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COMPARING THE EFFECTS of NMES and ENDURANCE TRAINING IN PATIENTS WITH SEVERE COPD PATIENTS

COMPARING THE EFFECTS of NMES and ENDURANCE TRAINING IN PATIENTS WITH SEVERE COPD PATIENTS. Pınar ERGÜN MD, Dicle KAYMAZ MD, Ebru ÇANAK , Neşe DEMİRCİ Atatürk Chest Disease and Chest Surgery Center P ULMONARY REHABLİTATION and HOME CARE UNIT. Exercise training in COPD.

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COMPARING THE EFFECTS of NMES and ENDURANCE TRAINING IN PATIENTS WITH SEVERE COPD PATIENTS

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  1. COMPARING THE EFFECTS of NMES and ENDURANCE TRAINING IN PATIENTS WITH SEVERE COPD PATIENTS Pınar ERGÜN MD, Dicle KAYMAZ MD, Ebru ÇANAK , Neşe DEMİRCİ Atatürk Chest Disease and Chest Surgery Center PULMONARY REHABLİTATION and HOME CARE UNIT

  2. Exercise training in COPD • Improves endurance • Muscle strength, • Exercise capacity, • HRQOL, • Dyspnea, • Scores of Anxiety-Depression However, physical training of very severe patients with intense breathlessness at rest or on minimum exertion, can be particularly difficult.

  3. Neuromuscular electrical stimulation (NMES) • Muscle strength and endurans, • Peripheral muscle capillary/fibre ratio, • fibre cross-sectional area • the number of type I and type II fibres, • improve oxidative potential of the muscle. Journal of Cardiopulmonary Rehabilitation and Prevention 2008;28:79-91

  4. Chest 2006;129;1540-48 Respiratory Medicine 2007;101:1236-43

  5. AIM; To compaire the level of improvement of NMES and endurance training in patients with severe COPD • exercise capacity • muscle strength • dyspnea • health related quality of life • phsycohological status • body composition

  6. METOD; • Patients: 50 COPD GOLD Stage IV • PR Programme:Multidisciplinary, outpatient • Exercise training: NMES and Endurance

  7. METOD; • DYSPNEA : MRC, BORG scale CRDQ dyspnea domaine • Exercise capacity: SWT ESWT • Peripheral muscle strength: Manuel muscle test • HRQOL: SGRQ • Phsycohological status: HAD skalası • Body composition: BMI, FFM,FFMI

  8. STUDY DESIGN EVALUTİON 50 patient DEĞERLENDİRME 50 olgu RANDOMISATION NMES 25 patient, 20 session Endurance 25 patient, 10 week Drop outs 2 patient OUTCOME EVALUATION n= 23 OUTCOME EVALUATİON n= 25

  9. NMES Protocol; • NMES SESSION; • Bilateral,Quadriceps; 9X5cm, • Deltoid; 5X5cm surfaca electrodes • Duration: 15min- 2day / Wk- 20 session. • First 2 Wk : Duty cicle:200-380µs, Stimulation frequency: 55 Hz. • Following sessions: • Duty cicle:220- 400 µs, • Stimulation frequency: 60Hz.

  10. ENDURANCE TRAINING; • 2 days in week , survised, 10 week • 15 min cycling ; • %50 Peak W • 15 min treadmill; • %85 Peak VO2

  11. Tabel-1: Demographic characteristics *p<0.05 **p<0.001

  12. Exercise capacity: SWT p<0.001 p<0.001 • Increases in exercise capacity for NMES and Endurance groups is simillar , there were not any statisticaly meaningfull differance in the gainings.

  13. ENDURANCE CAPACITY; ENDURANS SHUTTLE WALK TEST p<0.001 p<0.001 • Increases in endurance for NMES and Endurance groups is simillar , there were not any statisticaly meaningfull differance in the gainings.

  14. PERIPHERAL MUSCLE SRENGTH; Manuel Muscle Test • Before • After P>0,05 P<0,05 P<0,01 P<0,01 P P<0,01 5 4 3 2 1 0 Right Left Right Left Right Left Right Left Deltoid Quadriceps Deltoid Quadriceps NMES ENDURANCE • There were statistically meaninfull increases in the muscle strengths of upper and lower extremities evaluated with manuel muscle test. The level of gainings were simillar for the two gruops (p>0,05).

  15. DYSPNEA SENSATION p<0,001 p<0,001 p>0,05 p<0,05 p>0,05 MRC ist • There were imrovements in Dyspnea sensation in daily living acties for the two group though the dypsnea sensation scores in exercise did not reach a statistically meaningfull level. The level of gainings were simillar for the two gruops.

  16. HRQOL; SGRQ p<0.001 p<0.001 p>0.05 p<0.001 p<0.001 etkilenim • Increases in HRQOL for NMES and Endurance groups except the symptom domain is simillar , there were not any statisticaly meaningfull differance in the gainings.

  17. PHSYCOLOGIC STATUS; Anxiety/Depression p<0.05 (p<0.001) • There meaningfull improvements in Phsycologic comorbidties that were evaluated with HAD for NMES and Endurance groups. The level of gainings were simillar for the two gruops.

  18. BODY COMPOSITION YVK Kg BKİ Kg/m² YVKİ Kg/m² • There were not statitistically meaninfull changes in the body composition for the two groups.

  19. DISCUSSION • These results corralates with the literature which supports that NMES can be used as an effective treatment strategy in severe COPD Journal of Cardiopulmonary Rehabilitation and Prevention 2008;28:79-91 Thorax 2002;57:333-37 Chest 2006;129;1540-48 Respiratory Medicine 2007;101:1236-43

  20. CONCLUSION • The gainings for outcome parameters in NMES and Endurance programmes are simillar. • NMES can be used as an effective treatment strategy for peripheral muscle training in severe COPD patients.

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