Pulmonary Disease Clinical Trial
Official title:
Innovation Methods to Augment Pulmonary Rehabilitation
The purpose of this study was to compare the effect of exercise treatment combined with breathing retraining (a computerized feedback program), with exercise treatment combined with heliox (a helium and oxygen combination), with exercise only in patients with moderate to severe chronic obstructive pulmonary disease. This was an 8-week intervention study.
Dynamic hyperinflation limits exercise tolerance in patients with chronic obstructive
pulmonary disease (COPD). Recently, several innovative approaches have been developed to
reduce the burden of dynamic hyperinflation. Two such innovations, ventilation-feedback
training and Heliox supplementation during exercise show great promise and posit a reduction
in dynamic hyperinflation as a key to their effectiveness. In our recently completed trial,
when age, FEV1 and RV/TLC were controlled, exercise plus VF (E+VF) was superior to E
training alone (E only) or VF training alone in improving exercise tolerance. The mechanism
responsible for this difference was, in part, a reduction in exercise-induced dynamic
hyperinflation secondary to a change in breathing pattern. In additional preliminary
studies, we determined that exercise tolerance can be increased when patients exercise while
inhaling Heliox. Similar to VF, the mechanism for exercise improvement with Heliox was a
reduction in exercise-induced dynamic hyperinflation. Although both interventions are
promising, there are no definitive data to support use of either intervention as a standard
of care for pulmonary rehabilitation.
Hypothesis/Research Questions Overview: The two primary hypotheses are that patients with
moderate-severe COPD who successfully complete eight weeks of (a) E+VF training will achieve
longer exercise duration than patients randomly assigned to E only and (b) E+heliox training
will achieve longer exercise duration than patients randomly assigned to E only.
Methods: This study was a randomized controlled clinical trial. After baseline testing is
completed, 103 subjects with moderate-severe COPD were randomized into one of three groups:
E+VF, E+Heliox and E training only. Follow-up testing was completed at 8 weeks. testing,
activity monitoring, and dyspnea measurements. After baseline testing was completed,
randomized subjects trained in the Physical Performance Laboratory three times weekly.
Exercise prescriptions were standardized and based on data from the exercise stress test.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Treatment
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