Name: home-based prescribed pulmonary exercise in patients with stable chronic obstructive pulmonary disease
Uploaded: 2019-08-24T13:00:00
Description: Watch this Scientific Journal Video about Home-Based Prescribed Pulmonary Exercise in Patients with Stable Chronic Obstructive Pulmonary Disease at JoVE.com

This study was supported by the national fitness project of General Administration of Sport of China (No. 2017B021), the key basic research grants from Science and Technology Commission of Shanghai Municipality (No. 16JC1400500), the directed research grants from Science and Technology Commission of Shanghai Municipality (No. 18DZ1200600), and National Natural Science Foundation of China (No. 81472163).

The protocol has been approved by the Ethics Committee of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine affiliated with Shanghai University of Traditional Chinese Medicine (Shanghai, China).
1. Video construction and study design
<ol>
	<li>Construct a video of the prescribed pulmonary exercise. Our video was based on the TCE video issued by the General Administration of Sport of China.
	<ol>
		<li>In the video, have a member of the research team in a spacious place ...

<ol>
	<li>Organization, W. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> World health statistics 2017: monitoring health for the SDGs, Sustainable Development Goals. , (2017).</li><li>Negewo, N. A., Gibson, P. G., McDonald, V. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=COPD+and+its+comorbidities:+Impact,+measurement+and+mechanisms.">COPD and its comorbidities: Impact, measurement and mechanisms.</a> Respirology. 20 (8), 1160-1171 (2015).</li><li>Rabe, K. F., Watz, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chronic+obstructive+pulmonary+disease.">Chronic obstructive pulmonary disease.</a> The Lancet. 389 (10082), 1931-1940 (2017).</li><li>Agusti, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Characterisation+of+COPD+heterogeneity+in+the+ECLIPSE+cohort.">Characterisation of COPD heterogeneity in the ECLIPSE cohort.</a> Respiratory Research. 11 (122), (2010).</li><li>Global Initiative for Chronic Obstructive Lung Disease. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (2018 Report). , (2018).</li><li>Zambom-Ferraresi, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+combined+resistance+and+endurance+training+versus+resistance+training+alone+on+strength,+exercise+capacity,+and+quality+of+life+in+patients+with+COPD.">Effects of combined resistance and endurance training versus resistance training alone on strength, exercise capacity, and quality of life in patients with COPD.</a> Journal of Cardiopulmonary Rehabilitation and Prevention. 35 (6), 446-453 (2015).</li><li>Ramos, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effects+of+elastic+tubing-based+resistance+training+compared+with+conventional+resistance+training+in+patients+with+moderate+chronic+obstructive+pulmonary+disease:+a+randomized+clinical+trial.">The effects of elastic tubing-based resistance training compared with conventional resistance training in patients with moderate chronic obstructive pulmonary disease: a randomized clinical trial.</a> Clinical Rehabilitation. 28 (11), 1096-1106 (2014).</li><li>El-Kader, S. M. A., Al Jiffri, O. H., Al-Shreef, F. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Plasma+in&#64258;ammatory+biomarkers+response+to+aerobic+versus+resisted+exercise+training+for+chronic+obstructive+pulmonary+disease+patients.">Plasma in&#64258;ammatory biomarkers response to aerobic versus resisted exercise training for chronic obstructive pulmonary disease patients.</a> African Health Sciences. 16 (2), 507-515 (2016).</li><li>Iepsen, U. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+endurance+versus+resistance+training+on+quadriceps+muscle+dysfunction+in+COPD:+a+pilot+study.">Effect of endurance versus resistance training on quadriceps muscle dysfunction in COPD: a pilot study.</a> International Journal of Chronic Obstructive Pulmonary Disease. 11, 2659-2669 (2016).</li><li>Coquart, J. B., Le Rouzic, O., Racil, G., Wallaert, B., Grosbois, J. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Real-life+feasibility+and+effectiveness+of+home-based+pulmonary+rehabilitation+in+chronic+obstructive+pulmonary+disease+requiring+medical+equipment.">Real-life feasibility and effectiveness of home-based pulmonary rehabilitation in chronic obstructive pulmonary disease requiring medical equipment.