下肢肌肉训练方式对 COPD 严重呼吸困难合并股四头肌无力患者的疗效：DICES 试验结果。
Efficacy of lower-limb muscle training modalities in severely dyspnoeic individuals with COPD and quadriceps muscle weakness: results from the DICES trial.
机构信息
Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.
Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
出版信息
Thorax. 2014 Jun;69(6):525-31. doi: 10.1136/thoraxjnl-2013-204388. Epub 2014 Jan 7.
RATIONALE
Strength training and neuromuscular electrical stimulation (NMES) improve lower-limb muscle function in dyspnoeic individuals with chronic obstructive pulmonary disease (COPD). However, high-frequency NMES (HF-NMES) and strength training have never been compared head-to-head; and effects of low-frequency NMES (LF-NMES) have never been studied in COPD. Therefore, the optimal training modality to improve lower-limb muscle function, exercise performance and other patient-related outcomes in individuals with severe COPD remains unknown.
OBJECTIVES
To study prospectively the efficacy of HF-NMES (75 Hz), LF-NMES (15 Hz) or strength training in severely dyspnoeic individuals with COPD with quadriceps muscle weakness at baseline.
METHODS
120 individuals with COPD (FEV1: 33±1% predicted, men: 52%, age: 64.8±0.8 years) were randomised to HF-NMES, LF-NMES or strength training as part of a comprehensive inpatient pulmonary rehabilitation programme. No treadmill walking or stationary cycling was provided.
MEASUREMENTS AND MAIN RESULTS
Groups were comparable at baseline. Quadriceps muscle strength increased after HF-NMES (+10.8 Newton-metre (Nm)) or strength training (+6.1 Nm; both p<0.01), but not after LF-NMES (+1.4 Nm; p=0.43). Quadriceps muscle endurance, exercise performance, lower-limb fat-free mass, exercise-induced symptoms of dyspnoea and fatigue improved significantly compared with baseline after HF-NMES, LF-NMES or strength training. The increase in quadriceps muscle strength and muscle endurance was greater after HF-NMES than after LF-NMES.
CONCLUSIONS
HF-NMES is equally effective as strength training in severely dyspnoeic individuals with COPD and muscle weakness in strengthening the quadriceps muscles and thus may be a good alternative in this particular group of patients. HF-NMES, LF-NMES and strength training were effective in improving exercise performance in severely dyspnoeic individuals with COPD and quadriceps weakness.
TRIAL REGISTRATION
NTR2322.
原理
力量训练和神经肌肉电刺激（NMES）可改善慢性阻塞性肺疾病（COPD）呼吸困难患者的下肢肌肉功能。然而，高频 NMES（HF-NMES）和力量训练从未进行过直接比较；低频 NMES（LF-NMES）在 COPD 中的作用也从未被研究过。因此，改善严重 COPD 患者下肢肌肉功能、运动表现和其他患者相关结局的最佳训练方式仍不清楚。
目的
前瞻性研究 HF-NMES（75 Hz）、LF-NMES（15 Hz）或力量训练在基线时存在股四头肌无力的严重呼吸困难 COPD 患者中的疗效。
方法
120 名 COPD 患者（FEV1：预测值的 33±1%，男性：52%，年龄：64.8±0.8 岁）被随机分为 HF-NMES、LF-NMES 或力量训练组，作为综合住院肺康复计划的一部分。没有提供跑步机步行或固定自行车。
测量和主要结果
组间在基线时具有可比性。HF-NMES（+10.8 牛顿米（Nm））或力量训练（+6.1 Nm；均 p<0.01）后股四头肌力量增加，但 LF-NMES 后增加（+1.4 Nm；p=0.43）。HF-NMES、LF-NMES 或力量训练后，与基线相比，股四头肌耐力、运动表现、下肢去脂体重、运动引起的呼吸困难和疲劳症状均显著改善。HF-NMES 后股四头肌力量和耐力的增加大于 LF-NMES。
结论
HF-NMES 与力量训练在 COPD 呼吸困难和肌肉无力的严重患者中同样有效，可作为该特定患者群体的良好替代方案。HF-NMES、LF-NMES 和力量训练可有效改善严重呼吸困难 COPD 患者和股四头肌无力患者的运动表现。
试验注册
NTR2322。
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