ABSTRACT of ARTICLE 1

1. Comparison of Effects of Strength and Endurance Training in Patients with Chronic Obstructive Pulmonary Disease (COPD) We determined the effect of different exercise training modalitiesin patients with chronic obstructive pulmonary disease, includingstrength training (n = 17), endurance training (n = 16), andcombined strength and endurance (n = 14) (half of the enduranceand half of the strengthening exercises). Data were comparedat baseline, the end of the 12-week exercise-training program,and 12 weeks later. Improvement in the walking distance wasonly significant in the strength group. Increases in submaximalexercise capacity for the endurance group were significantlyhigher than those observed in the strength group but were ofsimilar magnitude than those in the combined training modality,which in turn were significantly higher than for the strengthgroup. Increases in the strength of the muscle groups measuredin five weight lifting exercises were significantly higher inthe strength group than in the endurance group but were of similarmagnitude than in the combined training group, which again showedsignificantly higher increases than subjects in the endurancegroup. Any training modality showed significant improvementsof the breathlessness score and the dyspnea dimension of thechronic respiratory questionnaire. In conclusion, the combinationof strength and endurance training seems an adequate trainingstrategy for chronic obstructive pulmonary disease patients. Key Words: chronic obstructive pulmonary disease • pulmonary rehabilitation • exercise training • skeletal muscle ABSTRACT of ARTICLE 1 BACKGROUND/INTRO The diagnosis for COPD was based on a smoking history and on pulmonary function tests that showed irreversible bronchial obstruction. They conducted the training program at their institution 3 days each week for 12 weeks. The level of evidence for this research was a level 2. It was a small RCT of 47 subjects that were randomly assigned to endurance training alone (n=16), strength training alone (n=17), or combined training of endurance and strength together (n=14) or a control group. They did note however that for the purpose of this report and to simplify comparisons the data in the control group wasn’t shown. They evaluated the subjects at baseline, at the end of 12 week training program and at 12 after training program. Endurance Training (n=16): 40 minute leg exercises on a calibrated ergocycle and the work rate was 70% of peak work rate achieved during baseline exercise test Strength Training (n=17): Included weight lifting procedures involving: 1. Chest pull (latissimus dorsi) 2. Butterfly (pectoralis major) 3. Neck Press (triceps brachii and deltoid) 4. Leg Flexion (biceps femoris and gastrocnemius) 5. Leg Extension (quadriceps) Patients performed four series of 6-8 reps for each at work rate of 70%-85% of one rep max and adjusted every 2 weeks Combined Training of Endurance and Strength (n=14) Two series of 6-8 reps of the same exercises plus 20 min of cycling Measurements Included: Spirometry Static lung volumes with plethysmograph and Arterial blood Expired 02 and CO2 analyzed with zirconium dioxide cell 02 analyzer and infrared C02 analyzer Shuttle Walk Tests (pt. walked between two cones placed 10m. apart at certain speeds, Endurance Tests, Strength Measurement Chronic breathlessness using the modified Baseline Dyspnea Index Health Related Quality of Life using Chronic Respiratory Questionnaire METHODS AND MATERIALS Effects of Exercise Training on Peripheral Muscle Strength At the end of the training period and at 12 weeks after training all patients in the three groups showed statistically significant increases in strength of muscle groups In the endurance group increases in strength measures involving upper extremities were lower compared with increases in strength measures involving lower extremities Strength group were significantly higher than endurance group but were similar magnitude to combined group Effects of Exercise Training on Exercise Capacity After training, the improvement in the shuttle walking test was only statistically significant in the strength training group (from 457 +/- 150 to 561 +/- 204 m, p<0.015) At the end of the training period and at 12 weeks after training, all patients in the three groups showed significant increases in the duration of endurance testing compared with pre-training values Pre-training (kg) 12 Weeks After Training (kg) Strength= 35.3 +/- 22 Strength= 45.1 +/- 18 Endurance= 33.4 +/- 20 Endurance= 66.6 +/- 26 Combined= 24.9 +/- 20 Combined= 42 +/- 23 Effects of Exercise Training on Breathlessness and Quality of Life Significant effect of any of the training on breathlessness score and the dyspnea dimension of the chronic respiratory questionnaire Strength group showed significant improvements in both fatigue and emotion Endurance group showed significant improvements only in fatigue Combined group showed significant improvements only in emotion RESULTS ARTICLE 2- SMALL RCT LEVEL 2 EVIDENCE Endurance and Strength Training in Patients with COPD M. Jeffery Mador, MD, Erkan Bozkanat, MD, Ajay Aggarwal, MD, Mary Shaffer, NP and Thomas J. Kufel, MD, FCCP The purpose of this study was to compare the effects of endurance training (ET) only to combined endurance and strength training (CT) in an RCT of patients with COPD Effect of Training on Muscle Strength (Supports)-It was successful in increasing strength in all muscles that underwent training. Effect of Training on Exercise Performance (Supports)-Endurance exercise time increased significantly in both groups. 