Exercise and COPD: therapeutic responses, disease-related outcomes, and activity-promotion strategies

Combating With COPD by QiGong Physical and Mental Exercise

Physical activity levels of patients with chronic obstructive pulmonary disease (COPD) are low due to the symptoms of COPD. The patients diagnosed with COPD are headed for complementary and alternative treatments to reduce the COPD symptoms, facilitate the treatment, and increase their physical activity. One of these treatments is QiGong, which is not yet common in our country. QiGong is a type of exercise based on ancient Chinese medicine, and mainly consists of active and passive exercises. These exercises open energy channels in the body, and thus prevent and/or heal diseases by establishing energy balance in the body through meditation, breath control, and bodily exercises. According to a literature review abroad, there are a small number of scientific studies related the therapeutic effect of QiGong exercises on symptom control, anxiety, reduction of stress and depression, increase in physical activity and quality of life, and the development of lung function of patients with COPD. By considering the educative role of nurses, it is important that the nurse has adequate knowledge of the treatment and care of patients with COPD. Therefore, this review is compiled to be informative about the effects of QiGong in the treatment of COPD, and assistance to subsequent studies.

Effects of combining functional exercises with exercise training on daily physical activities and functionality in patients with COPD: a protocol for a randomized clinical trial

INTRODUCTION

Functional training has been shown to be a viable alternative for the elderly and patients with chronic obstructive pulmonary disease (COPD). However, whether the combination of this type of training with aerobic and resistance training, commonly performed in pulmonary rehabilitation (PR) programs, induces more pronounced effects on daily physical activities and functionality remains unclear. The aims of the study will be to evaluate the short-term and sustained effects of the combination of a functional circuit program with a training program consisting of aerobic and resistance exercise.

METHODS

In this randomized controlled trial, patients with COPD will be randomly assigned (1:1:1) to an 8-week training program to follow one of the three a priori defined groups: (I) resistance and aerobic and functional exercises, (II) a conventional program including only resistance and aerobic exercises, or (III) a usual care program. Patients will be evaluated before and upon completion of 8 weeks of training regarding physical activity in daily life (PADL) using an activity monitor (accelerometer), activities of daily living (London Chest Activity of Daily Living), functional exercise capacity (6-minute walk test), and muscle strength (dynamometry). Additionally, the sustained effects of the interventions will be evaluated 22 weeks after commencing the study.

DISCUSSION

The inclusion of a protocol of functional physical training in the training conventionally performed by patients with COPD as an alternative to increase PADL and functionality may provide subsidies for the treatment of these patients, representing an advance and impacting on the physical training of patients with COPD.

TRIAL REGISTRATION

Brazilian Clinical Trials Registry (ReBEC) ID: RBR-3zmh3r. Registered: March 7, 2018.

The dyspnoea-inactivity vicious circle in COPD: development and external validation of a conceptual model

The vicious circle of dyspnoea-inactivity has been proposed, but never validated empirically, to explain the clinical course of chronic obstructive pulmonary disease (COPD). We aimed to develop and validate externally a comprehensive vicious circle model.We utilised two methods. 1) Identification and validation of all published vicious circle models by a systematic literature search and fitting structural equation models to longitudinal data from the Spanish PAC-COPD (Phenotype and Course of COPD) cohort (n=210, mean age 68 years, mean forced expiratory volume in 1 s (FEV1) 54% predicted), testing both the hypothesised relationships between variables in the model ("paths") and model fit. 2) Development of a new model and external validation using longitudinal data from the Swiss and Dutch ICE COLD ERIC (International Collaborative Effort on Chronic Obstructive Lung Disease: Exacerbation Risk Index Cohorts) cohort (n=226, mean age 66 years, mean FEV1 57% predicted).We identified nine vicious circle models for which structural equation models confirmed most hypothesised paths but showed inappropriate fit. In the new model, airflow limitation, hyperinflation, dyspnoea, physical activity, exercise capacity and COPD exacerbations remained related to other variables and model fit was appropriate. Fitting it to ICE COLD ERIC, all paths were replicated and model fit was appropriate.Previously published vicious circle models do not fully explain the vicious circle concept. We developed and externally validated a new comprehensive model that gives a more relevant role to exercise capacity and COPD exacerbations.

