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Physical training in patients with chronic obstructive pulmonary disease - COPD
Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation.
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Chronic obstructive pulmonary disease, COPD, places a substantial burden of disability on the growing number of patients and causes large costs for the society. Tobacco smoke is the most important risk factor. Progressive exertional dyspnea is the major symptom which leads to diminished physical and social activities, reduced physical capacity and decreased health related quality of life, HRQoL.

The aim of this thesis was to evaluate different physical training modalities in patients with COPD with regard to physical capacity and HRQoL. Patients with moderate to severe COPD were included in the studies. In the first intervention, 20 patients trained on a treadmill with or without supplemental oxygen, three times per week, during eight weeks. In the second intervention, 30 patients were randomised to high-intensity group training either in water or on land, and 13 patients were included in a control group. The patients in the water and land groups trained three times per week during three months and once a week during the following six months.

Oxygen supplementation during physical training did not enlarge the positive effects of the same training with air in patients with exercise-induced hypoxaemia. Both groups improved the distance walked after training. High-intensity group training in water and on land was found to be effective with regard to walking distance and HRQoL compared to the control group. Training in water seemed to be of greater benefit compared to training on land concerning walking distance and experienced physical health when the training was accomplished three times per week. The thigh muscle strength increased after training in both the water and the land group. The muscle endurance in knee extension was low in the majority of the patients and was not improved after the training intervention. An evaluation of the long-term effects of physical group training and the effects of decreased training frequency showed that training with low frequency (once a week) during six months did not seem to be sufficient to maintain the level achieved after a three months period of higher frequency training (three times per week). However, the two periods combined seemed to prevent decline in physical capacity and HRQoL compared to baseline.

The conclusion is that physical training is of benefit for patients with COPD with regard to physical capacity and HRQoL. Training can be performed individually or in groups, with high intensity, in water and on land. It is also concluded that the training can, under controlled conditions, be performed without supplemental oxygen even in patients with exercise-induced hypoxaemia.

Place, publisher, year, edition, pages
2004. , 89 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 917
Keyword [en]
Physical therapy, Chronic obstructive pulmonary disease, Physical training, Oxygen, Water training, Group training, Physical capacity, Health related quality of life, Long-term effect
Keyword [sv]
Sjukgymnastik
National Category
Physiotherapy
Identifiers
URN: urn:nbn:se:umu:diva-363ISBN: 91-7305-732-0 (print)OAI: oai:DiVA.org:umu-363DiVA: diva2:143254
Public defence
2004-12-04, 11:00 (English)
Opponent
Available from: 2004-11-12 Created: 2004-11-12 Last updated: 2009-08-07Bibliographically approved
List of papers
1. Physical training with and without oxygen in patients with chronic obstructive pulmonary disease and exerciseinduced hypoxaemia
Open this publication in new window or tab >>Physical training with and without oxygen in patients with chronic obstructive pulmonary disease and exerciseinduced hypoxaemia
2001 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 33, no 5, 200-205 p.Article in journal (Refereed) Published
Abstract [en]

A randomized, controlled, single-blind study was performed on 20 patients with chronic obstructive pulmonary disease and exercise-induced hypoxaemia. Ten patients each were randomly assigned to one of two groups, one training with air and the other training with oxygen. There were no significant differences between the groups regarding values measured prior to the study. The patients trained 3 times per week for 30 minutes each time for a duration of 8 weeks. The training consisted of interval walking on a treadmill (intensity set according to Borg ratings) with either air or oxygen administered through a nasal cannula at a rate of 5 l/min. Training significantly improved the 6-minute walking distance by 20% and 14% in the air and oxygen group, respectively, when the patients were tested on air. In the same test the air group significantly decreased Borg ratings for perceived exertion. Borg ratings for dyspnoea and perceived exertion significantly decreased in the oxygen group when they were tested on oxygen. It was concluded that oxygen supplementation did not further improve the training effect, compared with training with air, in patients with chronic obstructive pulmonary disease and exercise-induced hypoxaemia.

