Steiner M C, Barton R L, Singh S J, Morgan M D L
Institute for Lung Health, Department of Respiratory Medicine, Glenfield Hospital, Leicester LE3 9QP, UK.
Thorax. 2003 Sep;58(9):745-51. doi: 10.1136/thorax.58.9.745.
Pulmonary rehabilitation is effective in improving exercise performance and health status in chronic obstructive pulmonary disease (COPD). However, the role of nutritional support in the enhancement of the benefits of exercise training has not been explored. A double blind, randomised, controlled trial of carbohydrate supplementation was undertaken in patients attending outpatient pulmonary rehabilitation.
85 patients with COPD were randomised to receive a 570 kcal carbohydrate rich supplement or a non-nutritive placebo daily for the duration of a 7 week outpatient pulmonary rehabilitation programme. Primary outcome measures were peak and submaximal exercise performance using the shuttle walk tests. Changes in health status, body composition, muscle strength, and dietary macronutrient intake were also measured.
Patients in both the supplement and placebo groups increased shuttle walking performance and health status significantly. There was no statistically significant difference between treatment groups in these outcomes. Patients receiving placebo lost weight whereas supplemented patients gained weight. In well nourished patients (BMI >19 kg/m(2)) improvement in incremental shuttle performance was significantly greater in the supplemented group (mean difference between groups: 27 (95% CI 1 to 53) m, p<0.05). Increases in incremental shuttle performance correlated with increases in total carbohydrate intake.
When universally prescribed, carbohydrate supplementation does not enhance the rehabilitation of patients with COPD. This study suggests that exercise training results in negative energy balance that can be overcome by supplementation and that, in selected patients, this may improve the outcome of training. The finding of benefit in well nourished patients may suggest a role for nutritional supplementation beyond the treatment of weight loss in COPD.
肺康复对于改善慢性阻塞性肺疾病（COPD）患者的运动能力和健康状况有效。然而，营养支持在增强运动训练益处方面的作用尚未得到探索。一项针对门诊肺康复患者的碳水化合物补充剂双盲、随机、对照试验开展。
85例COPD患者被随机分组，在为期7周的门诊肺康复计划期间，每日分别接受含570千卡碳水化合物的补充剂或无营养的安慰剂。主要结局指标是使用往返步行试验评估的峰值和次最大运动能力。还测量了健康状况、身体成分、肌肉力量和膳食常量营养素摄入量的变化。
补充剂组和安慰剂组患者的往返步行能力和健康状况均显著改善。在这些结局方面，治疗组之间无统计学显著差异。接受安慰剂的患者体重减轻，而补充剂组患者体重增加。在营养良好的患者（BMI>19 kg/m²）中，补充剂组的递增往返步行能力改善显著更大（组间平均差异：27（95%CI 1至53）m，p<0.05）。递增往返步行能力的增加与总碳水化合物摄入量的增加相关。
普遍规定碳水化合物补充剂时，其并不能增强COPD患者的康复效果。本研究表明，运动训练导致能量负平衡，而补充剂可克服这一点，并且在特定患者中，这可能改善训练结果。在营养良好的患者中发现有益效果可能提示营养补充剂在COPD治疗中的作用可能不止于治疗体重减轻。
