Background: Health Promotion Administration, Ministry of Health and Welfare, Taiwan indicates that chronic obstructive pulmonary disease (COPD) has been one of the top ten causes of death in Taiwan for a long time, causing more than 6,000 deaths every year. Given the clinical course of irreversible airway obstruction due to chronic inflammation from air pollution, inhaling dust, smoke or chemical substances in the working environment, it will lead to deterioration of the pulmonary function test and dyspnea clinically. Besides medication treatment, pulmonary rehabilitation can be a proper adjunct to maintain residual pulmonary function. In which, personalized exercise intervention will safely augment the effect of pulmonary rehabilitation based on suitable intensity, time interval, and adequate monitoring.
Objective: The purpose of this study was to investigate the effect of 12-week low-load, high-repetition elastic band with dumbbell resistance training and upper/lower extremities high-repetition aerobic exercise training on respiratory muscles, related exercise tolerance, and associated quality of life in patients with COPD.
Method: This was a prospective, randomized, uni-institutional study and a total of 31 patients with COPD was enrolled from Aug. 2021 to Oct. 2021. All patients maintained the routine PR program (high-frequency chest wall oscillation equipment, non-invasive positive pressure ventilator, and negative pressure ventilator) accordingly. These patients were divided into two groups: the participants in the experimental group (n = 16) (EG) performed aerobic and resistance exercise for 60 minutes twice a week for 12 weeks; while the control group (CG) (n = 15) was prescribed with verbal/video instructions regarding above-mentioned exercise intervention and performing a tolerable exercise by themselves. Before and after 12-week exercise intervention, the participants received hand grip, muscle power (pectoralis major, deltoid, supraspinatus, and quadriceps femoris), spirometer (forced expiratory volume in one second (FEV1) and ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC)), COPD Assessment Test (CAT), Modified Medical Research Council (mMRC) survey, Borg dyspnea scale, and St. George's Respiratory Questionnaire (SGRQ) examinations. Six minutes walking test was adopted to determine the exercise tolerance. Meanwhile, the maximum inspiratory/expiratory pressure and body composition were measured for further comparison. Results of continuous variables were expressed as median (interquartile range) and a P value < 0.05 was considered statistically significant.
Result: After 12-weeks intervention of aerobic exercise with resistance training, we found that: (1) there was a significant increase of left hand grip strength among EG. (26.2 vs. 26.1 kgw; P ＝ 0.04) (2) muscle power of right pectoralis major (22.5 vs. 19.1 lbs; P < 0.01), right deltoid and supraspinatus (38.9 vs. 21.2 lbs; P < 0.01), left deltoid and supraspinatus (38.4 vs. 24.2 lbs; P < 0.01), right quadriceps femoris (38.1 vs. 24.2 lbs; P < 0.01) improved among EG. (3) The maximum inspiratory pressure (72.0 vs. 58.0 cmH2O; P < 0.01), maximum expiratory pressure (62.0 vs. 58.0 cmH2O; P < 0.01), and the six-minute walking distance (417.0 vs. 410.0 m; P < 0.01) improved among EG. (4) The CAT scores (1.5 vs. 2.0; P = 0.03), mMRC scores (9.5 vs. 10.0; P < 0.01), and Taiwanese Depression Questionnaire (9.0 vs. 4.0; P < 0.01), domains of symptom activity (35.0 vs. 50.9; P < 0.01) and effects (18.1 vs. 28.0; P < 0.01) in SGRQ improved among EG. Nevertheless, no improved pulmonary function test demonstrated among EG after 12-week exercise intervention. (FEV1: 1.2 vs. 1.2 L; P = 0.79) (FEV1/FVC: 0.7 vs. 0.6; P = 0.18)
Conclusion: Though no significant improvement of pulmonary function test was available, we herein still demonstrated the improvement of left hand grip strength, associated muscle powers, maximum inspiratory/expiratory pressure, exercise tolerance, and quality of life after 12-week low-load, high-repetition elastic band with dumbbell resistance training and upper/lower extremities high-repetition aerobic exercise training for those with COPD.
目錄
第一章 緒論 1
第一節 研究背景 1
第二節 研究動機 2
第三節 研究之目的 4
第四節 研究之假說 5
第五節 名詞定義 6
第二章 文獻探討 8
第一節 慢性阻塞性肺疾病臨床症狀及致病機轉 8
第二節 有氧運動影響 12
第三節 阻力訓練之重要性 15
第四節 肺部復原 19
第五節 生活品質與症狀評估 24
第三章 研究方法 25
第一節 研究設計與流程 25
第二節 研究設計 27
第三節 研究架構 28
第四節 研究運動訓練計畫 30
第五節 研究測量方法與工具 36
第六節 統計分析 41
第四章 資料分析與結果 42
第一節 研究受試者基本屬性 42
第二節 研究對象肌力指標之成效 44
第三節 握力及吸吐氣壓力成效 47
第四節 研究對象肌肉質量成效 49
第五節 六分鐘行走測試及運動肺功能成效 51
第六節 生活品質指標之成效 54
第五章 討論 56
第一節 研究對象之基本屬性 56
第二節 肌力、握力及最大吸吐氣壓力成效探討 57
第三節 肌肉質量成效探討 59
第四節 六分鐘行走測試及肺功能成效探討 60
第五節 生活品質指標之成效 61
第六章 結論與建議 62
第一節 結論 62
第二節 研究限制與建議 62
參考文獻 63
附錄 69


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