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 ...

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9.5K Views.  Shanghai University of Traditional Chinese Medicine. 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.

Video: 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...

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A Preliminary Study on Warm Acupuncture and Moxibustion for Treating Chronic Obstructive Pulmonary Disease with Abdominal Distension

auricular acupuncture as a traditional chinese medicine therapy for chronic obstructive pulmonary disease combined with sleep disorders

Author Spotlight: Utilizing Traditional Chinese Acupuncture of the Ear to Improve Sleep Disorders 

This protocol introduces an effective method to improve the sleep condition of patients with chronic obstructive pulmonary disease and alleviate cough symptoms by using auricular acupuncture techniques to percutaneously stimulate specific acupoints in the patients' ears.

Auricular Acupuncture as a Traditional Chinese Medicine Therapy for Chronic Obstructive Pulmonary Disease Combined with Sleep Disorders

alternative therapy for acute exacerbation of chronic obstructive pulmonary disease: moving cupping along meridians

Author Spotlight: Evaluating the Therapeutic Efficacy of Moving Cupping Along Meridians for Acute Exacerbation of COPD

This protocol presents a novel approach to alleviating the symptoms and improving the quality of life of patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) by employing moving cupping along meridians therapy to stimulate the first sideline of the bladder...

Alternative Therapy for Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Moving Cupping Along Meridians

acupoint application combined with ear plaster therapy for treating sleep disorders with acute exacerbation of chronic obstructive pulmonary disease

Author Spotlight: Traditional Chinese Medicine for Sleep Disorders in Acute COPD &#8212; A Safe, Cost-Effective Approach

The present protocol describes the specific process and efficacy of the acupoint application combined with ear plaster therapy for sleep disorders in a patient with acute exacerbation of chronic obstructive pulmonary disease, including medical devices, selection of acupoints, operating methods, and posttreatment...

Acupoint Application Combined with Ear Plaster Therapy for Treating Sleep Disorders with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Traditional Chinese Medicine Ear Point Therapy for Wheezing in COPD Patients

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Acupuncture Stimulation of Ears to Alleviate Sleeping Disorders in COPD Patients

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using continuous data tracking technology to study exercise adherence in pulmonary rehabilitation

Using Continuous Data Tracking Technology to Study Exercise Adherence in Pulmonary Rehabilitation

Pulmonary rehabilitation is widely recognized in the management of respiratory diseases. A key component to successful pulmonary rehabilitation is adherence to the recommended exercise training. The purpose of the present protocol is to describe how continuous data tracking technology can be used to precisely measure adherence to a prescribed aerobic training...

assessment of vascular function in patients with chronic kidney disease

Assessment of Vascular Function in Patients With Chronic Kidney Disease

The degree of vascular dysfunction and contributing physiological mechanisms can be assessed in patients with chronic kidney disease by measuring brachial artery flow-mediated dilation, aortic pulse-wave velocity, and vascular endothelial cell protein...

bedside ultrasound for guiding fluid removal in patients with pulmonary edema: the reverse-falls protocol

Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol

We describe an imaging protocol that enables the clinician to visualize, in real-time, the patient&#39;s intravascular and extravascular space volumes and set diuresis and fluid removal parameters accordingly for the safe and efficient treatment of pulmonary...

chronic thromboembolic pulmonary hypertension and assessment of right ventricular function in the piglet

Chronic Thromboembolic Pulmonary Hypertension and Assessment of Right Ventricular Function in the Piglet

Chronic Thromboembolic Pulmonary Hypertension (CTEPH) and Right Ventricular (RV) dysfunction were induced in piglets by progressive obstruction of the pulmonary arteries. Consequences were remarkably similar to those observed in CTEPH patients. This animal model would be a very useful tool for pathophysiology and therapeutic experiments on CTEPH and RV...

dual test gas pulmonary diffusing capacity measurement during exercise in humans using the single-breath method

Author Spotlight: Integrating Alveolar-Capillary Reserve Measurements in Exercise Adaptation and Therapeutic Strategies

This protocol presents a method to assess pulmonary alveolar-capillary reserve measured by combined single-breath measurement of the diffusing capacity to carbon monoxide (DL,CO) and nitric oxide (DL,NO) during exercise. Assumptions and recommendations for using the technique during exercise form the foundation of this article.

