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下肢耐力训练对慢性阻塞性肺疾病患者呼吸困难及肺功能的影响

Impact of Lower-Limb Endurance Training on Dyspnea and Lung Functions in Patients with COPD.

作者信息

Tarigan Amira Permatasari, Pandia Pandiaman, Mutiara Erna, Pradana Andika, Rhinsilva Ella, Efriyandi Efriyandi

机构信息

Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara, Jalan Bunga Lau 17, Adam Malik General Hospital, Sumatera Utara, Indonesia.

Department of Biostatistics, Faculty of Public Health, Universitas Sumatera Utara, Medan, Indonesia.

出版信息

Open Access Maced J Med Sci. 2018 Dec 17;6(12):2354-2358. doi: 10.3889/oamjms.2018.381. eCollection 2018 Dec 20.

Abstract

BACKGROUND

Patients with chronic obstructive pulmonary disease (COPD) exhibit persistent dyspnea in daily activities and irreversible airflow obstruction. These will finally lead to an inability to carry on daily activities and markedly decrease their quality of life. Endurance training was considered as therapy modality to alleviate several symptoms experienced by COPD patients.

AIM

This study aims to identify the impact of lower-limb exercise on dyspnea and spirometry test results in COPD patients.

METHODS

We performed a quasi-experimental study in July 2017 on 20 stable COPD patients divided both in group C and D according to GOLD 2017 criteria. Patients were given an individualised dose of stationary cycling twice a week for one month in which every session lasted 5-20 minutes gradually. Before and after rehabilitation program, pulmonary function tests were measured by spirometry to obtain per cent predicted of Forced Expiratory Volume in 1 second (FEV1), Forced Volume Capacity (FVC), Peak Expiratory Flow (PEF) and Forced Expiratory Flow at 25-75% of the pulmonary volume (FEF25-75), and dyspnea was measured by the mMRC index. Statistical analysis was performed by Wilcoxon and T-dependent test.

RESULTS

Baseline value of FVC (49.6 ± 21.6%) increased significantly to 59.65 ± 16.53% after one month of endurance training program (p = 0.01). Surprisingly, there was also a significant increase in FEV1 value from 46.9 ± 21.7 to 52.9 ± 20.7% (p < 0.005). The increase of FVC and FEV1 in group C was slightly higher than in group D although not statistically significant (p = 0.29; p = 0.25 respectively). However, no difference was observed in PEF and FEF25-75 value (p > 0.05). Patients' dyspnea scale also showed significant improvement (p < 0.001) from mMRC median scale 2 (range 1-3) to 1 (range 0-2) in both groups C and D. There was no exacerbation found during rehabilitation program.

CONCLUSION

Twice a week lower-limb endurance training for one-month improved dyspnea and pulmonary function test results in COPD patients safely and effectively.

摘要

背景

慢性阻塞性肺疾病(COPD)患者在日常活动中表现出持续性呼吸困难和不可逆的气流阻塞。这些最终将导致无法进行日常活动,并显著降低其生活质量。耐力训练被视为缓解COPD患者所经历的几种症状的治疗方式。

目的

本研究旨在确定下肢运动对COPD患者呼吸困难和肺功能测试结果的影响。

方法

2017年7月,我们对20名稳定期COPD患者进行了一项准实验研究,根据2017年GOLD标准将患者分为C组和D组。患者每周接受两次个体化剂量的固定自行车训练,为期一个月,每次训练持续时间逐渐从5分钟增加到20分钟。在康复计划前后,通过肺功能仪测量肺功能,以获得1秒用力呼气量(FEV1)、用力肺活量(FVC)、呼气峰值流速(PEF)和肺容量25%-75%时的用力呼气流量(FEF25-75)的预测百分比,并通过mMRC指数测量呼吸困难程度。采用Wilcoxon检验和配对t检验进行统计分析。

结果

经过一个月的耐力训练计划后,FVC的基线值(49.6±21.6%)显著增加至59.65±16.53%(p = 0.01)。令人惊讶的是,FEV1值也从46.9±21.7显著增加至52.9±20.7%(p < 0.005)。C组FVC和FEV1的增加略高于D组,尽管差异无统计学意义(分别为p = 0.29;p = 0.25)。然而,PEF和FEF25-75值未观察到差异(p > 0.05)。两组患者的呼吸困难量表也显示出显著改善(p < 0.001),从mMRC中位数量表2(范围1-3)改善至1(范围0-2)。在康复计划期间未发现病情加重。

结论

每周两次的下肢耐力训练持续一个月可安全有效地改善COPD患者的呼吸困难和肺功能测试结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a93/6311482/af6ebba62927/OAMJMS-6-2354-g001.jpg

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