Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic obstructive respiratory disease, which has become first-line treatment besides drug therapy. However, in the current clinical evaluation system of pulmonary rehabilitation, there is still a lack of simple, objective index,which can be monitored at any time.Neural respiratory drive , as an important physiological index, is closely related to the symptoms and the severity of the disease. It may be a sensitive indicator to evaluate the effectiveness of pulmonary rehabilitation. Surface EMGdi can accurately evaluate neural respiratory drive , its detection is non-invasive, simple and safety . In recent years, with the development of signal detection and analysis technology, EMG recording is more stable, but as the related research samples were low, surface diaphragm EMG has not yet the establishment of standardization. Therefore, based on the previous work, the project was carried out in a multicenter randomized controlled study,in which the stable stage of COPD patients were included in different ways of pulmonary rehabilitation training, a comprehensive clinical assessment will be conducted before and after training. Compared with the traditional evaluation methods and standard esophageal diaphragmatic electromyography, surface EMGdi detect the changes of neural respiratory drive in patients with COPD,that can help to explore the application value of surface EMGdi in the assessment of chronic obstructive pulmonary disease with pulmonary rehabilitation, to provide a basis for the promotion of the diaphragm and the optimization of pulmonary rehabilitation program.
The patients with COPD will participate in a rehabilitation program for 52 weeks. Participants in the proposed study will be randomly programmed into one of four intervention groups: 1. Neither cycle training nor inspiratory muscle training. 2. Cycle training program alone (performing on calibrated stationary cycle ergometer). 3. Inspiratory muscle training alone (performing on threshold loading device). 4. Combined cycle training and inspiratory muscle training(performing on calibrated stationary cycle ergometer and threshold loading device).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
500
Neither cycle training nor inspiratory muscle training.
The most common device to perform cycle training is calibrated cycle ergometer.
Threshold loading device is used to perform inspiratory muscle training.
Combined cycle training and inspiratory muscle training.The threshold loading device is composed of a mouth -piece attached to a small plastic cylinder that contains a spring-loaded poppet value. The valve opens to permit inspiratory flow only once the person has generated adequate negative intrathoracic pressure to condense the spring.
Zhujiang Hospital,Southern Medical Universtiy
Guangzhou, Guangdong, China
Diaphragmatic function(composite outcome measure)
Diaphragmatic function can be assessed by diaphragm electromyogram (EMGdi), which reflect the physiological activity of the diaphragm and indicate functional status of the central drive.
Time frame: Change from baseline in diaphragm electromyogram.(8 weeks later, 26 weeks later, 52 weeks later)
Inspiratory muscle function(composite outcome measure)
Currently, the maximal inspiratory pressure (PImax) and maximal expiratory pressures(PEmax) are measured by a digital manometer (AZ-8205, AZ Instrument, Taichung City, Taiwan)and combined to evaluate inspiratory muscle function.
Time frame: Change from baseline in inspiratory muscle function.(8 weeks later, 26 weeks later, 52 weeks later)
Pulmonary Function(composite outcome measure)
Pulmonary function is measured using a spirometer(PonyFX 229, Cosmed, Rome, Italy) that is calibrated daily.The FEV1 and percent-of-predicted FEV1, FVC and percent-of-predicted FVC which are presented in one report are used to evaluate Pulmonary Function.
Time frame: Change from baseline in pulmonary function.(8 weeks later, 26 weeks later, 52 weeks later)
Cardiopulmonary exercise test(composite outcome measure)
Cardiopulmonary exercise test can help to reflect the variables,like maximaloxygen uptake（VO2max）, anaerobic threshold (AT).
Time frame: Change from baseline in cardiopulmonary exercise test.(8 weeks later, 26 weeks later, 52 weeks later)
Degree of dyspnea(composite outcome measure)
Difference in the degree of dyspnea can be measured by Borg index.
Time frame: Change from baseline in degree of dyspnea.(8 weeks later, 26 weeks later, 52 weeks later)
Exercise capacity(composite outcome measure)
Exercise capacity is evaluated using the 6-min walking distance (6MWD) according to American Thoracic Society guidelines.
Time frame: Change from baseline in exercise performance.(8 weeks later, 26 weeks later, 52 weeks later)
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