</a> International Journal of Chronic Obstructive Pulmonary Disease. 12, 3549-3556 (2017).</li><li>Puente-Maestu, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+exercise+testing+in+the+evaluation+of+interventional+efficacy:+an+official+ERS+statement.">Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement.</a> The European Respiratory Journal. 47 (2), 429-460 (2016).</li><li>Coquart, J. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Home-based+neuromuscular+electrical+stimulation+improves+exercise+tolerance+and+health-related+quality+of+life+in+patients+with+COPD.">Home-based neuromuscular electrical stimulation improves exercise tolerance and health-related quality of life in patients with COPD.</a> International Journal of Chronic Obstructive Pulmonary Disease. 11, 1189-1197 (2016).</li><li>Spielmanns, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Whole-Body+Vibration+Training+During+a+Low+Frequency+Outpatient+Exercise+Training+Program+in+Chronic+Obstructive+Pulmonary+Disease+Patients:+A+Randomized,+Controlled+Trial.">Whole-Body Vibration Training During a Low Frequency Outpatient Exercise Training Program in Chronic Obstructive Pulmonary Disease Patients: A Randomized, Controlled Trial.</a> Journal of Clinical Medicine Research. 9 (5), 396-402 (2017).</li><li>Lan, C., Chou, S., Chen, S., Lai, J., Wong, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+aerobic+capacity+and+ventilatory+efficiency+during+exercise+in+Qigong+and+Tai+Chi+Chuan+practitioners.">The aerobic capacity and ventilatory efficiency during exercise in Qigong and Tai Chi Chuan practitioners.</a> The American Journal of Chinese Medicine. 32 (1), 141-150 (2004).</li><li>Chao, Y., Chen, S., Lan, C., Lai, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+cardiorespiratory+response+and+energy+expenditure+of+Tai-Chi-Qui-Gong.">The cardiorespiratory response and energy expenditure of Tai-Chi-Qui-Gong.</a> The American Journal of Chinese Medicine. 30 (4), 451-461 (2002).</li><li>Xiao, C., Zhuang, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+of+Liuzijue+Qigong+in+individuals+with+chronic+obstructive+pulmonary+disease+in+remission.">Efficacy of Liuzijue Qigong in individuals with chronic obstructive pulmonary disease in remission.</a> Journal of the American Geriatrics Socety. 63 (7), 1420-1425 (2015).</li><li>Li, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+long-term+home-based+liuzijue+exercise+combined+with+clinical+guidance+in+elderly+patients+with+chronic+obstructive+pulmonary+disease.">Effects of long-term home-based liuzijue exercise combined with clinical guidance in elderly patients with chronic obstructive pulmonary disease.</a> Clinical Interventions in Aging. 13, 1391-1399 (2018).</li><li>Zhang, M., Xv, G., Luo, C., Meng, D., Ji, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Qigong+Yi+Jinjing+promotes+pulmonary+function,+physical+activity,+quality+of+life+and+emotion+regulation+self-efficacy+in+patients+with+chronic+obstructive+pulmonary+disease:+a+pilot+study.">Qigong Yi Jinjing promotes pulmonary function, physical activity, quality of life and emotion regulation self-efficacy in patients with chronic obstructive pulmonary disease: a pilot study.</a> Journal of Alternative &amp; Complementary Medicine. 22 (10), 810-817 (2016).</li><li>Ng, B., Tsang, H., Jones, A., So, C., Mok, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Functional+and+psychosocial+effects+of+health+qigong+in+patients+with+COPD:+a+randomized+controlled+trial.">Functional and psychosocial effects of health qigong in patients with COPD: a randomized controlled trial.</a> Journal of Alternative &amp; Complementary Medicine. 17 (3), 243-251 (2011).</li><li>Liu, X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Therapeutic+effects+of+Qigong+in+patients+with+COPD:+A+randomized+controlled+trial.">Therapeutic effects of Qigong in patients with COPD: A randomized controlled trial.</a> Hong Kong Journal of Occupational Therapy. 22 (1), 38-46 (2012).</li><li>Jones, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=St.+George's+Respiratory+Questionnaire:+MCID.">St. George's Respiratory Questionnaire: MCID.</a> COPD. 2 (1), 75-79 (2005).</li><li>Liu, X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+home-based+prescribed+pulmonary+exercise+by+patients+with+chronic+obstructive+pulmonary+disease:+study+protocol+for+a+randomized+controlled+trial.">Effects of home-based prescribed pulmonary exercise by patients with chronic obstructive pulmonary disease: study protocol for a randomized controlled trial.