Cardiopulmonary Physiotherapy Laboratory, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
Central University of São Paulo, São Carlos, São Paulo, Brazil.
Respir Care. 2018 Nov;63(11):1388-1398. doi: 10.4187/respcare.05763. Epub 2018 Jun 26.
The primary objective of this study was to investigate whether noninvasive ventilation (NIV) can positively affect exercise capacity, maximum oxygen uptake (V̇ ), and symptoms after a 6-week physical training program for subjects with moderate to very severe COPD.
47 subjects with COPD who were enrolled in a physical training program were randomized to either physical training alone or NIV + physical training (NIV-Physical training). Physical training consisted of dynamic aerobic exercises on a treadmill 3 times/week for 6 weeks, for a total of 18 sessions. NIV was titrated according to the subject's tolerance at rest and during exercise. Assessments included physiological responses and symptoms at the incremental cardiopulmonary exercise test peak and during submaximal exercise on a treadmill, 6-min walk distance, maximum inspiratory (P) and expiratory pressure (P), BODE index, and health-related quality of life.
43 subjects completed the 6-week physical training program. Both groups improved 6-min walk distance, P, BODE index, and quality of life, and no differences were found between groups. However, significant improvements were observed for subjects in the NIV-Physical training group with regard to P, maximum V̇ , maximum metabolic equivalents, circulatory power, and maximum S .
A 6-week physical training program alone can improve tolerance for exercise and quality of life, in addition to reducing the risk of mortality. However, NIV associated with a physical training program was shown to have an additive beneficial effect on powerful prognostic markers (maximum V̇ and circulatory power) and to reduce symptoms and improve oxygen saturation in subjects with moderate to very severe COPD.
本研究的主要目的是探讨无创通气（NIV）是否能积极影响运动能力、最大摄氧量（V̇）以及中重度 COPD 患者 6 周体能训练后的症状。
47 例 COPD 患者参加体能训练计划，随机分为单纯体能训练组或 NIV+体能训练组（NIV-Physical training）。体能训练包括在跑步机上进行 3 次/周的动态有氧运动，共 18 次。NIV 根据患者在休息和运动时的耐受情况进行滴定。评估包括递增心肺运动试验峰值时的生理反应和症状以及在跑步机上进行亚极量运动时的症状、6 分钟步行距离、最大吸气（P）和呼气压力（P）、BODE 指数和健康相关生活质量。
43 例患者完成了 6 周的体能训练计划。两组 6 分钟步行距离、P、BODE 指数和生活质量均有改善，组间无差异。然而，NIV-Physical training 组患者的 P、最大 V̇、最大代谢当量、循环功率和最大 S 显著改善。
单独进行 6 周的体能训练计划可以提高运动耐量和生活质量，降低死亡率。然而，与体能训练计划相关的 NIV 显示出对有力的预后标志物（最大 V̇和循环功率）具有附加的有益效果，并能减轻中重度 COPD 患者的症状和提高血氧饱和度。
