Published ahead of print on January 17, 2008, doi:10.1164/rccm.200703-477OC Am. J. Respir. Crit. Care Med., Volume 177, Number 8, April 2008, 844-852 A more recent version of this article appeared on April 15, 2008
Submitted on March 23, 2007 Can Ventilation-Feedback Training Augment Exercise Tolerance in Patients with COPD?Eileen G Collins1*,1 Edward Hines Jr., VA Hospital, Hines, IL, USA; College of Nursing, University of Illinois at Chicago, Chicago, IL, USA, 2 Edward Hines Jr., VA Hospital, Hines, IL, USA; Loyola University, Maywood, IL, USA, 3 Edward Hines Jr., VA Hospital, Hines, IL, USA, 4 VA Cooperative Studies Program Coordinating Center, Edward Hines Jr., VA Hospital, Hines, IL, USA * To whom correspondence should be addressed. E-mail: ecollins{at}uic.edu.
Rationale: Exercise-induced dynamic hyperinflation contributes to decreased exercise tolerance in COPD. It is unknown whether respiratory retraining (ventilation-feedback training) can affect exercise-induced dynamic hyperinflation and increase exercise tolerance.
Objectives: To determine whether patients with COPD would achieve longer exercise duration if randomized to a combination of exercise-training plus ventilation-feedback training than either form of training on its own.
Methods: Sixty-four patients randomized to one of three groups: ventilation-feedback plus exercise (n=22), exercise alone (n=20), and ventilation-feedback alone (n=22).
Measurements: Exercise duration before and after 36 training sessions. Exercise-induced dynamic hyperinflation and respiratory pattern before and after training.
Results: In the 49 patients who completed training, duration of constant-workrate exercise was 40.0±20.4 minutes with ventilation-feedback plus exercise, 31.5±17.3 minutes with exercise alone, and 16.1±19.3 minutes with ventilation-feedback alone. Exercise duration was longer in ventilation-feedback plus exercise than ventilation-feedback alone (p<0.0001) but did not each predetermined statistical significance when ventilation-feedback plus exercise was compared to exercise alone (p=0.022) (p Key words: Pulmonary disease, COPD, Breathing exercises, Exercise
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0.0167 was used for statistical significance.) After training, exercise-induced dynamic hyperinflation, measured at isotime, in ventilation-feedback plus exercise was less than in exercise alone (p=0.014; between group changes) and less than in ventilation-feedback alone (p=0.019; between group changes). After training, expiratory-time was longer in ventilation-feedback plus exercise-training (P<0.001) and it was not significantly changed in the other two groups.
Conclusions: The combination of ventilation-feedback plus exercise-training decreases exercise-induced dynamic hyperinflation and increases exercise duration more than ventilation-feedback alone. An additive effect to exercise training from ventilation-feedback was not demonstrated by pre-determined statistical criteria.
www.clinicaltrials.gov i.d. = NCT00037973