Dual Test Gas Pulmonary Diffusing Capacity Measurement During Exercise in Humans Using the Single-Breath Method

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 include improving cognitive function and physical performance. As a result, there is an increase in the number of animal studies employing exercise. It is argued that one intrinsic value of forced exercise is that the investigator has control over the factors that can influence the impact of exercise on behavioral outcomes, notably exercise frequency, duration, and intensity of the exercise regimen. However, compliance in forced exercise regimens may be an issue, particularly if potential confounds of employing foot-shock are to be avoided. It is also important to consider that since most cognitive and locomotor impairments strike in the aged individual, determining impact of exercise on these impairments should consider using aged rodents with a highest possible level of compliance to ensure minimal need for test subjects. Here, the pertinent steps and considerations necessary to achieve nearly 100% compliance to treadmill exercise in an aged rodent model will be presented and discussed. Notwithstanding the particular exercise regimen being employed by the investigator, our protocol should be of use to investigators that are particularly interested in the potential impact of forced exercise on aging-related impairments, including aging-related Parkinsonism and Parkinson&#8217;s disease.

Exercise may alleviate behavioral impairments associated with neurodegenerative diseases. Studies of the mechanisms underlying exercise-mediated effects have increased in disease models, but the neurobiological background accompanying these diseases, specifically aging, is likely not considered. Here, we illustrate measures to increase the likelihood of a successful exercise paradigm in aged rats.

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

Assessment of Murine Exercise Endurance Without the Use of a Shock Grid: An Alternative to Forced Exercise

Using laboratory mouse models, the molecular pathways responsible for the metabolic benefits of endurance exercise are beginning to be defined. The most common method for assessing exercise endurance in mice utilizes forced running on a motorized treadmill equipped with a shock grid. Animals who quit running are pushed by the moving treadmill belt onto a grid that delivers an electric foot shock; to escape the negative stimulus, the mice return to running on the belt. However, avoidance behavior and psychological stress due to use of a shock apparatus can interfere with quantitation of running endurance, as well as confound measurements of postexercise serum hormone and cytokine levels. Here, we demonstrate and validate a refined method to measure running endurance in na&#239;ve C57BL/6 laboratory mice on a motorized treadmill without utilizing a shock grid. When mice are preacclimated to the treadmill, they run voluntarily with gait speeds specific to each mouse. Use of the shock grid is replaced by gentle encouragement by a human operator using a tongue depressor, coupled with sensitivity to the voluntary willingness to run on the part of the mouse. Clear endpoints for quantifying running time-to-exhaustion for each mouse are defined and reflected in behavioral signs of exhaustion such as splayed posture and labored breathing. This method is a humane refinement which also decreases the confounding effects of stress on experimental parameters.

A method to assess exercise endurance in laboratory mice without the use of a shock grid is demonstrated. This method is a humane refinement that can decrease the confounding effects of stress on experimental parameters.

Using laboratory mouse models, the molecular pathways responsible for the metabolic benefits of endurance exercise are beginning to be defined. The most ...

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 progressive loss of motor and speech abilities. In addition, cognitive functions are impaired in a subset of patients. To evaluate these potential deficits in severely physically impaired ALS patients, eye-tracking is a promising means to conduct cognitive tests. The present article focuses on how eye movements, an indirect means of communication for physically disabled patients, can be utilized to allow for detailed neuropsychological assessment. The requirements, in terms of oculomotor parameters that have to be met for sufficient eye-tracking in ALS patients are presented. The properties of stimuli, including type of neuropsychological tests and style of presentation, best suited to successfully assess cognitive functioning, are also described. Furthermore, recommendations regarding procedural requirements are provided. Overall, this methodology provides a reliable, easy to administer and fast approach for assessing cognitive deficits in patients who are unable to speak or write such as patients with severe ALS. The only confounding factor might be deficits in voluntary eye movement control in a subset of ALS patients.

Cognitive deficits are common in about one third of patients with amyotrophic lateral sclerosis, a neurological condition leading to progressive impairments in speech and movement abilities. To conduct cognitive tests in patients unable to speak or write a reliable and easy to administer eye-tracking paradigm was developed.

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 used to treat back and leg pain in FBSS patients. This paper presents a detailed protocol for using spinal cord stimulation with surgical leads in FBSS patients. In our department, with the patient under general anesthesia, we place the lead in the epidural space by means of a small laminectomy at the 10th thoracic level. Placement of the lead is followed by a 1 month trial period with an externalized lead. If pain relief is greater than 50% at the end of this 1 month stimulation trial (required by Belgian reimbursement criteria), an internal pulse generator is then placed under the skin and connected to the lead in a second surgical procedure. We have demonstrated that using this technique in rigorously selected FBSS patients can significantly improve back pain, leg pain, patient activity, and quality of life for a sustained period of time.

