Eccentric Training in Individuals With COPD
Condition: Copd
Study type: Interventional

Summary: 
      Skeletal muscle dysfunction as a systemic consequence of chronic obstructive pulmonary
      disease (COPD) has a major impact on quality of life, health care resource utilization, and
      mortality of patients with this disease. In fact, a vicious circle of inactivity and disuse
      is established in the advanced stages of the disease, inducing a progressive decline in
      exercise tolerance and a loss of muscle mass (especially in locomotor muscles), resulting in
      the inability of patients to perform even the simplest daily activities.

      In this context, the multidisciplinary rehabilitation approach includes not only recovery of
      exercise capacity but also training aimed at restoring muscle function in patients with COPD.
      However, there is considerable methodological variability among muscle resistance training
      programs used in clinical practice with patients with COPD. This is compounded by the need to
      identify alternative training strategies effective in inducing functional adaptation in
      skeletal muscle without increasing the degree of dyspnea or fatigue in those symptomatic
      patients with advanced stages of disease. Among these, eccentric exercise or negative work,
      i.e. the stretching of the muscle during the active contraction phase, represents a valid
      alternative to traditional concentric training in various rehabilitation contexts. The main
      advantages of this training method are: 1) eccentric contraction is able to produce greater
      forces than isometric and concentric contraction; 2) for the same resistance, eccentric
      contraction has a lower metabolic cost than concentric contraction. For these reasons,
      eccentric exercise is a valid method of muscle strengthening in rehabilitation and in
      particular in those subjects unable to sustain a high cardiorespiratory effort, as in the
      case of patients with moderate-severe COPD. Previous studies have also shown that eccentric
      exercise, even at low load, produces results equivalent if not superior to traditional
      training with respect to some particular characteristics of muscle function such as power and
      hypertrophy.

      However, eccentric training programs for muscle dysfunction recovery in patients with COPD
      are underused in clinical practice, so far. In contrast, the so called iso-weight eccentric
      training, more suitable for clinical practice, could also be applied to rehabilitation
      programs designed for COPD patients.

      The aim of this study is therefore to evaluate the reliability and efficacy of a low-load
      eccentric exercise training program compared to usual care for the improvement of muscle
      function in patients with COPD.
    


Intervention name(s): Low-load eccentric training; Usual care
Intervention type(s): Other; Other
Intervention description(s): Aerobic exercise training on a downhill walking treadmill with the following settings: 10% negative incline and constant speed corresponding to 75% of the average speed recorded during the initial 6-Minute walk test.
Resistance training: 5 minutes of warm-up on the manual ergometer, then 3 sets for 10 repetitions of the leg extension (performed unilaterally in eccentric phase) with a load of 75% of 1 repetition maximum (concentric) for the first two weeks. The following two weeks, 3 sets for 10 repetitions will be performed on the leg press (performed unilaterally in the eccentric phase) with 75% load of 1 repetition maximum (concentric). In addition, patients will perform 3 upper extremity strengthening exercises (free weights or elastic bands), including 2 sets of 10 repetitions for each exercise.; Aerobic exercise training using the cycle ergometer at an intensity calculated as follows: 2 minutes with load equal to 20% of maximum load, then 25 minutes with initial load at 50% of maximum load calculated as 103.217 + (30.500xGender) + (-1.613xAge) + [0.002x6-Minute walk work (6MWW)]. [Sex: female = 0; male:1] [6MWW = 6-Minute walk distance x weight in kg].
Resistance training: 5 minutes of warm-up on the manual ergometer, then 5 exercises for upper and lower limbs performed with free weights or elastic bands. For the first 2 weeks will be performed 2 sets X 20 repetitions with 1 minute break between sets and a load that allows to perform no more than 20 repetitions. For the following 2 weeks, 3 sets of 10 repetitions x 10 repetitions with 2 min break between sets and a load that allows for no more than 10 repetitions.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Copd; Pulmonary rehabilitation; Muscle strength; Resistance training