</a> Trials. 20 (1), 41 (2019).</li><li>Borg, G. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Psychophysical+bases+of+perceived+exertion.">Psychophysical bases of perceived exertion.</a> Medicine &amp; Science in Sports &amp; Exercise. 14 (5), 377-381 (1982).</li><li>Holland, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+official+European+Respiratory+Society/American+Thoracic+Society+technical+standard:+field+walking+tests+in+chronic+respiratory+disease.">An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease.</a> European Respiratory Journal. 44 (6), 1428-1446 (2014).</li><li>Rikli, R., Jones, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Senior Fitness Test Manual - 2nd edition. , 64-67 (2013).</li><li>Sciriha, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Health+status+of+COPD+patients+undergoing+pulmonary+rehabilitation:+a+comparative+responsiveness+of+the+CAT+and+SGRQ.">Health status of COPD patients undergoing pulmonary rehabilitation: a comparative responsiveness of the CAT and SGRQ.</a> Chronic Respiratory Disease. 14 (4), 352-359 (2017).</li><li>Jones, P. W., Quirk, F. H., Baveystock, C. M., Littlejohns, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+self-complete+measure+of+health+status+for+chronic+airflow+limitation.+The+St.+George's+Respiratory+Questionnaire.">A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire.</a> The American Review of Respiratory Disease. 145 (6), 1321-1327 (1992).</li><li>Leung, R., McKeough, Z., Peters, M., Alison, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Short-form+Sun-style+t'ai+chi+as+an+exercise+training+modality+in+people+with+COPD.">Short-form Sun-style t'ai chi as an exercise training modality in people with COPD.</a> European Respiratory Journal. 41 (5), 1051-1057 (2013).</li><li>Grosbois, J. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Six-minute+stepper+test:+a+valid+clinical+exercise+tolerance+test+for+COPD+patients.">Six-minute stepper test: a valid clinical exercise tolerance test for COPD patients.</a> International Journal of Chronic Obstructive Pulmonary Disease. 11, 657-663 (2016).</li><li>Coquart, J. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reproducibility+and+Sensitivity+of+the+6-Minute+Stepper+Test+in+Patients+with+COPD.">Reproducibility and Sensitivity of the 6-Minute Stepper Test in Patients with COPD.</a> COPD. 12 (5), 533-538 (2015).</li><li>Alexander, J., Phillips, W., Wagner, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effect+of+strength+training+on+functional+fitness+in+older+patients+with+chronic+lung+disease+enrolled+in+pulmonary+rehabilitation.">The effect of strength training on functional fitness in older patients with chronic lung disease enrolled in pulmonary rehabilitation.</a> Rehabilitation Nursing. 33 (3), 91-97 (2012).</li><li>Chen, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+home-based+lower+limb+resistance+training+on+muscle+strength+and+functional+status+in+stable+COPD+patients.">Effects of home-based lower limb resistance training on muscle strength and functional status in stable COPD patients.</a> Journal of Clinical Nursing. 27 (5-6), e1022-e1037 (2017).</li><li>Covey, M., Collins, E., Reynertson, S., Dilling, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Resistance+training+as+a+preconditioning+strategy+for+enhancing+aerobic+exercise+training+outcomes+in+COPD.">Resistance training as a preconditioning strategy for enhancing aerobic exercise training outcomes in COPD.</a> Respiratory Medicine. 108 (8), 1141-1152 (2014).</li><li>Chan, A., Lee, A., Lee, D., Sit, J., Chair, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+the+sustaining+effects+of+Tai+Chi+Qigong+in+the+sixth+month+in+promoting+psychosocial+health+in+COPD+patients:+a+single-blind,+randomized+controlled+trial.">Evaluation of the sustaining effects of Tai Chi Qigong in the sixth month in promoting psychosocial health in COPD patients: a single-blind, randomized controlled trial.</a> ScientificWorldJournal. 2013, 425082 (2013).</li><li>Wuytack, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+outpatient+and+home-based+exercise+training+programmes+for+COPD:+a+systematic+review+and+meta-analysis.">Comparison of outpatient and home-based exercise training programmes for COPD: a systematic review and meta-analysis.</a> Respirology. 23 (3), 272-283 (2018).</li></ol>

