Assessing the effect of high-repetitive single limb exercises (HRSLE) on exercise capacity and quality of life in patients with chronic obstructive pulmonary disease (COPD): study protocol for randomized controlled trial

Abstract

BackgroundSingle-limb knee extension exercises have been found to be effective at improving lower extremity exercise capacity in patients with chronic obstructive pulmonary disease (COPD). Since the positive local physiological effects of exercise training only occur in the engaged muscle(s), should upper extremity muscles also be included to determine the effect of single limb exercises in COPD patients.Methods/designTrial design: a prospective, assessor-blind, block randomized controlled, parallel-group multicenter trial. Participants: stage II-IV COPD patients, > 40 years of age, ex-smokers, with stable medical treatment will be included starting May 2011. Recruitment at three locations in Sweden. Interventions: 1) high-repetitive single limb exercise (HRSLE) training with elastic bands, 60 minutes, three times/week for 8 weeks combined with four sessions of 60 minutes patient education, or 2) the same patient education alone. Outcomes: Primary: determine the effects of HRSLE on local muscle endurance capacity (measured as meters walked during 6-minute walk test and rings moved on 6-minute ring and pegboard test) and quality of life (measured as change on the Swedish version of the Chronic Respiratory Disease Questionnaire). Secondary: effects on maximal strength, muscular endurance, dyspnea, self-efficacy, anxiety and depression. The relationship between changes in health-related variables and changes in exercise capacity, sex-related differences in training effects, feasibility of the program, strategies to determine adequate starting resistance and provide accurate resistance for each involved movement and the relationship between muscle fatigue and dyspnea in the different exercise tests will also be analyzed. Randomization: performed by a person independent of the recruitment process and using a computer random number generator. Stratification by center and gender with a 1:1 allocation to the intervention or control using random block sizes. Blinding: all outcome assessors will be blinded to group assignment.DiscussionThe results of this project will contribute to increase the body of knowledge regarding COPD and HRSLE.Trial registrationClinicalTrials.gov Identifier: NCT01354067. Registration date: 2011-05-11. First participant randomized: 2011-09-02

A Cohort Study to Evaluate the Feasibility of Low Load/High Repetition Elastic Band Resistance Training for People with Chronic Obstructive Pulmonary Disease

“…The study is reported in line with strengthening the reporting of observational studies in epidemiology guideline [10]. Recruitment, data collection and followup were performed from August 15, 2011 to May 3, 2012 [9].…”

“…The study was performed on people with COPD who were randomly assigned to participate in an eight week RT regimen [9]. The present study was approved by the Regional Ethical Board, Umeå University, Umeå, Sweden (Dnr: 2010-344-31 M) and was registered at www.clinicaltrials.gov (NCT01354067).…”

“…Eligibility criteria for physiotherapists included at least two years' experience of working as a physiotherapist, one year experience of working with cardiorespiratory patients, and at least one year experience of leading training groups [9]. Written informed consent was obtained from both patients and physiotherapists.…”

“…The sessions lasted approximately 60 minutes including warm-up, exercise and cooldown, each part designed in accordance to American College of Sports Medicine recommendations [12][13][14]. Volume, initial load, rest periods, frequency, repetition velocity, and progression in the RT regimen were standardized in accordance with recommendations for increasing peripheral muscular endurance [9,14]. The exercises within the RT regimen target muscles with decreased strength/endurance (compared to healthy individuals), muscles which are important for upper extremity activities of daily living, and muscles which are important for walking [15][16][17][18].…”

“…All exercises were executed using a single limb at a time, alternating left to right side in order to minimize the risk of a central constraint [19]. Execution of all exercise was standardized to optimize activation of targeted muscles, and included execution in the most clinically effective portion of elastic resistance [2,9,[20][21][22]. The length of each individual elastic band, patient position from elastic resistance insertion and, start and stop positions for each exercise, were also standardized [9,23].…”