Reducing Dynamic Hyperinflation through Breathing Retraining

通过呼吸再训练减少动态恶性通货膨胀

基本信息

批准号：
7748064
负责人：
Eileen G Collins
金额：
--
依托单位：
EDWARD HINES JR VA HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-07-01 至 2013-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7748064
关键词：
Abdomen Activities of Daily Living Address Affect American Area Auditory Behavioral Blood Blood flow Breathing Cardiac Output Cardiovascular system Caring Cause of Death Chest Chronic Chronic Obstructive Airway Disease Complex Computers Contracts Control Groups Critical Care Data Data Analyses Development Dyspnea Educational process of instructing Enrollment Environmental Risk Factor Environmental air flow Ergometry Exercise Exercise stress test Exhalation Fatigue Feedback Functional disorder Gases General Population Goals Grant Review Health Helium Hospitalization Hospitals Human Resources Impairment Individual Inspiratory Capacity Intention Intervention Intervention Studies Investigation Journals Knowledge Leg Life Limb structure Lip structure Living Wills Lung Lung Compliance Lung diseases Measurement Measures Mechanics Medicine Methodology Methods Modeling Muscle Muscle Fibers Muscle function Muscular Atrophy Nose Nurses Office Visits Oxygen Oxygen Therapy Care Patient Education Patients Pattern Perception Performance Peripheral Physical Function Physical activity Physicians Physiological Positive-Pressure Respiration Press Releases Publications Publishing Pulmonary function tests Randomized Randomized Controlled Clinical Trials Recruitment Activity Regression Analysis Rehabilitation therapy Reporting Research Research Personnel Resistance Respiratory Diaphragm Respiratory Muscles Respiratory System Sampling Sampling Studies Societies Specific qualifier value Stress Symptoms System Techniques Technology Testing Theft Time Training Treadmill Tests United States Veterans Visit Visual Walking Work Workload abstracting auditory feedback base clinical practice compare effectiveness computer program coping cost effectiveness density disability electric impedance experience follow-up health administration improved innovation lung volume meetings muscle form muscle strength news novel pressure primary outcome programs prototype psychologic public health relevance quadriceps muscle respiratory response rib bone structure social standard of care success user-friendly visual feedback

项目摘要

DESCRIPTION (provided by applicant): Abstract Dynamic hyperinflation limits exercise duration in chronic obstructive pulmonary disease (COPD). To limit dynamic hyperinflation during exercise and thus improve exercise duration, we successfully developed a visual-auditory ventilation-feedback system. The system retrains patient's breathing pattern during exercise. The goal of the current proposal is to develop a user-friendly ventilation-feedback technique with a novel auditory feedback system. We reason that the proposed feedback system plus exercise training will be superior to exercise training alone while having the potential for an easier application into clinical practice. Hypotheses: The primary hypothesis is that the exercise duration of patients with moderate-to-severe COPD who successfully complete a 12-week program of breathing retraining plus exercise will be longer than that of patients who complete a 12-week program of treadmill exercise training alone. We also hypothesize that the primary predictor of improved exercise duration will be a reduction in dynamic hyperinflation and to a lesser extent, improvement in peripheral muscle function. Lastly, we hypothesize that dyspnea will be reduced in patients assigned to breathing retraining plus exercise when compared to exercise training alone. Methods: The proposed study is a randomized controlled clinical trial. 246 patients with moderate-to-severe COPD will be enrolled and randomized into breathing retraining plus exercise or exercise training alone. Both groups will receive 12-weeks of treadmill exercise training three times weekly. The breathing retraining plus exercise group will also receive auditory feedback to decrease respiratory rate and prolong exhalation. The goal of breathing retraining is to reduce exercise- induced dynamic hyperinflation. Follow-up testing will be completed at 6, 12, and 24 weeks. Testing will include a pulmonary function test, symptom-limited and constant workrate treadmill tests, six-minute walk, dyspnea measurements, testing of respiratory muscle strength and endurance, and quadriceps muscle endurance testing. Analysis: Measures of central tendency will be used to describe the study sample. A two-sample t-test (1 = 0.05) will be used to analyze changes from baseline to 12-weeks between the breathing retraining plus exercise group and exercise training alone group. In data analysis, intention-to-treat principles will be used. Since several measures will be taken on each patient, mixed-models analysis will be used to compare changes over time between the two groups. Multiple regression analysis will be employed to determine the predictors of improved exercise performance. PUBLIC HEALTH RELEVANCE: Relevance_Narrative Relevance to the VA. COPD is the fourth leading cause of death in the United States and the sixth most common chronic condition cited among veterans enrolled in the Veterans Health Administration. Over 16 million individuals in the United States are afflicted with COPD. As compared with the general population, patients with COPD are more likely to rate their health as poor, to report more limitations in daily activities, to visit their physician, to stay in the hospital and to report more disability days. More than 17 million office-visits and over 700,000 hospitalizations resulted from COPD. Innovative approaches to pulmonary rehabilitation of patients with COPD may be instrumental in modifying this cyclical pattern of increasing impairment leading to more hospitalizations and decreasing reserve to cope with the stress and strain of daily living.

描述（由申请人提供）：抽象的动态性超充电限制了慢性阻塞性肺疾病（COPD）的运动持续时间。为了限制运动过程中的动态过度充气，从而改善了运动持续时间，我们成功地开发了一个视觉通风反馈系统。该系统在运动过程中培训患者的呼吸模式。当前建议的目的是通过新颖的听觉反馈系统开发一种用户友好的通风反馈技术。我们认为，拟议的反馈系统加运动训练将优于运动训练，同时有可能更容易应用临床实践。假设：主要的假设是，成功完成为期12周的呼吸训练和运动计划的中度至重度COPD患者的运动时间要比完成为期12周的跑步机运动训练计划的患者长。我们还假设，改善运动持续时间的主要预测因子将减少动态性过度充电，并在较小程度上改善周围肌肉功能。最后，我们假设与仅运动训练相比，分配给呼吸训练的患者将减少呼吸困难。方法：拟议的研究是一项随机对照临床试验。 246例中度至重度COPD的患者将被招募，并随机分为呼吸再训练以及仅运动或运动训练。两组将每周三次接受12周的跑步机运动训练。呼吸再训练加运动组还将接收听觉反馈，以降低呼吸频率并延长呼气。呼吸训练的目的是减少运动引起的动态过度充电。后续测试将在6、12和24周完成。测试将包括肺功能测试，症状受限和恒定的工作跑步机测试，步行六分钟，呼吸困难测量，呼吸肌肉力量和耐力的测试以及股四头肌肌肉耐力测试。分析：中央趋势的度量将用于描述研究样本。两样本的t检验（1 = 0.05）将用于分析呼吸重新训练加上运动组和单独运动训练组之间从基线到12周的变化。在数据分析中，将使用意向性治疗原则。由于将对每个患者采取多种措施，因此将使用混合模型分析来比较两组之间的变化。将采用多元回归分析来确定改善运动绩效的预测指标。公共卫生相关性：与VA相关的相关性。 COPD是美国的第四大死亡原因，也是退伍军人卫生管理局的退伍军人中第六个最常见的慢性病。在美国，超过1600万人患有COPD。与普通人群相比，COPD患者更有可能对健康状况较差，报告日常活动的更多限制，拜访其医生，留在医院并报告更多的残疾日。 COPD导致了超过1700万个办公室访问和70万以上住院。 COPD患者肺部康复的创新方法可能有助于改变这种周期性的减损方式，从而导致更多的住院和减少储备，以应对日常生活的压力和压力。