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Research ArticleOriginal Research

Adjuncts to Physical Training of Patients With Severe COPD: Oxygen or Noninvasive Ventilation?

Audrey Borghi-Silva, Renata Gonçalves Mendes, Andreza Cristina Toledo, Luciana Maria Malosá Sampaio, Tatiane Patrocínio da Silva, Luciana Noemi Kunikushita, Hugo Celso Dutra de Souza, Tânia F Salvini and Dirceu Costa
Respiratory Care July 2010, 55 (7) 885-894;
Audrey Borghi-Silva
Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
PT PhD
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  • For correspondence: [email protected]
Renata Gonçalves Mendes
Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
MSc
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Andreza Cristina Toledo
Physiotherapy Department, Methodist University of Piracicaba, São Paulo, Brazil.
MSc
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Luciana Maria Malosá Sampaio
Physiotherapy Department, Nove de Julho University, São Paulo, Brazil.
PhD
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Tatiane Patrocínio da Silva
Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
MSc
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Luciana Noemi Kunikushita
Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
PT
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Hugo Celso Dutra de Souza
Physiotherapy Department, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
PhD
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Tânia F Salvini
Skeletal Muscle Plasticity Unit, Federal University of São Carlos, São Paulo, Brazil
PhD
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Dirceu Costa
Physiotherapy Department, Nove de Julho University, São Paulo, Brazil.
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Abstract

BACKGROUND: Previous studies have shown positive effects from noninvasive ventilation (NIV) or supplemental oxygen on exercise capacity in patients with COPD. However, the best adjunct for promoting physiologic adaptations to physical training in patients with severe COPD remains to be investigated.

METHODS: Twenty-eight patients (mean ± SD age 68 ± 7 y) with stable COPD (FEV1 34 ± 9% of predicted) undergoing an exercise training program were randomized to either NIV (n = 14) or supplemental oxygen (n = 14) during group training to maintain peripheral oxygen saturation (SpO2) ≥ 90%. Physical training consisted of treadmill walking (at 70% of maximal speed) 3 times a week, for 6 weeks. Patients were assessed at baseline and after 6 weeks. Assessments included physiological adaptations during incremental exercise testing (ratio of lactate concentration to walk speed, oxygen uptake [V̇O2], and dyspnea), exercise tolerance during 6-min walk test, leg fatigue, maximum inspiratory pressure, and health-related quality of life.

RESULTS: Two patients in each group dropped out due to COPD exacerbations and lack of exercise program adherence, and 24 completed the training program. Both groups improved 6-min walk distance, symptoms, and health-related quality of life. However, there were significant differences between the NIV and supplemental-oxygen groups in lactate/speed ratio (33% vs −4%), maximum inspiratory pressure (80% vs 23%), 6-min walk distance (122 m vs 47 m), and leg fatigue (25% vs 11%). In addition, changes in SpO2/speed, V̇O2, and dyspnea were greater with NIV than with supplemental-oxygen.

CONCLUSIONS: NIV alone is better than supplemental oxygen alone in promoting beneficial physiologic adaptations to physical exercise in patients with severe COPD.

  • bi-level positive airway pressure
  • chronic respiratory disease
  • exercise training
  • exercise tolerance
  • non invasive ventilation
  • oxygen supplementation

Footnotes

  • Correspondence: Audrey Borghi-Silva PT, Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, Washington Luis, Km 235 São Carlos, São Paulo 13565-905, Brazil. E-mail: audrey{at}ufscar.br.
  • This research was partly supported by the Ministry of Education/Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Coordination of Advanced Higher Education [CAPES]), Brazil.

  • The authors have disclosed no conflicts of interest.

  • Copyright © 2010 by Daedalus Enterprises Inc.
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Respiratory Care: 55 (7)
Respiratory Care
Vol. 55, Issue 7
1 Jul 2010
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Adjuncts to Physical Training of Patients With Severe COPD: Oxygen or Noninvasive Ventilation?
Audrey Borghi-Silva, Renata Gonçalves Mendes, Andreza Cristina Toledo, Luciana Maria Malosá Sampaio, Tatiane Patrocínio da Silva, Luciana Noemi Kunikushita, Hugo Celso Dutra de Souza, Tânia F Salvini, Dirceu Costa
Respiratory Care Jul 2010, 55 (7) 885-894;

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Adjuncts to Physical Training of Patients With Severe COPD: Oxygen or Noninvasive Ventilation?
Audrey Borghi-Silva, Renata Gonçalves Mendes, Andreza Cristina Toledo, Luciana Maria Malosá Sampaio, Tatiane Patrocínio da Silva, Luciana Noemi Kunikushita, Hugo Celso Dutra de Souza, Tânia F Salvini, Dirceu Costa
Respiratory Care Jul 2010, 55 (7) 885-894;
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Keywords

  • bi-level positive airway pressure
  • chronic respiratory disease
  • exercise training
  • exercise tolerance
  • non invasive ventilation
  • oxygen supplementation

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