Kaminsky David A, Guntupalli Kalpalatha K, Lippmann Joan, Burns Stephanie M, Brock Melissa A, Skelly Joan, DeSarno Michael, Pecott-Grimm Heidi, Mohsin Ali, LaRock-McMahon Catherine, Warren Penney, Whitney Martha C, Hanania Nicola A
1 Department of Medicine, Division of Pulmonary and Critical Care, University of Vermont College of Medicine , Burlington, VT.
2 Vermont Lung Center, University of Vermont College of Medicine , Burlington, VT.
J Altern Complement Med. 2017 Sep;23(9):696-704. doi: 10.1089/acm.2017.0102. Epub 2017 Jul 17.
Pulmonary rehabilitation improves exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). However, many patients do not have access to pulmonary rehabilitation programs. We hypothesized that an alternative to pulmonary rehabilitation to improve exercise tolerance is the practice of pranayama, or yoga breathing, which could be done independently at home. We also sought to determine whether yoga nonprofessionals could adequately teach pranayama to patients.
Proof-of-concept, randomized, double-blind, controlled pilot trial.
SETTINGS/LOCATION: Two academic pulmonary practices.
Forty-three patients with symptomatic, moderate-to-severe COPD.
Twelve weeks of pranayama plus education versus education alone. Two yoga professionals trained the research coordinators to conduct all pranayama teaching and monitored the quality of the teaching and the practice of pranayama by study participants.
The primary outcome was a change in the 6-min walk distance (6MWD). Secondary outcomes included changes in lung function, markers of oxidative stress and systemic inflammation, and measures of dyspnea and quality of life.
The 6MWD increased in the pranayama group (least square mean [95% confidence interval] = 28 m [-5 to 61]) and decreased in the control group (-15 m [-47 to 16]), with a nearly significant treatment effect (p = 0.06) in favor of pranayama. Pranayama also resulted in small improvements in inspiratory capacity and air trapping. Both groups had significant improvements in various measures of symptoms, but no overall differences in respiratory system impedance or markers of oxidative stress or systemic inflammation.
This pilot study successfully demonstrated that pranayama was associated with improved exercise tolerance in patients with COPD. Lay personnel were able to adequately teach patients to practice pranayama. These results suggest that pranayama may have significant clinical benefits for symptomatic patients with COPD, a concept that needs to be confirmed in future, larger clinical trials.
肺康复可提高慢性阻塞性肺疾病（COPD）患者的运动耐量。然而，许多患者无法获得肺康复项目。我们假设，一种改善运动耐量的肺康复替代方法是练习调息法，即瑜伽呼吸法，患者可在家中自行练习。我们还试图确定非专业瑜伽人员是否能够充分地向患者教授调息法。
概念验证性、随机、双盲、对照试验。
两家学术性肺部诊疗机构。
43例有症状的中重度COPD患者。
12周的调息法练习加教育与单纯教育。两名瑜伽专业人员培训研究协调员进行所有调息法教学，并监测教学质量以及研究参与者的调息法练习情况。
主要观察指标为6分钟步行距离（6MWD）的变化。次要观察指标包括肺功能、氧化应激和全身炎症标志物的变化，以及呼吸困难和生活质量的测量指标。
调息法组的6MWD增加（最小二乘均值[95%置信区间]=28米[-5至61]），而对照组减少（-15米[-47至16]），支持调息法的治疗效果接近显著（p=0.06）。调息法还使吸气量和气体潴留略有改善。两组在各种症状指标上均有显著改善，但在呼吸系统阻抗、氧化应激标志物或全身炎症方面无总体差异。
这项初步研究成功表明，调息法与COPD患者运动耐量的改善相关。非专业人员能够充分地教授患者练习调息法。这些结果表明，调息法可能对有症状的COPD患者具有显著的临床益处，这一概念需要在未来更大规模的临床试验中得到证实。
