School of Nursing and Midwifery, The University of Newcastle, Callaghan, New South Wales, Australia.
School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.
Respirology. 2016 Jul;21(5):875-82. doi: 10.1111/resp.12746. Epub 2016 Feb 24.
Obesity is an established risk factor for poor health outcomes, but paradoxically in chronic obstructive pulmonary disease (COPD), it is associated with improved survival and lung function. A major evidence gap exisits to inform treatment recommendations for patients with COPD who are obese. We aimed to determine the effect of weight reduction involving a low-energy diet utilizing a partial meal replacement plan, coupled with resistance exercise training in obese COPD patients.
In a proof of concept before-after clinical trial, obese (body mass index ≥30 kg/m(2) ) COPD patients received a 12 week weight reduction programme involving meal replacements, dietary counselling by a dietitian and resistance exercise training prescribed and supervised by a physiotherapist. Patients were reviewed face to face by the dietitian and physiotherapist every 2 weeks for counselling.
Twenty-eight participants completed the intervention. Mean (standard deviation) body mass index was 36.3 kg/m(2) (4.6) at baseline and reduced by 2.4 kg/m(2) ((1.1) P < 0.0001) after the intervention. Importantly, skeletal muscle mass was maintained. Clinical outcomes improved with weight loss including exercise capacity, health status, dyspnea, strength and functional outcomes. There was also a significant reduction in the body mass index, obstruction, dyspnea and exercise score (BODE). Systemic inflammation measured by C-reactive protein however did not change.
In obese COPD patients, dietary energy restriction coupled with resistance exercise training results in clinically significant improvements in body mass index, exercise tolerance and health status, whilst preserving skeletal muscle mass. This novel study provides a framework for development of guidelines for the management of obese COPD patients and in guiding future research.
肥胖是健康状况不佳的既定危险因素，但在慢性阻塞性肺疾病（COPD）中却存在矛盾现象，肥胖与生存率和肺功能改善相关。对于肥胖 COPD 患者，存在着重大的证据空白，以告知治疗建议。我们旨在确定涉及低能量饮食和部分代餐计划，结合阻力运动训练对肥胖 COPD 患者体重减轻的影响。
在一项概念验证前后临床试验中，肥胖（体重指数≥30kg/m²）COPD 患者接受了为期 12 周的体重减轻计划，包括代餐、营养师的饮食咨询以及物理治疗师规定和监督的阻力运动训练。营养师和物理治疗师每 2 周面对面为患者提供咨询。
28 名参与者完成了干预。基线时平均（标准差）体重指数为 36.3kg/m²（4.6），干预后降低了 2.4kg/m²（1.1）P<0.0001）。重要的是，骨骼肌量得以维持。随着体重减轻，临床结局得到改善，包括运动能力、健康状况、呼吸困难、力量和功能结局。体重指数、阻塞、呼吸困难和运动评分（BODE）也显著降低。但 C 反应蛋白等系统炎症并未改变。
在肥胖 COPD 患者中，饮食能量限制加上阻力运动训练可显著改善体重指数、运动耐量和健康状况，同时保持骨骼肌量。这项新研究为肥胖 COPD 患者的管理指南的制定提供了框架，并指导了未来的研究。
