Healthy Clinical Trial
Official title:
Effect of the Combined (Aerobic/Resisted) and Interval Physical Training on Oxygen Uptake and Heart Rate On-kinetics Responses in Patients With Moderate to Very Severe COPD: Double-blind, Randomized, Controlled Trial
Patients with chronic obstructive pulmonary disease (COPD) present slowed pulmonary oxygen uptake (VO2) and heart rate (HR) kinetics compared with age-matched controls. Patients with COPD present significant loss of body mass, decreased strength and endurance of respiratory muscles and lower limbs, leading reduced exercise capacity. This reduced exercise capacity can be marked by slowed kinetics of VO2 and HR at the onset of heavy-intensity exercise. Additionally, derangements in the diffusive and convective transport of oxygen to skeletal muscle mitocondria, and intramyocyte metabolic machinery, higher ventilation and disturbances in mechanics of breathing, hypoxemia, pulmonary hemodynamics, autonomic balance, and peripheral vasodilation, and accumulation of by-products that might be related to increased muscle fatigability could slow the response of systemic (central) and peripheral (microvascular) oxygen delivery to a point where the kinetics of VO2 might become limited by O2 availability and HR. Thus, the physical training programs of the lower limbs, in addition to presenting scientific evidence "A", are important components, resulting in the reversal of the manifestations of COPD, resulting in improvement in exercise capacity, well significantly speeded VO2 and HR kinetics in patients with COPD. However, it should be taken into account the choice of an appropriate program limitations and severity of disease. Assuming that COPD patients present slower VO2 and HR kinetics, the investigators hypothesized that the heavy-intense interval physical training in equipament elliptical would promote a greater increase in the functionality (functional performance) and speeded kinetics in the cycle ergometer and elliptical equipment constant-load intense exercises tests of COPD patients. In this context, the present study intends to evaluate and compare the effects of resistive plus aerobic physical training and interval physical training on oxygen consumption (VO2) and heart rate (HR) kinetics responses at the onset in cycle ergometer and elliptical equipment constant-load intense exercises tests in patients with COPD.
Subjects performed after and before of two physical training program the following tests:
lung function test,cardiopulmonary exercise testing (CPT), constant-load exercise test in
cycle ergometer, Constant-load exercise test in elliptical equipament, one repetition
maximum test(1RM), on alternate days.
- Lung function: All patients underwent spirometry with the determination of FEV1 and FVC
according to American Thoracic Society recommendations. Spirometry was performed using
a COSMED microQuark PC - based Spirometer ®, (Pavona di Albano - Roma, Itália), which
was calibrated before each test.
- Cardiopulmonary Exercise Testing (CPT): Incremental symptom-limited exercise testing
was performed on a cycle-ergometer(Ergo FIT®, model Ergo 167 Cycle, Pirmasens, Germany)
using a computer-based ventilatory expired gas analysis system (VO2000, Medgraphics
Corp., St. Paul, MN). All subjects underwent a CPT to determine the peak work rate and
the peak oxygen uptake (peak VO2). The subjects' electrocardiographic recordings were
monitored using a cardiac monitor, SpO2, BP and sensation of dyspnea and fatigue using
the BE-CR-10. A gas analyzer (VO2000 Medgraphics®, St Paul MN, USA) was used to obtain
the participants' VO2 at each stage of the test. The ergospirometric values were
recorded by the mean value measured every three breaths using the Aerograph® program.
The VO2 was determined choosing the higher and more coherent value in the final 30
seconds of each stage.
- Constant-load exercise test in cycle ergometer and Constant-load exercise test in
elliptical equipament: The two exercise tests were performed at 70% of the previously
determined work rate in CPT. During the CSET, VO2 was measured breath-by-breath and
averaged every three respiration, while SpO2, HR, and the electrocardiogram were
continuously monitored, and calculated a on-Kinetics of VO2 and HR.
* Physical training program:
- The interval physical training on the elliptical trainer (Kiko's® HM 6022, São Paulo,
SP, Brazil) totalized 18 sessions that the individuals of both groups had to attend at
least twice a week. Each session lasted not more than 60 minutes and they were all
individual meetings. The minimal work rate of the equipment was 40W and the lower
increment work rate was 10W. The elliptical trainer allowed combined exercise with the
upper limb, however, in the present study, the exercise was performed with the arms
fixed, and every participant's HR was monitored using a pulse frequency meter (Polar®
FS2cTM Kempele, Finland), the pulse oxygen saturation (SpO2) using a pulse oximeter
(Nonin®, model 8500A, Minneapolis, Mn, USA), the blood pressure (BP) using a mercury
sphygmomanometer (Oxigel®, São Paulo, SP, Brazil) and the sensation of dyspnea and
lower limb fatigue using the Modified Borg CR-10 Scale (BE-CR10). The elliptical
exercise was an interval training and was based on studies that performed interval
training exercise in cycle ergometer. This was a 30-minute exercise with a rest
interval established in one minute. The exercise's work rateworkload was the maximal
achieved in the CPT, and it was not modified until the sessions were finished The
individuals who did not reach 40W in the CPT performed 30 seconds exercising periods at
40W with 1-minute resting interval. The volunteers who achieved workload equal or
higher 40W performed 1-minute exercising periods at the workload achieved in the CPT
with 1-minute resting interval. During the exercise on the equipment, the individuals
should keep the speed between 40 and 50 rpm.Vital signs (HR, BP, SpO2) were recorded at
the beginning and at the end of each session, as well as monitored before, during and
after the elliptical exercise. During the training, the vital signs were recorded on
the first 30 seconds of each resting interval.
- The aerobic associate resisted physical training consisted of thirty minutes oa aerobic
training at 60-70% of work rate obtained in CPT and subsequently three sets of fifteen
repetitions of resistance training in lower limbs on leg press with an intensity of
40-60% of one repetition maximum test.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Investigator), Primary Purpose: Treatment
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