Tai Chi after Pulmonary Rehabilitation in Patients with COPD: A Randomized Trial

慢性阻塞性肺病患者肺康复后的太极拳：一项随机试验

• 批准号: 8540342
• 负责人: Marilyn L. Moy
• 金额: $ 60.26万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-29 至 2017-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8540342
• 关键词: Activities of Daily Living; Address; Adherence; Aerobic; Aerobic Exercise; Breathing; Cardiopulmonary; Cause of Death; Chinese People; Chronic Obstructive Airway Disease; Clinical; Data; Dyspnea; Education; Elements; Exercise; Exercise Tolerance; Exhibits; Guidelines; Healed; Home environment; Home visitation; Hospitalization; House Call; Individual; Intervention; Investigation; Life; Lower Extremity; Lung; Martial Arts; Medical; Modality; Moods; Morbidity - disease rate; Operative Surgical Procedures; Patients; Persons; Physical activity; Physical therapy; Population; Public Health; Quality of life; Questionnaires; Randomized; Randomized Controlled Trials; Recommendation; Rehabilitation therapy; Relaxation; Reporting; Risk Factors; Self Efficacy; Self Perception; Support Groups; Symptoms; Tai Ji; Techniques; Testing; Time; Training; United States; Upper Extremity; Walking; arm; base; body-mind; clinical care; cost; follow-up; healing; health related quality of life; improved; mortality; novel; programs; randomized trial; standard care; stress management

DESCRIPTION (provided by applicant): Chronic obstructive pulmonary disease (COPD) is a major public health problem and is the fourth leading cause of death in the United States. Despite pharmacologic and surgical therapy, COPD continues to cause considerable morbidity, and patients suffer from exercise intolerance and decreased physical activity, which are independent risk factors for exacerbations, hospitalizations, and mortality.Pulmonary rehabilitation (PR) has been shown to improve symptoms of dyspnea, health-related quality of life, and exercise capacity and national guidelines now recommend that all patients with COPD participate in such programs. Unfortunately, long-term exercise adherence after initial rehabilitation is very poor, and it is clear that benefits gained during PR diminish rapidly if patients do not continue to exercise. There remains a critical need for novel interventions that may sustain the benefits of regular exercise after PR, as well as promote long-term exercise adherence and exercise self-efficacy in the post-rehabilitation period in patients with COPD. Tai chi is a popular mind-body exercise that incorporates low-moderate intensity physical activity, self awareness, relaxation, and meditative slow breathing. It may be particularly suited to deconditioned individuals with COPD who suffer from limited exercise tolerance and dyspnea. Importantly, tai chi exercise comprehensively integrates several key elements of PR (aerobic exercise, upper and lower extremity training, breathing, and stress management) into one relatively low-cost and accessible activity. Studies in varied populations have suggested that tai chi can improve exercise capacity, quality of life, and promote exercise self-efficacy; and that adherence may be favorable when compared to conventional exercise modalities. In this application, we propose a three-arm randomized controlled trial in patients with COPD (N=126) to evaluate the benefits of six months of tai chi exercise, versus group walking, versus general recommendations for self-exercise (standard care) in maintaining clinical improvements after the completion of standard, supervised PR. Our primary aim will be to investigate whether tai chi can maintain gains in exercise capacity three and six months after PR. Secondary aims will examine quality of life, dyspnea, mood, activites of daily living, as well as exercise self-efficacy, intervention adherence and overall activity. Long-term follow-up assessment will be conducted at 1 year. The results of the proposed project have the potential to transform the clinical care of patients with COPD by providing a new strategy that may substantially extend the benefits of PR and promote continued physical activity in this population.

描述（由申请人提供）：慢性阻塞性肺疾病（COPD）是一个主要的公共卫生问题，是美国第四大死因。尽管进行了药物和手术治疗，COPD 仍然导致相当大的发病率，患者患有运动不耐受和体力活动减少，这些是病情加重、住院和死亡的独立危险因素。肺康复 (PR) 已被证明可以改善呼吸困难的症状、与健康相关的生活质量和运动能力以及国家指南现在建议所有慢性阻塞性肺病患者参加此类计划。不幸的是，初始康复后的长期运动坚持性非常差，而且很明显，如果患者不继续运动，PR 期间获得的益处会迅速减少。仍然迫切需要新的干预措施，以维持 PR 后定期运动的益处，并促进 COPD 患者康复后的长期运动坚持和运动自我效能。 太极拳是一种流行的身心运动，它结合了中低强度的身体活动、自我意识、放松和冥想式缓慢呼吸。它可能特别适合运动耐量有限和呼吸困难的慢性阻塞性肺病患者。重要的是，太极拳运动将PR的几个关键要素（有氧运动、上下肢训练、呼吸和压力管理）全面整合为一项成本相对较低且易于接受的活动。对不同人群的研究表明，太极拳可以提高运动能力、生活质量，并提高运动自我效能；与传统的锻炼方式相比，坚持可能会更好。 在本申请中，我们提出了一项针对 COPD 患者 (N=126) 的三组随机对照试验，以评估六个月太极拳锻炼相对于集体步行的益处，以及自我锻炼（标准护理）的一般建议。完成标准、监督的 PR 后保持临床改善。我们的主要目标是调查太极拳是否可以在 PR 后三个月和六个月内保持运动能力的提高。次要目标将检查生活质量、呼吸困难、情绪、日常生活活动，以及运动自我效能、干预依从性和整体活动。 1年进行长期跟踪评估。拟议项目的结果有可能通过提供一种新策略来改变 COPD 患者的临床护理，该策略可以大大扩展 PR 的益处并促进该人群持续的身体活动。