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Low-load/high-repetition elastic band resistance training in patients with COPD: a randomized, controlled, multicenter trial
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
Institutionen för klinisk fysiologi, Karolinska universitetssjukhuset, Stockholm; Institutionen för molekylär medicin och kirurgi, Karolinska Institutet, Stockholm.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
2015 (English)In: Clinical Respiratory Journal, ISSN 1752-6981, E-ISSN 1752-699X, Vol. 9, no 3, 278-288 p.Article in journal (Refereed) Published
Abstract [en]

Background: High-repetitive resistance training is recommended to increase peripheral muscular endurance in healthy adults, however the effects of resistance training with this design on exercise capacity and health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD) is unknown.

Objective: Investigate if low load / high repetition elastic band resistance training (RT) could improve functional capacity, muscular function, endurance cycle capacity or HRQOL in patients with COPD.

Methods: A prospective, randomized controlled multicentre trial was constructed with concealed allocation, blinded outcome assessment, and intention-to-treat analysis. A total of 44 patients with moderate to very severe COPD (FEV1 44.6% predicted) were included. Patients were randomized to either the experimental group receiving eight weeks of RT (3 sessions/week) in combination with patient education (four occasions) or the control group receiving the patient education alone.

Results: At post-tests, the between-group differences were in favor of the experimental group on the 6 minute walk test (mean difference (95% confidence interval)): 34 meters (14 to 54) and the 6 minute pegboard and ring test (20 rings (3 to 37). No difference between groups was found on the chronic respiratory disease questionnaire (0.1 (-0.2 to 0.4). On secondary outcomes, results were in favor of the experimental group regarding upper extremity endurance capacity, muscular function and depression but no difference was seen between groups on endurance cycle capacity and HRQOL.

Conclusion: RT can increase functional capacity and muscular function but not cycle endurance capacity and HRQOL in patients with moderate to severe COPD

Place, publisher, year, edition, pages
John Wiley & Sons, 2015. Vol. 9, no 3, 278-288 p.
Keyword [en]
Exercise, Lower Extremity, Pulmonary Disease, Chronic Obstructive, Quality of Life, Resistance Training, Upper Extremity, Single limb
National Category
Physiotherapy
Identifiers
URN: urn:nbn:se:umu:diva-87856DOI: 10.1111/crj.12141OAI: oai:DiVA.org:umu-87856DiVA: diva2:712069
Available from: 2014-04-13 Created: 2014-04-13 Last updated: 2017-12-05Bibliographically approved
In thesis
1. Single limb exercises in patients with chronic obstructive pulmonary disease: feasibility, methodology, effects and evidence
Open this publication in new window or tab >>Single limb exercises in patients with chronic obstructive pulmonary disease: feasibility, methodology, effects and evidence
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. COPD is a slowly progressive, inflammatory disease in the airways and lungs, caused mainly by smoking. The inflammation leads to a narrowing of the small airways (airway obstruction) and a destruction of tissue in the lungs. This gives a decreased expiratory airflow which leads to dyspnea, the primary symptom of the disease. The chronic airflow limitation also is associated with the development of limb muscle dysfunction. Decreases in both limb muscle strength and endurance have been shown which, in turn, is associated with exercise intolerance, one of the key disabling factors of the disease. Pulmonary rehabilitation including exercise training is the cornerstone of treatment and is strongly recommended. However, it is still unclear how to optimize exercise training for this group of patients. Also how to address the increase in dyspnea which limits the exercise stimulus, and how to assess muscular strength, need further study. Partitioning the exercising muscle mass, known as single limb exercises, is a novel exercise strategy aimed at reducing the negative consequences of chronic airflow limitation in patients with COPD.

The aim of this thesis was to study the current evidence of single limb approaches in patients with COPD, to examine the feasibility and effects of a high-repetitive single limb exercise (HRSLE) regimen in patients with COPD and to examine whether elastic resistance could be used to evaluate muscular strength.

This thesis is based on five papers. In order to study the evidence on single limb exercises, a systematic review of randomized controlled trials was performed. The review showed that single limb exercises, performed as one-legged cycling appeared to be more effective than two-legged cycling with regard to exercise capacity but not dyspnea, and might be included in exercise programs for patients with COPD (Paper I). Thirty healthy older women and men participated in a validation study comparing elastic resistance maximal strength with isokinetic dynamometry measurements. Excellent levels of agreement and no differences between the two pieces of equipment were found which indicates that elastic resistance could be used to evaluate muscular strength (Paper II). A study protocol was created for a randomized controlled trial designed to identify the effects of HRSLE in combination with COPD-specific patient training (experimental group) in comparison to patient information alone (control group) (Paper III). HRSLE was performed as resistance training, using a single limb at a time, elastic bands as resistance and a high number of repetitions (25 repetitions in 2 sets) with the aim of increasing limb muscle endurance. After eight weeks of exercise, the differences between the groups were in favor of the experimental group on lower- and upper-extremity functional capacity, upper-extremity endurance capacity and muscular function. No differences were seen between the groups on endurance-cycle capacity or health-related quality of life (Paper IV). In patients with COPD, the HRSLE regimen was considered feasible with a high attendance rate, excellent compliance and high relative exercise intensity. No severe adverse events occurred. The physiotherapists conducting the HRSLE in the clinical setting also found it to be feasible (Paper V).

