# Exercise as it relates to Disease/Lifting for the Lungs - Resistance Training in COPD Patients During Periods of Acute Exacerbation

This Wiki Book is an analysis of the journal article "Impact of resistance training in chronic obstructive pulmonary disease patients during periods of acute exacerbation" by Borges, Rodrigo C; Carvalho, Celso R (2014)

## What is the background to this research?

Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term that describes long-term diseases of the lungs such as Emphysema, Chronic Bronchitis, and Asthma. Symptoms of these diseases include: shortness of breath and regular coughing up of mucus, the onset of these symptoms are gradual and if no treatment or preventative measures are used, the disease will continuously decline until everyday activities become a struggle.
Risk Factors:
* Smoking
* Genetics
* Chronic exposure to air pollution
COPD is diagnosed using Spirometry, which measures how much air can be inhaled and exhaled, and also how fast air can be exhaled. Doctors can recommend other tests such as chest X-rays or CT scans, however, Spirometry is the most common.
There is no cure for COPD, however, there are many strategies to control and prevent the decline of the disease such as:
* Quit smoking
* Physical activity
* Diet changes
* Lung Rehabilitation
* Medication
Resistance training has been proven to improve the quality of life for people suffering from many different chronic diseases such as Alzheimer's disease and sarcopenia. It involves both concentric (shortening) and eccentric (lengthening) contractions of the muscles to move an external resistance.

## Where is the research from?

This study was conducted at the University of São Paulo (USP) Hospital and the Physical Therapy department of São Paulo University Medical school in Brazil. USP is ranked number 2 in the top universities in Latin America. Both authors; Borges and Carvalho are physical therapists and educators at the São Paulo School of Medicine. Borges has a Masters in physical therapy, and Carvalho has a Ph.D.; together they are involved in over 100 research studies.

## What kind of research was this?

A Randomised Controlled Trial (RCT) of 46 participants, where 29 completed the trial as either the control group or the training group. The participants were patients that were hospitalised due to COPD exacerbations and were selected for the trial on the first day of hospitalisation. RCTs are one of the most common types of studies, they are the best way to study the safety and validity of a new treatment

## What did the research involve?

* Control Group (N=14) involved normal patient care for exacerbated COPD including chest physiotherapy, oxygen, and drug therapy.
* Training group (N=15) involved the same care as the control group, although were concurrently undergoing a whole body resistance training program. The exercises were chosen and supervised by physiotherapists, some of these being: shoulder, hip and knee flexion and extension. This was conducted every morning with free weights, in a seated position for 2 sets of 8 repetitions with an initial load set at 80% of a 1 repetition maximum. Adjustments to the participants' programs were made based on symptoms, Borg's Dyspnea scale and fatigue.
An evaluation of both groups was conducted at 3 separate times: second day of hospitalisation, at discharge and 1 month after discharge. The evaluation included the following parameters:
* 6-minute walking distance
* Muscle strength
* Systemic inflammatory mediators
* Blood gas levels
* Lung function
* Health-related quality of life (HRQOL) - questionnaire

## What were the basic results?

Following all three evaluations the following results were observed:
| Parameters | Improved | No Change |
| 6-minute walking distance | ✓ | |
| Muscle Strength | ✓ | |
| Systemic inflammatory mediators | | ✓ |
| Blood gas levels | | ✓ |
| Lung function | | ✓ |
| Health-related quality of life | ✓ | |
The improvements in the 6-minute walking distance and health-related quality of life are due to the increase in muscle strength and the confidence that came with it.
It was expected that there would be no change in Systemic inflammatory mediators, blood gas levels and lung function after the resistance program.

## What conclusions can we take from this research?

This research explains the relationship between whole-body resistance training and improving exacerbated COPD patients quality of life. When structured and monitored correctly, whole-body resistance training is safe and can improve the HRQOL in exacerbated COPD patients by increasing muscle strength without systemic inflammation. However, it also demonstrates that resistance training does not improve the patient's lung function.

## Limitations

The population used in this study is a limiting factor, the participants chosen were only patients that were admitted into the ward. This rules out patients with acute exacerbation of COPD that are in the intensive care unit; these patients are likely not able to perform any of the tests in this study.
The resistance training and tests used for this study relies on patient motivation, this could potentially make this study unreliable as some patients may not put in as much effort as others.
Using a questionnaire as a test can also be a limiting factor as it is very common for participants to over or underestimate their answer.

## Practical advice

Resistance training can improve an exacerbated COPD patient's HRQOL through muscle strengthening. As this study only covers hospitalised patients with exacerbated COPD that have been admitted to a medical ward, the same program used may not be effective with the general COPD population.
Only patients that have been admitted into a medical ward should consider resistance exercise and not patients admitted into the intensive care unit.
This training should only be undertaken with the administration and supervision of a medical professional.

## Further information/resources

Follow the links below for further information regarding resistance training for COPD patients:
* COPD Background
* High repetition resistance training for mild/severe COPD

## References

* 1 2 3 4 5 6 7 Borges, R. C. and C. R. Carvalho (2014). "Impact of Resistance Training in Chronic Obstructive Pulmonary Disease Patients During Periods of Acute Exacerbation." Archives of Physical Medicine and Rehabilitation 95(9): 1638-1645.
* 1 2 Australia, L. F. (2016). "COPD Backgrounder." from http://lungfoundation.com.au/wp-content/uploads/2015/12/COPD-
* 1 2 3 National Heart, L. a. B. I. N. (2017). "Explore COPD: Risk Factors." from https://www.nhlbi.nih.gov/health/health-topics/topics/copd/atrisk.
* ↑ National Heart Lung and Blood Institute(2013), File:Copd 2010Side.JPG
* ↑ Garuffi, M., et al. (2013). "Effects of resistance training on the performance of activities of daily living in patients with Alzheimer's disease." Geriatrics & Gerontology International 13(2): 322-328.
* ↑ Johnston, A. P. W., et al. (2008). "Resistance training, sarcopenia, and the mitochondrial theory of aging." Applied Physiology, Nutrition & Metabolism 33(1): 191-199.
* ↑ Rankings, T. U. (2017). "Latin America University Rankings." from https://www.timeshighereducation.com/world-university-rankings/2017/latin-america-university-rankings#!/page/0/length/25/sort_by/rank/sort_order/asc/cols/stats.
* ↑ ORCID (2017). "Carvalho CR Biography." from https://orcid.org/0000-0003-3046-3412.
* ↑ Kabisch, M., et al. (2011). "Randomized Controlled Trials: Part 17 of a Series on Evaluation of Scientific Publications." Deutsches Ärzteblatt International 108(39): 663-668.
* ↑ Nyberg, A., et al. (2015). "Low-load/high-repetition elastic band resistance training in patients with COPD: a randomized, controlled, multicenter trial: High repetitive resistance training in COPD." The Clinical Respiratory Journal 9(3): 278-288.