Effectiveness of a combined exercise training and home-based walking programme on physical activity compared with standard medical care in moderate COPD: a randomised controlled trial

OBJECTIVE

To estimate the effectiveness of a 10-week combined exercise training and home-based walking programme on daily physical activity (PA) compared with standard medical care in patients with moderate chronic obstructive pulmonary disease (COPD).

DESIGN

Randomised controlled trial.

SETTING

Primary care physiotherapy.

PARTICIPANTS

Consecutive patients with stable COPD at Gold Stage II with a score of two or more on the Medical Research Council Dyspnoea Scale.

INTERVENTION

Ten-week combined exercise training and home-based walking programme compared with standard medical care.

MAIN OUTCOMES

At baseline and after 10 weeks, daily PA was evaluated by accelerometry using three levels of intensity and expressed as metabolic equivalent of task. In addition, daily activities (Physical Activity Scale for the Elderly), functional exercise capacity (6-minute Walk Test), health-related quality of life (Chronic Respiratory Questionnaire) and exercise self-efficacy (Exercise Self-Regulatory Efficacy Scale) were measured.

RESULTS

Fifty-two patients {34 females; mean age 70.2 [standard deviation (SD) 9.5] years; mean forced expiratory volume in 1second 67% (SD 9.2) of predicted} were randomised. PA, adjusted for baseline differences, increased significantly in the intervention group compared with the control group, by 26.1minutes/day [95% confidence interval (CI) 7.3 to 44.9]. The increase in functional capacity between groups was clinically relevant (34.0m, 95% CI 2.3 to 65.6) in favour of the intervention group.

CONCLUSIONS

A combined exercise training and home-based walking programme in primary care physiotherapy improved PA in patients with moderate COPD. Clinical trial registration number NL24766.018.08.

Does Downhill Walking on Treadmill Improve Physical Status and Quality of Life of A Patient With COPD?

Introduction:

Chronic obstructive pulmonary disease (COPD) is accompanied by several extra-pulmonary consequences, such as skeletal muscle weakness and atrophy which will have a negative impact on daily life in patients and lead to their debilitation; therefore, when treating COPD patients, protocols should be taken into account to improve function and quality of life (QoL).

Case Presentation:

The case was a 71- year-old woman suffering from chronic bronchitis and bronchiectasis for 30 years that has been faced with increased musculoskeletal disorders in recent months. The case was managed by downhill treadmill walking for four months with the aim of improving her functional ability and QoL. Functional tests, thigh girth measurement and St. george’s respiratory questionnaire (SGRQ) were used to assess the physical status and QoL of the patient. The outcomes measures confirmed the improvement of the studied case. The improvements continued three months after the beginning of the treatment.

Conclusions:

The eccentric exercise therapy in the form of downhill walking had positive effects on functions and QoL of studied case, especially had an augmenting effect on the thigh muscles size.

Examining the role of activity, exercise, and pharmacology in mild COPD

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide and, although it is a preventable and treatable disease, it often remains undiagnosed in patients with mild disease. It is now evident that pathologic changes and physiologic impairment start early in disease progression, and even patients with mild airflow limitation have impairment in the form of exertional dyspnea, general fatigue, and exercise intolerance. Primary care physicians are optimally positioned to recognize these progressive activity restrictions in their patients, usually involving little more than a detailed patient history and a simple symptom questionnaire. Once a patient with persistent activity-related dyspnea has been diagnosed with COPD, bronchodilators can effectively address expiratory airflow limitation and lung hyperinflation that underlie symptoms. These pharmacologic interventions work in conjunction with nonpharmacologic interventions, including smoking cessation, exercise training, and pulmonary rehabilitation. Although the benefits of exercise intervention are well established in patients with more severe COPD, a small amount of new data is emerging that supports the benefits of both pharmacologic treatment and exercise training for improving exercise endurance in patients with mild-to-moderate COPD. This review examines the growing body of data that suggests that early identification-most likely by primary care physicians-and appropriate intervention can favorably impact the symptoms, exercise tolerance, health status, quality of life, hospitalizations, and economic costs of COPD.