Keyword
chronic obstructive pulmonary disease, exercise training, hypoxaemia, oxygen, 6MWD, walking, Borg.
Identifiers
urn:nbn:se:umu:diva-4240 (URN)10.1080/165019701750419581 (DOI)11585150 (PubMedID)
Available from: 2004-11-12 Created: 2004-11-12 Last updated: 2017-12-14Bibliographically approved
2. High intensity physical training in water: an effective training modality for patients with COPD
Open this publication in new window or tab >>High intensity physical training in water: an effective training modality for patients with COPD
2004 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 98, no 5, 428-438 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to examine the effect of high intensity physical group training in water and on land for patients with COPD with regard to physical capacity and health related quality of life (HRQoL). A controlled, semi-randomised study was conducted where 30 patients were randomised to training either in water or on land. Thirteen patients constituted a control group. Forty-three outpatients, with moderate to severe COPD (27w/16m), from two local hospitals in northern Sweden, were included in the study. High intensity physical group training in water (water group) or on land (land group) was performed for 12weeks, three times per week, 45min per session. The control group received no intervention. Pre- and post-intervention, all patients performed incremental and endurance shuttle walking tests (ISWT and ESWT), cycle ergometer tests and responded questionnaires about HRQoL (St. Georges Respiratory Questionnaire--SGRQ and SF-36). The patients trained with a mean heart rate of 80-90% of peak heart rate. Both training groups increased the distance walked, i.e. land group in ISWT (25m) and water group in ESWT (179m). The water group increased the distance in ESWT significantly more that both the land and the control groups. Both training groups increased the time cycled (40-85s) and work load (10-20W) in the cycle ergometer test. The control group deteriorated in HRQoL according to total score in SGRQ while the training groups remained constant. The water group improved their activity score in SGRQ and their physical health score in SF-36 and those improvements were significant as compared to the land and the control groups. In conclusion, high intensity physical group training in water is of benefit for patients with COPD. It was in some areas found to be even more effective regarding improvements in physical capacity and experienced physical health compared to the same kind of training on land.

Keyword
Aged, Exercise Test, Exercise Therapy/*methods, Exercise Tolerance, Female, Forced Expiratory Volume/physiology, Health Status, Heart Rate/physiology, Humans, Hydrotherapy/*methods, Male, Middle Aged, Pulmonary Disease; Chronic Obstructive/physiopathology/*rehabilitation, Quality of Life, Treatment Outcome, Vital Capacity/physiology
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-4241 (URN)10.1016/j.rmed.2003.11.010 (DOI)15139572 (PubMedID)
Available from: 2004-11-12 Created: 2004-11-12 Last updated: 2017-12-14Bibliographically approved
3. Muscle performance in patients with chronic obstructive pulmonary disease: Effects of a physical training programme
Open this publication in new window or tab >>Muscle performance in patients with chronic obstructive pulmonary disease: Effects of a physical training programme
Show others...
2005 (English)In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 7, no 2, 51-59 p.Article in journal (Refereed) Published
Abstract [en]

The main aim was to evaluate how thigh muscle performance in patients with chronic obstructive pulmonary disease (COPD) is affected after a 3-month training programme. Another aim was to investigate if responders to training could be discriminated from non-responders. Thirty patients participated in high-intensity physical training in water or on land, three times per week, and 13 patients constituted a non-training control group. Maximal dynamic strength and endurance in thigh muscles were tested in an isokinetic dynamometer (KinCom) before and after training. At baseline, physical and pulmonary function were tested and used in the analysis of responders/non-responders. Maximal knee flexion strength improved in both training groups, whereas knee extension was improved in the land and control group. Sixty-four percent of all patients were not able to complete the muscle endurance test at baseline and no change was seen in muscle endurance after training within or between groups. A normal body mass index seemed to predict an improvement in muscle performance in responders. We conclude that physical training in water and on land is effective regarding maximal thigh muscle strength in COPD patients. BMI seems to be a discriminating factor for an increased muscle strength. Thigh muscle endurance was decreased in the majority of the patients and did not improve with the evaluated training programme.

Keyword
COPD, dynamic muscle strength, muscle endurance, responder, water training
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-7007 (URN)10.1080/14038190510010269 (DOI)
Available from: 2008-01-02 Created: 2008-01-02 Last updated: 2017-12-14Bibliographically approved
4. Group training in patients with COPD: long-term effects of decreased training frequency
Open this publication in new window or tab >>Group training in patients with COPD: long-term effects of decreased training frequency
2005 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 27, no 10, 571-581 p.Article in journal (Refereed) Published
Abstract [en]

Purpose.To investigate effects of decreased training frequency in patients with COPD.

Methods.Forty-three COPD patients participated in a controlled study. The intervention group (30 patients) trained 3 times a week during 3 months and once a week during 6 months. Before, after 3 and 9 months all patients performed walking tests, cycle ergometer tests and responded questionnaires on health-related quality of life (HRQoL) (SGRQ, SF-36).

Results.At 9 months compared to 3 months there were no changes in distance walked in the groups. Both groups decreased their VO2peak and the training group deteriorated in HRQoL. At 9 months compared to baseline the training group showed increased distance walked compared to the control group. In the disease-specific SGRQ the training group tended to improve their activity score while the control group tended to deteriorate in total score. In SF-36 the control group decreased their physical component score.

Conclusion.Training once a week does not seem to be sufficient to maintain the level achieved after the 3-month period of training in COPD patients. However, training once a week during 6 months preceded by 3 months of high frequency training seems to prevent deterioration in physical capacity and HRQoL compared to baseline. Further studies are needed to investigate how to best sustain the benefits gained after physical training.

Keyword
Physical training, physical capacity, walking distance, health-related quality of life, water exercise
Identifiers
urn:nbn:se:umu:diva-4243 (URN)10.1080/09638280400018627 (DOI)16019866 (PubMedID)
Available from: 2004-11-12 Created: 2004-11-12 Last updated: 2017-12-14Bibliographically approved

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