This paper presents a method that uses spinal cord stimulation with a multicolumn lead to treat neuropathic low back pain in failed back surgery patients.

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 physiological or pathological changes. The object location task (OLT) and the novel object recognition task (NORT) are two effective behavioral tasks commonly used to reveal the function and relative health of specific brain regions involved in memory. While both of these tests exploit the inherent preference of mice for the novelty to reveal memory for previously encountered objects, the OLT primarily evaluates spatial learning, which relies heavily on hippocampal activity. The NORT, in contrast, evaluates non-spatial learning of object identity, which relies on multiple brain regions. Both tasks require an open-field-testing arena, objects with equivalent intrinsic value to mice, appropriate environmental cues, and video recording equipment and the software. Commercially available systems, while convenient, can be costly. This manuscript details a simple, cost-effective method for building the arenas and setting up the equipment necessary to perform the OLT and NORT. Furthermore, the manuscript describes an efficient testing protocol that incorporates both OLT and NORT and provides typical methods for data acquisition and analysis, as well as representative results. Successful completion of these tests can provide valuable insight into the memory function of various mouse model systems and appraise the underlying neural regions that support these functions.

Here we provide a protocol which includes comprehensive instructions for the economical establishment of murine object location and novel object recognition behavioral testing, including the design, cost, and construction of required equipment as well as execution of behavioral testing, data collection, and analysis.

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 international guidelines for patients suffering from cardiovascular diseases, more specifically, lower extremity artery diseases, where the patients' walking capacity is considerably altered, affecting their quality of life. 
Traditionally, both low continuous exercise and interval training have been used. Recently, supramaximal training has also been shown to improve athletes' performances via vascular adaptations, amongst other mechanisms. The combination of this type of training with hypoxia could bring an additional and/or synergic effect, which could be of interest for certain pathologies. Here, we describe how to perform supramaximal intensity training sessions in hypoxia on healthy mice at 150% of their maximal speed, using a motorized treadmill and a hypoxic box. We also show how to dissect the mouse in order to retrieve organs of interest, particularly the pulmonary artery, the abdominal aorta, and the iliac artery. Finally, we show how to perform ex vivo vascular function assessment on the retrieved vessels, using isometric tension studies.

High-intensity training in hypoxia is a protocol that has been proven to induce vascular adaptations potentially beneficial in some patients and to improve athletes&#39; repeated sprint ability. Here, we test the feasibility of training mice using that protocol and identify those vascular adaptations using ex vivo vascular function assessment.

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 join existing programs at cardiac rehabilitation centers. The unique remote patient monitoring system presented here enables healthcare providers to monitor CR patients at home in real-time and at low cost. The system combines mobile technology, artificial intelligence, and supportive services, expanding the delivery of medical care to the patient&#39;s home. The primary aim of the study is to increase the long-term adherence to physical activity in patients who participate in CR via the addition of a home-based digitally monitored CR component to the standard CR program in patients with ischemic heart disease (IHD), with the idea of forming new habitual health behaviors and increasing the long-term motivation for physical exercise (PE) habits at home. Secondary aims are to assess the program&#39;s impact on the physical activity level measured by average steps per day, minutes of exercise per week, blood pressure, metabolic parameters, body mass index, and waist-to-hip ratio, as well as a quality-of-life (QoL) questionnaire.The study has two arms: (1) home-based monitored exercise using a smart digital garment and wristband, in addition to motivation and reinforcement via text messages; (2) standard CR facility-based exercise. The study design is a randomized, controlled trial comparing standard CR to a home-based monitoring and reinforcement program. The study program is designed for 12 weeks.Clinical tests and anthropometric measurements are performed before and after the study, measuring height, weight, waist circumference, visceral fat and body mass index (BMI), blood pressure, and HbA1c and lipid profile. Patients have to complete a baseline survey including socio-demographic characteristics and QoL questionnaire SF-36. At the end of the study, patients complete a survey regarding the use of the smart digital garment&#39;s benefits and usability. The study is currently underway.

The aim is to promote a new approach to cardiac rehabilitation (CR), using a unique remote patient monitoring system that will enable healthcare providers to monitor CR patients at home at low cost, with the intention of making CR services more accessible and improving compliance. The study is currently underway.