In this study, a modified TCE referred to as prescribed pulmonary exercise is used in an intervention program, and a number of fitness tests are used to investigate the effects of home-based prescribed pulmonary exercise on exercise capacity and quality of life in stable COPD patients. The main finding is that many improvements occurred in upper and lower limb exercise capacity, endurance exercise capacity, and quality of life after 3 months of intervention. The results indicate that prescribed pulmonary exercise as a CO...

Chronic non-communicable diseases have gradually become the biggest threat to global health, accounting for 70% of global mortality. A majority of such deaths have been caused by four main diseases, while COPD ranks third and only falls behind cardiovascular disease and cancer. Moreover, the ranking of COPD in leading to years of life lost has risen from eleventh in 2007 to seventh in 20171. This change indicates unsatisfactory effects of current treatments in the rehabilitation of COPD progression. More studies have recognized that COPD is not only a respiratory disease but also a complex, multi-systemic, and multi-complicative condition2,3. COPD complications (i.e., skeletal muscle dysfunction) exist in all stages of the disease and play an important role in progression and prognosis4. Considering interactions between the respiratory symptoms and exercise capacity, rehabilitation of exercise capacity has received a lot of attention.
Pulmonary rehabilitation as a comprehensive intervention program, including but not limited to exercise training, health education, and self-management, has demonstrated effectiveness on physical and psychological condition of COPD patients5. Among the different types of exercise training, aerobic exercise plays a critical role in the improvement of endurance performance and muscle power6. In contrast, resistance exercise shows advantages in the improvement of muscle strength and functional exercise capacity7. Moreover, the interventional mechanisms of these two exercise types are distinct. Compared to resistance exercise, aerobic exercise is more effective in modulating inflammatory cytokine levels and inducing oxidized phenotypes of the quadriceps8,9.
Although the effects of these two conventional exercises in pulmonary rehabilitation has been demonstrated, regardless of the location (in hospital or at home)10,11, implementation of conventional exercise training is still limited due to the requirements of specific equipment, spacious room, and safety monitoring. These constraints not only inflict a burden on a patient&rsquo;s family but also to the healthcare system. Alternative interventions such as neuromuscular electrical stimulation and whole-body vibration training share the same constraints12,13.
Traditional Chinese exercises (TCE), including tai chi, liu zi jue, wu qin xi, ba duan jin, and yi jin jing, belong to the self-exercise category, which focuses on adjustment of the breath accompanied with coordinated movement. These exercises also rely on psychological-physiological-morphological mechanisms to achieve health-related fitness. Previous studies have shown that 1) TCE as a low-and medium-intensity aerobic exercise induces a maximum heart rate of 43%&ndash;49%14, 2) exercise intensity ranges from 1.5 to 2.6 metabolic equivalents of energy (METs)15, and 3) it exerts positive effects in patients with stable COPD through clinical and family rehabilitation16,17,18,19. Compared to conventional exercise training, the advantage of TCE is that it is easy to execute at home without any equipment or spatial constraints.
As a modified TCE, the prescribed pulmonary exercise described in this protocol has been developed from the theory of traditional Chinese medicine and aims at the rehabilitation of COPD dyspnea and exercise capacity. Previous studies have showed significant improvements in the exercise capacity (assessed by 6 min walking test, 6MWT), daily life (Zhongshan COPD questionnaire for quality of life), and systemic inflammation levels in COPD patients after prescribed pulmonary exercise20. However, the effects of prescribed pulmonary exercise on the exercise capacity of upper and lower limbs and quality of life in COPD patients is still unclear.
This study compares 3 months of usual medicinal treatment without exercise intervention (control group, CG) vs. 3 months of prescribed pulmonary exercise intervention (PG) in stable COPD patients to investigate the effects of prescribed pulmonary exercise. The effects on upper limb exercise capacity are evaluated by the 30 s arm curl test, effects on lower limb exercise capacity evaluated by the 30 s sit-to-stand test (30 s SST), effects on endurance exercise capacity evaluated by the 6 min walking test (6MWT), and effects on quality of life evaluated by St. George&rsquo;s Respiratory Questionnaire (SGRQ).

<table>
	<tbody>
		<tr>
			<td>4643a</td>
			<td>Tanita</td>
			<td></td>
			<td>Used for the evaluation of height, weight, and body mass index</td>
		</tr>
		<tr>
			<td>Borg CR10</td>
			<td>None</td>
			<td></td>
			<td>Used for the evaluation of dyapnea</td>
		</tr>
		<tr>
			<td>PASS 15.0</td>
			<td>NCSS, LLC</td>
			<td></td>
			<td>Used for power calculation</td>
		</tr>
		<tr>
			<td>Polar team 2</td>
			<td>Polar</td>
			<td></td>
			<td>Used for supervising the heart rate of participants</td>
		</tr>
		<tr>
			<td>SGRQ software</td>
			<td>Developed by Peking Union Medical College</td>
			<td></td>
			<td>Used for calculating the score of quality of life</td>
		</tr>
		<tr>
			<td>SPSS 24.0</td>
			<td>IBM Corporation</td>
			<td></td>
			<td>Used for statistical analysis</td>
		</tr>
	</tbody>
</table>

home-based prescribed pulmonary exercise in patients with stable chronic obstructive pulmonary disease