6MWT distance significantly increased in both groups after training (1,274 +/- 106 ft. to 1,360 +/- 106 ft. in endurance group) and (1,235 +/- 115 ft. to 1,345 +/- 124 ft. in the combined group. Effect of Training on Quality of Life (Supports)-Both groups had statistically and clinically significant improvement in the dyspnea and fatigue domains after training CONCLUSION AND SUMMARY As a DPT profession we must understand how to properly rehabilitate/exercise our patients diagnosed with COPD and prescribe a program specific to address their impairments and functional limitations. By combining strength and endurance training our patients with COPD should improve in strength, endurance and possibly quality of life. CLINICAL SIGNIFICANCE In conclusion the research identified the commonality among COPD patients as an intolerance to exercise and a poor quality of life due to muscular weakness and atrophy. Strength training, endurance training and a combination training group were examined in order to provide evidence for optimal treatment. Research for all three articles suggested the optimal treatment for patients with COPD involved a combination of strength and endurance training. ARTICLE 3- SMALL RCT LEVEL 2 EVIDENCE Exercise training is considered an essential component of pulmonary rehabilitation in patients with COPD. Whether the goal of training should be strength, endurance, or both is still under investigation. Common patient problems associated with COPD are intolerance to exercise, muscle weakness and atrophy, and a poor quality of life due involving dyspnea and fatigue. Effect of Three Exercise Programs on Patients with Chronic Obstructive Pulmonary Disease V.Z. Dourado, S.E. Tanni, L.C.O. Antunes, S.A.R. Paiva, A.O. Campana, A.C.M. Renno and I. Godoy The aim of this study was to compare three different physical exercise programs in patients with COPD: Strength training (ST), low-intensity general training (LGT) and combined training (CT). Effects of Training on Peripheral Muscle Strength (Supports)-ST and CT groups had a significant post training improvement in all 1RM values (Supports)-No significant 1 RM values were observed in LGT group Effects of Exercise Training on Functional Exercise Tolerance (Supports and Refutes)-Significant increase in 6MWT distance and in endurance time in the CT group and ST groups. Article 1 claims significant statistics for their shuttle walk test was only found in their strength group not a combined. (Supports)-Significant increase in treadmill endurance in LGT group Effect of Exercise Training on Health Related Quality of Life and Dyspnea (Refutes)-Significant improvement in BDI was only found in ST group, only a minor trend towards improvement in BDI in CT and LGT group. Article 1 claims significant effect of any training on dyspnea. 1. Ortega F, Toral J, Cejudo P, Villagomez R, Sanchez H, Castillo J, et al. Comparison of effects of strength and endurance training in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2002; 166: 669-674. http://ajrccm.atsjournals.org/cgi/content/full/166/5/669 2. MadorMJ, Bozkanat E, Aggarwal A, Shaffer M, Kufel TJ. Endurance and strength training in patients with COPD. Chest 2004; 125: 2036-2045. http://chestjournal.chestpubs.org/content/125/6/2036.short 3. DOURADO, V.Z. et al. Effect of three exercise programs on patients with chronic obstructive pulmonary disease. Braz J Med Biol Res [online]. 2009, vol.42, n.3 [cited  2011-10-20], pp. 263-271 http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-879X2009000300007&lng=en&nrm=iso&tlng=en Confirmed benefit of the 3 modalities of exercise training (strength, endurance, or combined) on dyspnea and quality of life in patients in COPD. Improvement of these parameters remained 3 months after the training intervention. Strength training was greater than endurance in improving muscle strength and endurance training was more efficient than strength in improving submaximal exercise tolerance. Combined training intervention produced improvements in peripheral muscle strength and endurance comparable to those obtained by each modality alone. The combined training produced superior benefit in each intervention and seems to be the optimal strategy for training patients with COPD. The aim of the study was to compare the efficacy of endurance, strength, and the combination of strength and endurance training in patients with COPD. REFERENCES DISCUSSION PURPOSE Francisco Ortega, Javier Toral, Pilar Cejudo, Rafael Villagomez, Hildegard Sánchez, José Castillo and Teodoro Montemayor Ortega F, Toral J, Cejudo P, Villagomez R, Sanchez H, Castillo J, et al. Comparison of effects of strength and endurance training in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2002; 166: 669-674 http://ajrccm.atsjournals.org/cgi/content/full/166/5/669 PRESENTED BY: NICK HANSEN BELLARMINE UNIVERSITY STUDENT OF DOCTOR OF PHYSICAL THERAPY PROGRAM Free Tobacco. http://www.freetobacco.info/cigarette-stories/expensive-habit-cigarette-robbery-to-cost-man-up-to-10-years/