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 daily activities. Vestibular sensors are located in the inner ear on both sides of the head and project to the vestibular nuclei in the brainstem. Vestibular dysfunction is often due to an asymmetry between input from the two sides. This results in asymmetrical neural inputs from the two ears, which can produce an illusion of rotation, manifested as vertigo. The vestibular system has an impressive capacity for compensation, which serves to rebalance how asymmetrical information from the sensory end organs on both sides is processed at the central level. To promote compensation, various rehabilitation programs are used in the clinic; however, they primarily use exercises that improve multisensory integration. Recently, visual-vestibular training has also been used to improve the vestibulo-ocular reflex (VOR) in animals with compensated unilateral lesions. Here, a new method is introduced for rebalancing the vestibular activity on both sides in human subjects. This method consists of five unidirectional rotations in the dark (peak velocity of 320&#176;/s) toward the weaker side. The efficacy of this method was shown in a sequential, double-blinded clinical trial in 16 patients with VOR asymmetry (measured by the directional preponderance in response to sinusoidal rotations). In most cases, VOR asymmetry decreased after a single session, reached normal values within the first two sessions in one week, and the effects lasted up to 6 weeks. The rebalancing effect is due to both an increase in VOR response from the weaker side and a decrease in response from the stronger side. The findings suggest that unidirectional rotation can be used as a supervised rehabilitation method to reduce VOR asymmetry in patients with longstanding vestibular dysfunction.

A new rehabilitation method is presented for rebalancing the vestibular system in patients with asymmetric responses, which consists of unidirectional rotations toward the weaker side. By directly modifying the vestibular pathway rather than enhancing the multisensory aspects of compensation, asymmetry can be normalized within 1-2 sessions and show lasting effects.

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 been described. The exercise-induced cTnT response distorts the diagnostic role of the cTnT assay. Although high-intensity interval exercise (HIE) is growing in popularity and concerns remain about its safety, available data related to cTnT release after HIE is limited, which hampers the use of HIE as a health intervention. Here, we present three representative HIE protocols [traditional HIE (repeated 4 min cycling at 90% V&#775;O2max interspersed with 3 min rest, 200 kJ/session); sprint interval exercise (SIE, repeated 1 min cycling at 120% V&#775;O2max interspersed with 1.5 min rest, 200 kJ/session); and repeated sprint exercise (RSE, 40 x 6 s all-out sprints interspersed with 9 s rest)] and one representative MCE protocol (continuous cycling exercise at an intensity of 60% V&#775;O2max, 200 kJ/session). Forty-seven sedentary, overweight young women were randomly assigned to one of four groups (HIE, SIE, RSE, and MCE). Six bouts of respective exercise were performed by every single group, with each being 48 h apart. Meanwhile, for four groups, the duration of the entire testing period was identical, being 10 days. Before and after the first and final exercise bouts, an assessment was conducted of cTnT. The current study provides a frame of reference giving a clear picture of how a specific exercise session affects the circulating cTnT concentration at the early stage of training. The information may assist with clinical interpretations of post-exercise cTnT elevation and guide the prescription of exercise, especially for HIE.

Here, we present protocols of high-intensity interval and moderate-intensity continuous exercise to observe the response of circulating cardiac troponin T (cTnT) concentration to acute exercise over 10 days. The information may assist with clinical interpretations of post-exercise cTnT elevation and guide the prescription of exercise.

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

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 measures motivation to expend effort and obtain reward. In mice, chronic stress exposure significantly impacts motivation to work for a higher value reward when a lesser value reward is freely available compared to unstressed mice. Here we describe the chronic corticosterone administration paradigm, which produces a shift in effortful responding in the Y-maze barrier task. In the Y-maze task, one arm contains 4 food pellets, while the other arm contains only 2 pellets. After mice learn to select the high reward arm, barriers with progressively increasing height are then introduced into the high reward arm over multiple test sessions. Unfortunately, most chronic stress paradigms (including corticosterone and social defeat) were developed in male mice and are less effective in female mice. Therefore, we also discuss chronic non-discriminatory social defeat stress (CNSDS), a stress paradigm we developed that is effective in both male and female mice. Repeating results with multiple distinct chronic stressors in male and female mice combined with increased usage of translationally relevant behavior tasks will help to advance the understanding of how chronic stress can precipitate mood disorders.

The Y-maze barrier task is a behavior test that examines motivation to expend effort for reward. Here, we discuss testing multiple well-validated chronic stressors including chronic corticosterone and social defeat stress with this behavior, as well as the novel chronic non-discriminatory social defeat stress (CNSDS), which is effective in females.

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