Improving exercise capacity in chronic obstructive pulmonary disease patients through uphill walking

上坡步行提高慢性阻塞性肺疾病患者的运动能力

• 批准号: 9885096
• 负责人: DEBRA J ROMBERGER
• 金额: --
• 依托单位: OMAHA VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2021-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9885096
• 关键词: Address; Air; Applications Grants; Award; Biological Rhythm; Breathing; Cardiopulmonary; Cause of Death; Chronic Obstructive Airway Disease; Complex; Coupled; Coupling; Cross-Sectional Studies; Data; Discipline; Disease; Dyspnea; Effectiveness; Enrollment; Exercise; Exercise Test; Frequencies; Future; General Population; Goals; Health; Healthcare; High Prevalence; Human; Lung; Measures; Morbidity - disease rate; Outcome; Outcome Study; Oxygen; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Pattern; Performance; Physiological; Population; Positioning Attribute; Prevalence; Regimen; Rehabilitation Outcome; Rehabilitation therapy; Research; Risk; Sampling; Severity of illness; Space-Walks; Speed; Testing; Time; Training; Translating; United States; Veterans; Walking; Work; base; burden of illness; design; disability; effectiveness evaluation; exercise capacity; exercise intensity; exercise prescription; experience; improved; improved outcome; innovation; mortality; multidisciplinary; novel strategies; programs; pulmonary rehabilitation; recruit; respiratory; treadmill; uptake; walking speed

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality and presents an important healthcare problem, especially for Veterans. Prevalence of COPD in the Veteran population ranges from 33%-43%, a higher prevalence than among the general population of the United States. COPD patients experience diminished exercise capacity. A significant portion of this limitation in exercise capacity is due to dynamic hyperinflation and dyspnea. Humans demonstrate a coupled relationship between walking and breathing. Our preliminary data indicates that patients with COPD demonstrate an abnormal coupling pattern compared to those without COPD, using one stride for one breath, even at speeds outside of their self-selected walking pace. Current pulmonary rehabilitation relies on increasing intensity of exercise through accelerated walking. Based on coupling patterns in patients with COPD, increasing speed leads to an increase in respiratory rate, dynamic hyperinflation, and dyspnea, thus limiting exercise time. The goal of this proposed project is to investigate, in Veteran COPD patients, the effect of walking faster vs. walking on a slope on dynamic hyperinflation and dyspnea, oxygen uptake and dead space, and walking and breathing coupling. We hypothesize that walking on a slope will alter breathing and walking coupling, lower respiratory rates, and reduce dynamic hyperinflation and associated dyspnea. We predict that walking on a slope will permit an increase in oxygen uptake and a decrease in dead space in patients with COPD as compared to accelerated walking speeds. These hypotheses will be tested through three aims: 1) Identify differences in dynamic hyperinflation and dyspnea; 2) Compare differences in respiratory rate, oxygen uptake, and lung dead space; 3) Determine the complexity of walking and breathing coupling ratios. In this cross-sectional study, Veterans with COPD will be recruited and screened using a cardiopulmonary exercise test. A total of 25 eligible Veterans will be enrolled through stratified sampling of disease severity. The time course of work rate will be calculated from the cardiopulmonary exercise test. The speed and slope that corresponds to 70%-80% of peak work rate will be used. An additional constant work rate test will be given using increases in speed with a level treadmill to determine the speed that elicits oxygen uptake comparable to the sloped walking test. Subjects will be asked to perform two experimental trials (walking faster vs. walking on a slope) at 70%-80% peak work rate. Measures of dynamic hyperinflation, dyspnea, oxygen uptake, dead space, and coupling will be recorded during all walking trials. Possible covariates will also be collected. We anticipate that dynamic hyperinflation and dyspnea will be reduced in patients with COPD due to slower walking and slower respiratory rates during sloped walking as compared to faster level walking. It is expected that this will be influenced by the complexity in breathing and walking coupling ratios. Our multidisciplinary team will provide combined expertise from several disciplines and is uniquely qualified to complete the aims proposed. Results from this feasibility and acceptability study will set the stage for a rigorous, well-powered, full Merit award outcome study evaluating the effectiveness of a slope-based training regimen as part of rehabilitation.

慢性阻塞性肺疾病（COPD）是发病率和死亡率的主要原因，并提出 重要的医疗保健问题，尤其是对于退伍军人。资深人口范围COPD的患病率 从33％-43％开始的患病率高于美国的普通人群。 COPD患者 经验降低了运动能力。锻炼能力的很大一部分是由于 动态过度充气和呼吸困难。人类表现出步行与 呼吸。我们的初步数据表明COPD患者表现出异常耦合模式 与没有COPD的人相比，即使以自选之外的速度，使用一次大步进行一次呼吸 步行步伐。当前的肺康复依赖于通过加速运动的增加强度 步行。基于COPD患者的耦合模式，速度提高导致增加 呼吸速率，动态过度充气和呼吸困难，从而限制了运动时间。这个提议的目标 项目是在经验丰富的COPD患者中调查步行速度与步行的效果 关于动态性过度充电和呼吸困难，氧气吸收和死空间，以及步行和呼吸 耦合。我们假设在斜坡上行走会改变呼吸和行走耦合，较低 呼吸速率，并减少动态过度充气和相关的呼吸困难。我们预测走路 在斜坡上，摄入氧气的增加，并减少 与加速的步行速度相比，COPD。这些假设将通过三个目标进行检验：1） 确定动态过度充电和呼吸困难的差异； 2）比较呼吸率，氧气的差异 吸收和肺死亡空间； 3）确定步行和呼吸耦合比的复杂性。在这个 横截面研究，将使用心肺运动招募和筛选COPD的退伍军人 测试。通过分层的疾病严重程度采样，将总共25名合格的退伍军人参加。时间 工作率将根据心肺运动测试计算。速度和坡度 对应于峰值工作率的70％-80％。将进行额外的恒定工作率测试 使用水平跑步机使用速度提高，以确定引起氧气吸收的速度 倾斜的步行测试。受试者将被要求进行两项实验试验（步行速度与行走速度更快 坡度为70％-80％的峰值工作率。动态过度充电，呼吸困难，氧气吸收，死亡的度量 在所有步行试验期间，将记录空间和耦合。也将收集可能的协变量。我们 预计COPD患者将降低COPD患者的动态过度充电和呼吸困难 与更快的步行速度相比，步行速度和呼吸速度较慢。预计 这将受到呼吸和步行耦合比的复杂性的影响。我们的多学科 团队将提供来自多个学科的组合专业知识，并具有独特的资格来完成目标 建议的。这项可行性和可接受性研究的结果将为严格，能力充分的全面奠定阶段 成绩奖的成果研究评估基于坡度的培训方案的有效性 康复。