15% reduction in caloric intake, exercise three times/week, combined diet and exercise, and control) (NCT01150851). Adipocytokines (adiponectin and leptin) were measured at the beginning and end of the study period as secondary outcomes. Treatment effect was analyzed in a multivariable model adjusted for baseline outcome values, age, gender, site and diabetes. A total of 122 participants were consented, 111 were randomized (42% female, 25% diabetic, and 91% hypertensive), 104 started intervention and 92 completed the study (Figure 1). Plasma adiponectin levels increased significantly in response to diet by 23% (95% CI: 0.2%, 49.8%, p = 0.048) among participants randomized to the caloric restriction and usual activity arm but not to exercise, whereas circulating leptin did not change by either treatment.ConclusionOur data suggest that dietary caloric restriction increases plasma adiponectin levels in stage 3–4 CKD patients, with limited effect on leptin levels. These findings suggest the potential for improving the metabolic milieu of CKD with moderate calorie restriction.     

Enrolment of patients to clinical trials in haematological cancer in New South Wales: current status,perceived barriers and opportunities for improvement

Background: Enrolment of cancer patients in clinical trials is associated with significant positive outcomes. There are, however, limited Australian data on enrolment of patients with haematological malignancies to clinical trials. Aim: The aim of this study is to document the number of patients with haematological malignancies enrolled on clinical trials in NSW, to establish the barriers to trial recruitment and to examine possible means by which clinical trials participation may be improved. Methods: Quantitative data on clinical trial accrual were obtained from all sites participating in clinical trials in haematological malignancies in NSW from 2004 to 2007 and were compared with the cancer incidence data for that period. Qualitative data on barriers and strategies for improvement were gathered using semi‐structured interviews with clinical trials professionals from throughout NSW. Results: Between 2004 and 2007 there were significant increases in the number of active centres, clinical trials and trial participation, and by 2007, 10.5% of all eligible patients with haematological malignancies in NSW were enrolled in relevant clinical trials. Resource constraints were the greatest perceived barrier to participation, but the success of clinical trials is also challenged by difficulties associated with communication, ethics review, trial coordination, trial design and support for emerging centres. Conclusion: While participation in clinical trials in haematological cancer in NSW improved between 2004 and 2007, participation in clinical trials remains suboptimal. The development of specific strategies to address barriers to participation may facilitate increased enrolment and ultimately improve clinical outcomes in patients with haematological malignancies.