Effect of Two Physical Training Programs on Oxygen Uptake and Heart Rate On-kinetics in Patients COPD
Condition: Chronic Obstructive Pulmonary Disease; Healthy
MeSH terms: Lung Diseases; Lung Diseases, Obstructive; Pulmonary Disease, Chronic Obstructive
Study type: Interventional

Summary: 
      Patients with chronic obstructive pulmonary disease (COPD) present slowed pulmonary oxygen
      uptake (VO2) and heart rate (HR) kinetics compared with age-matched controls. Patients with
      COPD present significant loss of body mass, decreased strength and endurance of respiratory
      muscles and lower limbs, leading reduced exercise capacity. This reduced exercise capacity
      can be marked by slowed kinetics of VO2 and HR at the onset of heavy-intensity exercise.
      Additionally, derangements in the diffusive and convective transport of oxygen to skeletal
      muscle mitocondria, and intramyocyte metabolic machinery, higher ventilation and disturbances
      in mechanics of breathing, hypoxemia, pulmonary hemodynamics, autonomic balance, and
      peripheral vasodilation, and accumulation of by-products that might be related to increased
      muscle fatigability could slow the response of systemic (central) and peripheral
      (microvascular) oxygen delivery to a point where the kinetics of VO2 might become limited by
      O2 availability and HR. Thus, the physical training programs of the lower limbs, in addition
      to presenting scientific evidence "A", are important components, resulting in the reversal of
      the manifestations of COPD, resulting in improvement in exercise capacity, well significantly
      speeded VO2 and HR kinetics in patients with COPD. However, it should be taken into account
      the choice of an appropriate program limitations and severity of disease. Assuming that COPD
      patients present slower VO2 and HR kinetics, the investigators hypothesized that the
      heavy-intense interval physical training in equipament elliptical would promote a greater
      increase in the functionality (functional performance) and speeded kinetics in the cycle
      ergometer and elliptical equipment constant-load intense exercises tests of COPD patients. In
      this context, the present study intends to evaluate and compare the effects of resistive plus
      aerobic physical training and interval physical training on oxygen consumption (VO2) and
      heart rate (HR) kinetics responses at the onset in cycle ergometer and elliptical equipment
      constant-load intense exercises tests in patients with COPD.
    

Detailed description: 
      Subjects performed after and before of two physical training program the following tests:
      lung function test,cardiopulmonary exercise testing (CPT), constant-load exercise test in
      cycle ergometer, Constant-load exercise test in elliptical equipament, one repetition maximum
      test(1RM), on alternate days.

        -  Lung function: All patients underwent spirometry with the determination of FEV1 and FVC
           according to American Thoracic Society recommendations. Spirometry was performed using a
           COSMED microQuark PC - based Spirometer ®, (Pavona di Albano - Roma, Itália), which was
           calibrated before each test.

        -  Cardiopulmonary Exercise Testing (CPT): Incremental symptom-limited exercise testing was
           performed on a cycle-ergometer(Ergo FIT®, model Ergo 167 Cycle, Pirmasens, Germany)
           using a computer-based ventilatory expired gas analysis system (VO2000, Medgraphics
           Corp., St. Paul, MN). All subjects underwent a CPT to determine the peak work rate and
           the peak oxygen uptake (peak VO2). The subjects' electrocardiographic recordings were
           monitored using a cardiac monitor, SpO2, BP and sensation of dyspnea and fatigue using
           the BE-CR-10. A gas analyzer (VO2000 Medgraphics®, St Paul MN, USA) was used to obtain
           the participants' VO2 at each stage of the test. The ergospirometric values were
           recorded by the mean value measured every three breaths using the Aerograph® program.
           The VO2 was determined choosing the higher and more coherent value in the final 30
           seconds of each stage.

        -  Constant-load exercise test in cycle ergometer and Constant-load exercise test in
           elliptical equipament: The two exercise tests were performed at 70% of the previously
           determined work rate in CPT. During the CSET, VO2 was measured breath-by-breath and
           averaged every three respiration, while SpO2, HR, and the electrocardiogram were
           continuously monitored, and calculated a on-Kinetics of VO2 and HR.

           * Physical training program:

        -  The interval physical training on the elliptical trainer (Kiko's® HM 6022, São Paulo,
           SP, Brazil) totalized 18 sessions that the individuals of both groups had to attend at
           least twice a week. Each session lasted not more than 60 minutes and they were all
           individual meetings. The minimal work rate of the equipment was 40W and the lower
           increment work rate was 10W. The elliptical trainer allowed combined exercise with the
           upper limb, however, in the present study, the exercise was performed with the arms
           fixed, and every participant's HR was monitored using a pulse frequency meter (Polar®
           FS2cTM Kempele, Finland), the pulse oxygen saturation (SpO2) using a pulse oximeter
           (Nonin®, model 8500A, Minneapolis, Mn, USA), the blood pressure (BP) using a mercury
           sphygmomanometer (Oxigel®, São Paulo, SP, Brazil) and the sensation of dyspnea and lower
           limb fatigue using the Modified Borg CR-10 Scale (BE-CR10). The elliptical exercise was
           an interval training and was based on studies that performed interval training exercise
           in cycle ergometer. This was a 30-minute exercise with a rest interval established in
           one minute. The exercise's work rateworkload was the maximal achieved in the CPT, and it
           was not modified until the sessions were finished The individuals who did not reach 40W
           in the CPT performed 30 seconds exercising periods at 40W with 1-minute resting
           interval. The volunteers who achieved workload equal or higher 40W performed 1-minute
           exercising periods at the workload achieved in the CPT with 1-minute resting interval.
           During the exercise on the equipment, the individuals should keep the speed between 40
           and 50 rpm.Vital signs (HR, BP, SpO2) were recorded at the beginning and at the end of
           each session, as well as monitored before, during and after the elliptical exercise.
           During the training, the vital signs were recorded on the first 30 seconds of each
           resting interval.

        -  The aerobic associate resisted physical training consisted of thirty minutes oa aerobic
           training at 60-70% of work rate obtained in CPT and subsequently three sets of fifteen
           repetitions of resistance training in lower limbs on leg press with an intensity of
           40-60% of one repetition maximum test.
    

Intervention name(s): Resisted/Aerobic physical training; Interval physical training in elliptical equipament; Interval physical training in elliptical equipament; Resisted/Aerobic physical training
Intervention type(s): Other; Other; Other; Other
Intervention description(s): COPD, aerobic physical training in cicloergometer, resisted physical training in cicloergometer, oxygen uptake kinetic, heart rate kinetic.; Control group (healthy individuals), interval physical training, elliptical equipment, oxygen uptake kinetic, heart rate kinetic.; COPD, interval physical training, elliptical equipament, oxygen uptake kinetic, heart rate kinetic; Control group, aerobic physical training in cicloergometer, resisted physical training in leg-press oxygen uptake kinetic heart rate kinetic
Other intervention name(s): COPD,; aerobic physical training in cicloergometer,; resisted physical training in cicloergometer,; oxygen uptake kinetic,; heart rate kinetic.; Control group (healthy individuals),; interval physical training in elliptical equipment,; oxygen uptake kinetic,; heart rate kinetic.; COPD,; interval physical training in elliptical equipament,; oxygen uptake kinetic,; heart rate kinetic.; Control group,; aerobic physical training in cicloergometer,; resisted physical training in leg-press,; oxygen uptake kinetic,; heart rate kinetic.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: Chronic Obstructive Pulmonary Disease; Physical training; Oxygen uptake kinetic; Heart rate kinetic