As a systemic disease, chronic obstructive pulmonary disease (COPD) affects the respiratory system, inducing restless and exercise dyspnea. It also impacts exercise capacity and forms a vicious circle in which it further aggravates the condition of patients and accelerates disease progression. As a functional holistic exercise, traditional Chinese exercises (TCE) play an important role in the rehabilitation of COPD on the basis of adjusting the breath and performing coordinated movements. This study investigates the effects of prescribed pulmonary exercises (which are modified from TCE) on exercise capacity of upper and lower limbs, endurance exercise capacity, and quality of life in stable COPD patients. The goal is to determine the accessibility of these prescribed exercises in COPD rehabilitation. Participants are randomly divided into a non-exercise control group (CG) or prescribed pulmonary exercise group (PG) at a ratio of 1: 1. The PG receives intervention for 60 min twice per day, 7 days a week, for a total of 3 months. The intensity is measured using the Borg category-ratio 10 scale and with a heart-rate monitor. Then, an exercise capacity test and quality of life questionnaire are scheduled at 1 week before and after the formal intervention. After 3 months of intervention, the 30 s arm curl test, 30 s sit-to-stand test, 6 min walking test, and quality of life show significant improvement in COPD patients (p &#60; 0.05). These findings indicate that prescribed pulmonary exercises can be applied as alternative, convenient, and effective home- and community-based exercises for stable COPD patients.

The protocol above describes a randomized controlled trial to investigate whether prescribed pulmonary exercise improves exercise capacity and quality of life in stable COPD patients. While 44 participants were recruited, only 37 (84%) participants completed the study (CG = 19, PG = 18). Thus, data analysis was carried out using the 37 participants, and the two groups showed no significant differences in basic characteristics including age, sex, BMI, duration, and disease grade (Table 1).
<p class="j...

Watch this Scientific Journal Video about Home-Based Prescribed Pulmonary Exercise in Patients with Stable Chronic Obstructive Pulmonary Disease at JoVE.com

Home-Based Prescribed Pulmonary Exercise in Patients with Stable Chronic Obstructive Pulmonary Disease

Presented here is a protocol to investigate the effects of home-based prescribed pulmonary exercise in stable chronic obstructive pulmonary disease (COPD) patients, which is modified based on traditional Chinese exercises according to dyspnea and limited exercise capacity observed in COPD patients.

As a systemic disease, chronic obstructive pulmonary disease (COPD) affects the respiratory system, inducing restless and exercise dyspnea. It also ...

