背景:耐力训练(ET)和阻力训练(RT)之间的比较在慢性阻塞性肺疾病(COPD)患者中产生了模棱两可的发现。我们的研究目的是探讨在COPD患者的常规药物治疗中加入ET和RT的有效性和长期结局。次要目标是研究不同疾病严重程度的患者的运动训练所带来的临床改善。
方法:这项研究是一个多中心,COPD稳定期患者的前瞻性试验。该队列被随机分为三组:个体化药物治疗组(MT),MT+耐力训练组(MT+ET)和MT+抗阻训练组(MT+RT)。在12周内每周进行3次锻炼。运动能力的终点,与健康相关的生活质量,COPD症状,肺功能,焦虑和抑郁问卷在基线时重新评估,在完成干预以及6个月和12个月的随访时.根据GOLD指南提供的COPD评估工具,患者被分为GOLDA组和B组和GOLDC和D组进行进一步的亚组分析.
结果:意向治疗(ITT)人群包括366名患者,其中328人在12个月内完成了研究方案(PP人群)。主要结局没有显着差异,生活质量,在单独接受药物治疗(MT)的患者之间,MT+耐力训练(MT+ET),或MT+阻力训练(MT+RT)在完成干预,6-,或12个月随访。此外,MT之间没有观察到显著差异,MT+RT,或MT+ET组关于主要结局,运动能力(3MWD),经过最初3个月的干预。然而,在12个月时,与MT+RT相比,MT+ET有较小的统计学差异(ITT:ET中的Δ3MWD与RT=5.53m,95%置信区间:0.87~13.84m,P=0.03)(PP:ET中的Δ3MWD与RT=7.67m,95%置信区间:0.93~16.27m,P=0.04)。对于GOLDC和D组的患者,ET或RT后生活质量的改善明显优于单纯的医疗干预。此外,锻炼方案完成后,在这些患者中,与ET相比,RT在焦虑方面表现出更大的改善(ITT:3个月时的ΔHAD-A:RT=-1.63±0.31vsET=-0.61±0.33,p<0.01)(PP:ΔHAD-3个月时的A:RT=-1.80±0.36vsET=-0.75±0.37,p<0.01)。
结论:我们的研究提供了ET和RT结合标准药物治疗的有益效果的证据,以及干预后一段时间的长期影响。虽然观察到在运动能力方面有利于ET而不是RT的统计学显着效果,应该谨慎解释。COPD严重阶段的患者可能从ET或RT中获得更大的益处,因此应给予鼓励。这些发现对COPD患者的运动处方具有重要意义。
背景:ChiCTR-INR-16009892(11月17日,2016)。
BACKGROUND: Comparisons between endurance training (ET) and resistance training (RT) have produced equivocal findings in chronic obstructive pulmonary disease (COPD) patients. The purpose of our
study is to investigate the effectiveness and long-term outcomes of adding ET and RT to conventional medical treatment in patients with COPD. A secondary objective is to investigate the clinical improvements resulting from exercise training in patients with different disease severities.
METHODS: The
study was a multicenter, prospective
trial in people with stable COPD. The cohort was randomized to three groups: individualized medical treatment group (MT), MT + endurance training group (MT + ET) and MT + resistance training group (MT + RT). Exercise was performed 3 times weekly over a 12-week period. The endpoints of exercise capacity, health-related quality of life, COPD symptoms, lung function, and anxiety and depression questionnaires were re-evaluated at baseline, at the completion of the intervention and at 6 and 12-month follow-up. According to the COPD assessment tool offered by GOLD guidelines, patients were stratified into GOLD A and B groups and GOLD C and D groups for further subgroup analysis.
RESULTS: The intention-to-treat (ITT) population included 366 patients, 328 of them completed the
study protocol over 12 months (the PP-population). There were no significant differences in the primary outcome, quality of life, between patients who underwent medical treatment (MT) alone, MT + endurance training (MT + ET), or MT + resistance training (MT + RT) at the completion of the intervention, 6-, or 12-month follow-up. Additionally, no significant differences were observed between MT, MT + RT, or MT + ET groups concerning the primary outcome, exercise capacity (3MWD), after initial 3 months of intervention. However, a small statistically significant difference was noted in favor of MT + ET compared to MT + RT at 12 months (ITT: Δ3MWD in ET vs RT = 5.53 m, 95% confidence interval: 0.87 to 13.84 m, P = 0.03) (PP: Δ3MWD in ET vs RT = 7.67 m, 95% confidence interval: 0.93 to 16.27 m, P = 0.04). For patients in the GOLD C and D groups, improvement in quality of life following ET or RT was significantly superior to medical intervention alone. Furthermore, upon completion of the exercise regimen, RT exhibited a greater improvement in anxiety compared to ET in these patients (ITT: ΔHAD-A at 3-month: RT = -1.63 ± 0.31 vs ET = -0.61 ± 0.33, p < 0.01) (PP: ΔHAD-A at 3-month: RT = -1.80 ± 0.36 vs ET = -0.75 ± 0.37, p < 0.01).
CONCLUSIONS: Our
study presents evidence of the beneficial effects of ET and RT in combination with standard medical treatment, as well as the long-term effects over time after the intervention. While the statistically significant effect favoring ET over RT in terms of exercise capacity was observed, it should be interpreted cautiously. Patients in severe stages of COPD may derive greater benefits from either ET or RT and should be encouraged accordingly. These findings have implications for exercise prescription in patients with COPD.
BACKGROUND: ChiCTR-INR-16009892 (17, Nov, 2016).