This thesis shows that single limb exercises performed as one-legged cycling may be useful and effective for patients with COPD. Eight weeks of HRSLE was feasible and effective with regard to exercise capacity but without effect with regard to health-related quality of life. Elastic resistance could be used as exercise equipment to improve limb muscle function in patients with COPD and to evaluate muscular strength in healthy older adults.

Abstract [sv]

Kroniskt obstruktiv lungsjukdom (KOL) är idag ett stort globalt problem.  KOL är en långsamt fortskridande inflammatorisk sjukdom i luftvägar och lungor, i huvudsak orsakad av cigarrettrökning. Inflammationen leder till en förträngning i de små luftvägarna och förstör vävnaden i lungorna. Detta medför en luftvägsobstruktion där flödet av luft vid utandning är minskat, vilket bidrar till varierande grad av andnöd hos patienten. Luftvägsobstruktionen är relaterad till försämrad muskelfunktion hos patientgruppen. Både nedsatt muskulär styrka och uthållighet har påvisats vilket är relaterat till ett av huvudproblemen vid KOL; nedsatt förmåga till fysisk aktivitet och träning.  Lungrehabilitering inklusive fysisk träning är centralt i behandlingen och starkt rekommenderat. Det är dock inte fastställt hur patientgruppen skall träna för att optimera effekterna av träningen eller hur träningen bäst kan utvärderas. Det är också oklart hur man skall hantera den successivt ökande andfåddheten vid träning. Träning med en arm eller ett ben i taget, så kallad lokal muskelträning är en strategi som syftar till att minska andnöd under träning hos patienter med KOL

Syftet med denna avhandling var att undersöka vilken evidens det finns för lokal muskelträning hos patienter med KOL, utvärdera genomförbarhet och effekter av lokal högrepetitiv muskelträning utfört med elastiska träningsband hos patienter med KOL samt att undersöka ifall elastiska träningsband kan användas för att utvärdera muskelstyrka.

Avhandlingen består av fem delstudier. För att undersöka evidens för lokal muskelträning genomfördes en systematisk litteraturgranskning av randomiserade kontrollerade studier. Granskningen visade att lokal muskelträning, i form av cykling med ett ben i taget kan vara effektivt, avseende fysisk förmåga, men utan effekt avseende andfåddhet för patienter med KOL (delstudie 1). Trettio friska kvinnor och män, deltog i en valideringsstudie där jämförelser gjordes mellan maximal kraftutveckling utfört med elastiska träningsband och en isokinetisk dynamometer. Ett högt samband mellan de två metoderna och ingen skillnad i maximal kraft, indikerade att elastiska band kan användas för att utvärdera muskelstyrka (delstudie 2). Ett studieprotokoll skapades för en randomiserad kontrollerad studie, som syftade till att undersöka effekterna av lokal högrepetitiv muskelträning i kombination med KOL-specifik patientutbildning (interventionsgrupp) jämfört med enbart KOL-specifik patientutbildning (kontrollgrupp) (delstudie 3). Lokal högrepetitiv muskelträning utfördes i grupp med elastiska träningsband som redskap. Övningarna genomfördes med en arm eller ett ben i taget med 25 repetitioner i 2 set med syfte att påverka muskulaturens uthållighet. Efter åtta veckors träning hade interventionsgruppen bättre muskelfunktion i både övre och nedre extremitet samt en bättre funktionell förmåga jämfört med kontrollgruppen. Inga skillnader i effekt sågs mellan grupperna avseende uthållighet vid test på ergometercykel eller avseende hälsorelaterade utfallsmått, såsom livskvalitet och tilltro till sin egen förmåga (delstudie 4). För patienter med KOL, visade sig lokal högrepetitiv muskelträning vara en genomförbar metod avseende följsamhet och närvaro i träningen. De fysioterapeuter som ledde träningen i klinisk verksamhet ansåg att den var möjlig att genomföra med hög relativ intensitet och utan allvarliga biverkningar (delstudie 5).

Sammanfattningsvis visar denna avhandling att lokal muskelträning kan vara en användbar och effektiv metod för patienter med KOL. Åtta veckor med lokal högrepetitiv muskelträning är genomförbart och effektivt avseende fysisk förmåga hos dessa patienter. Elastiska träningsband kan användas som träningsredskap för att förbättra muskelfunktion hos patienter med KOL samt för att utvärdera muskelstyrka hos friska vuxna.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2014. 72 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1645
Keyword
Chronic obstructive pulmonary disease, elastic resistance, exercise capacity, health-related quality of life, randomized controlled design, single limb exercises, systematic review, study protocol
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-88024 (URN)978-91-7601-049-5 (ISBN)
Public defence
2014-05-23, Aulan, Vårdetarhuset, Umeå universitet, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2014-04-30 Created: 2014-04-22 Last updated: 2014-06-13Bibliographically approved

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Nyberg, AndreLindström, BrittaWadell, Karin

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