Nyberg Andre, Martin Mickael, Saey Didier, Milad Nadia, Patoine Dany, Morissette Mathieu C, Auger Dominique, Stål Per, Maltais Francois
Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden; Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada.
Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada.
Chest. 2021 May;159(5):1821-1832. doi: 10.1016/j.chest.2020.12.005. Epub 2020 Dec 13.
Training volume is paramount in the magnitude of physiological adaptations following resistance training. However, patients with severe COPD are limited by dyspnea during traditional two-limb low-load/high-repetition resistance training (LLHR-RT), resulting in suboptimal training volumes. During a single exercise session, single-limb LLHR-RT decreases the ventilatory load and enables higher localized training volumes compared with two-limb LLHR-RT.
Does single-limb LLHR-RT lead to more profound effects compared with two-limb LLHR-RT on exercise capacity (6-min walk distance [6MWD]), health status, muscle function, and limb adaptations in patients with severe COPD?
Thirty-three patients (mean age 66 ± 7 years; FEV 39 ± 10% predicted) were randomized to 8 weeks of single- or two-limb LLHR-RT. Exercise capacity (6MWD), health status, and muscle function were compared between groups. Quadriceps muscle biopsy specimens were collected to examine physiological responses.
Single-limb LLHR-RT did not further enhance 6MWD compared with two-limb LLHR-RT (difference, 14 [-12 to 39 m]. However, 73% in the single-limb group exceeded the known minimal clinically important difference of 30 m compared with 25% in the two-limb group (P = .02). Health status and muscle function improved to a similar extent in both groups. During training, single-limb LLHR-RT resulted in a clinically relevant reduction in dyspnea during training compared with two-limb LLHR-RT (-1.75; P = .01), but training volume was not significantly increased (23%; P = .179). Quadriceps muscle citrate synthase activity (19%; P = .03), hydroxyacyl-coenzyme A dehydrogenase protein levels (32%; P < .01), and capillary-to-fiber ratio (41%; P < .01) were increased compared with baseline after pooling muscle biopsy data from all participants.
Single-limb LLHR-RT did not further increase mean 6MWD compared with two-limb LLHR-RT, but it reduced exertional dyspnea and enabled more people to reach clinically relevant improvements in 6MWD. Independent of execution strategy, LLHR-RT improved exercise capacity, health status, muscle endurance, and enabled several physiological muscle adaptations, reducing the negative consequences of limb muscle dysfunction in COPD.
ClinicalTrials.gov; No.: NCT02283580; URL: www.clinicaltrials.gov.
在抗阻训练后生理适应性变化程度方面，训练量至关重要。然而，重度慢性阻塞性肺疾病（COPD）患者在传统的双肢低负荷/高重复抗阻训练（LLHR-RT）过程中会受到呼吸困难的限制，导致训练量未达最佳。在单次训练中，与双肢LLHR-RT相比，单肢LLHR-RT可降低通气负荷，并能实现更高的局部训练量。
与双肢LLHR-RT相比，单肢LLHR-RT对重度COPD患者的运动能力（6分钟步行距离[6MWD]）、健康状况、肌肉功能和肢体适应性是否有更显著的影响？
33例患者（平均年龄66±7岁；预测第1秒用力呼气容积[FEV₁]为预计值的39±10%）被随机分为接受8周单肢或双肢LLHR-RT训练组。比较两组间的运动能力（6MWD）、健康状况和肌肉功能。采集股四头肌活检标本以检查生理反应。
与双肢LLHR-RT相比，单肢LLHR-RT并未进一步提高6MWD（差值为14[-12至39米]）。然而，单肢组73%的患者6MWD超过了已知的最小临床重要差异30米，而双肢组为25%（P = 0.02）。两组的健康状况和肌肉功能改善程度相似。在训练期间，与双肢LLHR-RT相比，单肢LLHR-RT使训练期间的呼吸困难在临床上有显著减轻（-1.75；P = 0.01），但训练量未显著增加（23%；P = 0.179）。汇总所有参与者的肌肉活检数据后发现，与基线相比，股四头肌柠檬酸合酶活性增加了19%（P = 0.03），羟酰基辅酶A脱氢酶蛋白水平增加了32%（P < 0.01），毛细血管与肌纤维比例增加了41%（P < 0.01）。
与双肢LLHR-RT相比，单肢LLHR-RT并未进一步提高平均6MWD，但它减轻了运动性呼吸困难，并使更多患者在6MWD上达到临床相关改善。独立于训练执行策略，LLHR-RT改善了运动能力、健康状况、肌肉耐力，并实现了多种生理性肌肉适应性变化，减少了COPD患者肢体肌肉功能障碍的负面影响。
ClinicalTrials.gov；编号：NCT02283580；网址：www.clinicaltrials.gov 。