Activity restriction in mild COPD: a challenging clinical problem

Dyspnea, exercise intolerance, and activity restriction are already apparent in mild chronic obstructive pulmonary disease (COPD). However, patients may not seek medical help until their symptoms become troublesome and persistent and significant respiratory impairment is already present; as a consequence, further sustained physical inactivity may contribute to disease progression. Ventilatory and gas exchange impairment, cardiac dysfunction, and skeletal muscle dysfunction are present to a variable degree in patients with mild COPD, and collectively may contribute to exercise intolerance. As such, there is increasing interest in evaluating exercise tolerance and physical activity in symptomatic patients with COPD who have mild airway obstruction, as defined by spirometry. Simple questionnaires, eg, the modified British Medical Research Council dyspnea scale and the COPD Assessment Test, or exercise tests, eg, the 6-minute or incremental and endurance exercise tests can be used to assess exercise performance and functional status. Pedometers and accelerometers are used to evaluate physical activity, and endurance tests (cycle or treadmill) using constant work rate protocols are used to assess the effects of interventions such as pulmonary rehabilitation. In addition, alternative outcome measurements, such as tests of small airway dysfunction and laboratory-based exercise tests, are used to measure the extent of physiological impairment in individuals with persistent dyspnea. This review describes the mechanisms of exercise limitation in patients with mild COPD and the interventions that can potentially improve exercise tolerance. Also discussed are the benefits of pulmonary rehabilitation and the potential role of pharmacologic treatment in symptomatic patients with mild COPD.

Comparison of cardiopulmonary exercise testing variables in COPD patients with and without coronary artery disease

BACKGROUND

Coronary artery disease (CAD) is a common concomitant condition and an important cause of morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD). Since COPD and CAD can both independently cause reduced exercise capacity, it is reasonable to hypothesize that the combination of these diseases may compound the abnormalities observed during cardiopulmonary exercise testing (CPET). However, little is known about the impact of CAD on the CPET response in COPD patients. The aim of this study is to compare exercise capacity and gas exchange variables in COPD patients with and without CAD.

METHODS

Fifty-four COPD subjects without CAD (COPDnoCAD) were matched to 54 COPD subjects diagnosed with CAD (COPD/CAD) according to age, gender, body mass index and severity of COPD. All subjects underwent resting pulmonary function and symptom-limited CPET.

RESULTS

Comparing COPDnoCAD patients with COPD/CAD patients revealed that exercise capacity, as measured by % peak oxygen consumption (42 ± 16% vs 53 ± 19%, p = 0.002) and % peak wattage (23 ± 13% vs 32 ± 16%, p = 0.001), was significantly lower in COPD/CAD. Ventilatory response, as measured by VE/VCO2 nadir (36 ± 9 vs 32 ± 5, p = 0.001), was significantly higher in COPD/CAD, with % peak VO2 and VE/VCO2 nadir correlating to % FEV1 and inversely correlating with %DLCO.

CONCLUSION

COPD patients with CAD have significantly impaired CPET responses with lower exercise capacity and impaired gas exchange compared to COPD patients without CAD. These findings may affect the clinical interpretation of CPET data in COPD patients who have concomitant CAD.

The association between co-morbidities and physical performance in people with chronic obstructive pulmonary disease

A systematic review was conducted to examine the association between co-morbidity and physical performance in people with chronic obstructive pulmonary disease (COPD). MEDLINE, EMBASE, CINAHL, SCOPUS and Cochrane Central Register of Controlled Trials were searched from inception to end-February 2013, using keywords ‘COPD’, ‘exercise’, ‘physical activity’, ‘rehabilitation’, ‘co-morbidity’ and individual co-morbid conditions. Studies reporting associations of co-morbidities in COPD with at least one objective measure of physical performance were included. Study quality was appraised using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Nine studies met inclusion criteria. Mean (standard deviation (SD)) STROBE score was 16 (3) (maximum score = 21). Four studies examined anxiety as a co-morbid condition; three examined depression; two examined obesity and two examined a range of conditions. Reduced physical performance was associated with higher Charlson score (odds ratio (OR) = 0.72, 95% confidence interval (CI) = 0.54–0.98), metabolic disease (OR = 0.58, 95% CI = 0.49–0.67), anxiety (OR = 0.37, 95% CI = 0.23–0.59) and osteoporosis (OR = 0.28, 95% CI = 0.11–0.70). Depression had minimal association with physical performance but was associated with higher dropout rates from pulmonary rehabilitation programmes. Obesity was negatively associated with baseline physical performance but not with change from an exercise intervention. The presence of co-morbid conditions in people with COPD may negatively affect physical performance and should be identified and accounted for analysis of interventions.