This protocol can be applied as a convenient alternative and effective community based exercise program for stable COPD patients. The prescribed pulmonary exercise have been developed from the theory of traditional Chinese medicine and are aimed at the rehabilitation of COPD dyspnea and the exercise capacity. This method can also be used the geriatric method to improve the cardiovascular and musculoskeletal fitness and to delay the progressively declined fitness of elderly patients.The skill operating in coordination with movement may be the most challenging part of the technique for a novice. Demonstrating the testing procedure will be Peijun Li a graduate student from my laboratory. Before the formal training session, give introductory training sessions three times within two weeks to the prescribed pulmonary exercise participants.Ask the participants to study the complete action and breathing requirements of each intervention after each training session. At the formal training session, give the prescribed pulmonary exercises video and the exercise record brochure to the participants in prescribed pulmonary exercises groups. Instruct the prescribed pulmonary exercise participants to perform the prescribed pulmonary exercises in accordance with the intervention program.Instruct the prescribed pulmonary exercise participants to perform a warmup exercise for 10 minutes mainly focusing on the dynamic flexibility exercises of the involved muscle groups and stretching of the muscles. At the end of the warmup, have the participants perform the prescribed pulmonary exercises of hu and si sounds in liuzijue, pushing up the sky to regulate the triple warmer, and drawing a bow to shoot a vulture in baduanjin, the crane actions in wuqinxi, and cross-armed iron staff in yijinjing over a period of 40 minutes. When all of the exercises have been completed, instruct the prescribed pulmonary exercise participants to perform a cool down exercise for 10 minutes mainly focusing on stretching and relaxing the muscles.Instruct the participants to record details after each exercise session in the exercise record brochure including information about the exercise method, time, duration, intensity, and site. At the end of the exercise treatment period, explain the six minute walking test to the participants and inform the participants that temporary rest is available when discomfort or exhaustion arises. Prior to the beginning of the test, use the Borg CR10 to assess each participant for their level of dyspnea.Then have the participants walk back and forth as quickly as possible in a marked 30 meter straight line using standardized phrases of encouragement for each minute. After six minutes, ask the participants to stand still and record their distance in meters and levels of dyspnea. After a 30 minute rest, have the participants perform the test a second time.Before beginning the 30 second arm curl test, explain and demonstrate the test procedure. Have the participants sit on a 43 centimeter tall, straight back, armless chair in an upright position and with their feet flat on the ground. With the participants arm in the down position of the arm curl position, have the participant perform the arm curl motion one to two times without moving the wrist to familiarize themselves with the movement.When each participant is ready, have them hold an appropriately weighted dumbbell in the dominant hand and on the go signal, have the participant curl the weight through a full range of motion as quickly and as many times as possible in 30 seconds while standing to the side to time and record the results. To preform a 30 second stand to sit test, first place a chair with the backrest leaning against a wall and explain and demonstrate the test procedure. Next, have the participant sit in the middle of the chair with a straight back, arms crossed on the chest, hands placed on the opposite shoulders, with the feet separated and the knees flexed at about 90 degrees.Have the participants perform the standing up motion one to two times to familiarize themselves with the movement. Then on go, have the participant stand up and sit down as quickly and as many times as possible in 30 seconds while standing to the side to time and record the results. In this representative study, data from 37 participants was analyzed with no significant differences observed in the basic participant characteristics between the control and prescribed pulmonary exercise groups.After three months of intervention, the number of repetitions of the 30 second arm curl and 30 second sit to stand tests increased in the prescribed pulmonary exercise group. In addition, the activity score showed a significant increase in the control group, while the total and item scores of St.George's Respiratory Questionnaire was significantly decreased in the prescribed pulmonary exercise group. The prescribed pulmonary exercise video, exercise record brochure registered by the participants themselves and their encouragement and instruction from staff praise played an irreplaceable role in the success of this protocol.Tests to evaluate the function of pulmonary and skeletal muscle can be performed and the results can provide further understanding into the effects of the prescribed pulmonary exercise. These procedures can also be applied to other chronic noncommunicable diseases to determine the efficacy of prescribed pulmonary exercise.

Research

JoVE Journal

Behavior

Getting to Compliance in Forced Exercise in Rodents: A Critical Standard to Evaluate Exercise Impact in Aging-related Disorders and Disease

There is a major increase in the awareness of the positive impact of exercise on improving several disease states with neurobiological basis; these ...

Eye-Tracking Control to Assess Cognitive Functions in Patients with Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder with pathological involvement of upper and lower motoneurons, subsequently leading to ...

Treating Low Back Pain in Failed Back Surgery Patients with Multicolumn-lead Spinal Cord Stimulation

Failed back surgery syndrome (FBSS) refers to persistent, chronic pain following spinal surgery. Spinal cord stimulation with dorsal epidural leads can be ...

Novel Object Recognition and Object Location Behavioral Testing in Mice on a Budget

Ethologically relevant behavioral testing is a critical component of any study that uses mouse models to study the cognitive effects of various ...

Supramaximal Intensity Hypoxic Exercise and Vascular Function Assessment in Mice

Exercise training is an important strategy for maintaining health and preventing many chronic diseases. It is the first line of treatment recommended by ...

A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program

Despite the evidence that cardiac rehabilitation (CR) reduces the risk of recurrent cardiac events, only a minority of eligible patients are willing to ...

Using Unidirectional Rotations to Improve Vestibular System Asymmetry in Patients with Vestibular Dysfunction

The vestibular system provides information about head movement and mediates reflexes that contribute to balance control and gaze stabilization during ...

Impact of High-intensity Interval Exercise and Moderate-Intensity Continuous Exercise on the Cardiac Troponin T Level at an Early Stage of Training

An elevation in cardiac troponin T (cTnT), as a highly specific biomarker of cardiomyocyte damage, after moderate-intensity continuous exercise (MCE) has ...

Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions

Evidence accumulated from the last decade has proven that silent cerebrovascular lesions (SCLs) and their underlying pathogenic processes contribute to ...

Chronic Stress Shifts Effort-Related Choice Behavior in a Y-Maze Barrier Task in Mice

Mood disorders, including major depressive disorder, can be precipitated by chronic stress. The Y-maze barrier task is an effort-related choice test that ...