Effectiveness of Non-Presential Individualized Exercise Training PrOgram(NIETO) in Lower Limb Physical Performance in Advanced COPD.

Juan Miguel Sánchez-Nieto,Roberto Bernabeu-Mora,Andrés Carrillo-Alcaraz,Irene Fernández-Muñoz

doi:10.3390/jcm10051010

Abstract

Muscle training, a component of pulmonary rehabilitation (PR), improves the physical performance of patients with chronic obstructive pulmonary disease (COPD). Despite the existing evidence, the traditional center-based PR model is applied to a small percentage of patients and presents numerous problems of accessibility, adherence, and costs. This study presents a home model of simple muscle training, non-presential, monitored by telephone and individualized, according to the severity of the COPD. In addition, to evaluate the results, simple tests associated with the physical performance of the lower limbs, previously validated in COPD, have been used, such as the four-meter walk, speed test (4MGS) and the five-repetition test sitting and standing (5STS). The objective was to evaluate whether the Individualized Non-Presential Exercise Training PrOgram (NIETO) induces improvements in the 4MGS, 5STS and quadriceps muscle strength (QMS) tests in outpatients with advanced COPD (FEV1 ≤ 50%). After one year, the QMS was significantly higher in the intervention group (IG) than in the control group (CG) (2.44 ± 4.07 vs. 0.05 ± 4.26 kg; p = 0.009). The 4MGS and 5STS tests were significantly shorter in IG than in CG (−0.39 ± 0.86 vs. 0.37 ± 0.96 s; p = 0.001) and (−1.55 ± 2.83 vs. 0.60 ± 2.06 s; p = 0.001), respectively. A home model of simple muscle training monitored by telephone such as NIETO, can improve 4MGS, 5STS, and quadriceps strength tests in outpatients with advanced COPD.

Highlights

Patients with chronic obstructive pulmonary disease (COPD) usually have reduced daily physical activity [1,2] and subjects who perform some level of regular physical activity have a lower risk of both COPD admissions and mortality [3]
43 patients with advanced COPD who completed the Non-presential Individualized Exercise Training PrOgram (NIETO) were analyzed Compared to patients in the control group (CG), patients of the intervention group (IG) were similar in relation to the baseline characteristics (p > 0.05)
The intervention cohort had a mean age of 67 years; most subjects were male (79.1%), had a mean forced expiratory volume in 1 s (FEV1) of 40% predicted value and 16.3% were current smokers

Summary

Introduction

Patients with chronic obstructive pulmonary disease (COPD) usually have reduced daily physical activity [1,2] and subjects who perform some level of regular physical activity have a lower risk of both COPD admissions and mortality [3]. Low physical activity is a strong risk factor of hospitalization and mortality among patients with COPD [4,5,6]. Many patients with COPD have impaired peripheral skeletal muscle strength and mobility activity limitations [11,12]. Up to a third of COPD patients, even in early stages of their disease, show impaired muscle function in their limbs and strength 25% lower than that developed by control subjects [15]. A primary focus of medical treatment is to detect these dysfunctions and develop specific and effective rehabilitation strategies [7,8,9,10,17]

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Discussion

Conclusion