Respuesta ventilatoria al ejercicio post-entrenamiento de miembros superiores en la enfermedad pulmonar obstructiva crónica / Ventilatory response to upper limb exercise after training in COPD

Está poco estudiada la modificación de la respuesta ventilatoria al ejercicio de miembros superiores (MS) post-entrenamiento en la EPOC. Se realizó un estudio prospectivo, aleatorio y controlado en pacientes con EPOC, entrenando un grupo los miembros inferiores (GC) y otro adicionalmente los MS (GM). Se comparó la respuesta ventilatoria al ejercicio de MS pre y post-entrenamiento. Se estudiaron 43 pacientes, 84% varones, estadio GOLD II (moderado) 6 (14%), GOLD III (grave) 15 (35%) y GOLD IV (muy grave) 22 (51%). Veintiocho pacientes completaron el estudio. Post-entrenamiento: se observó en el grupo GM (N = 14) incrementos del V T isotiempo (p < 0.0001) y del % de capacidad inspiratoria (CI) isotiempo (8.8%, p = 0.001), mayores Ti isotiempo (29.3%, p = 0.022) y Ti/Tot isotiempo (37.4%, p = 0.0004) al ejercicio de MS. Se redujo el Te isotiempo (26%, p = 0.009). La CI isotiempo se incrementó (p = 0.01). Post-entrenamiento: en el grupo GC (N = 14) se incrementó el V T/Ti isotiempo (66.86%, p = 0.0005), y disminuyeron el Ti isotiempo (27.9%, p = 0.015) y el Ti/Tot isotiempo (22.74%, p = 0.00016) al ejercicio de MS. Se observó correlación moderada entre la Δ de frecuencia respiratoria y la Δ de CI al ejercicio de MS, post-entrenamiento solo para el grupo GM (r = -0.53, p< 0.001). Comparando ambos grupos en la respuesta al ejercicio de MS, se observó en el grupo GM, reducción del Te isotiempo (p = 0.049) y del V T/Ti (p = 0.0015), mayores Ti isotiempo (p = 0.0019), Ti/tot isotiempo (p = 0.000076) y CI (% predictivo, p = 0.01). El entrenamiento de MS modificó la respuesta ventilatoria, y también redujo el atrapamiento aéreo que se generó por el ejercicio de MS en la EPOC.

There are scarce studies evaluating the modification of ventilatory response to upper limb exercise (ULE) post-training in COPD patients. A prospective, randomized, controlled study was performed comparing two groups: training lower limbs (LL), vs. LL plus upper limb training (UL), in relation to their pre and post-training ventilatory response to ULE. A total of 43 COPD patients were included; 84% male, 6 (14%) GOLD moderate stage (II), 15 (35%) severe stage (III), and 22 (51%) very severe (IV); 28 patients completed the study. After ULE, in UL group (N = 14) a training increased isotime VT (p < 0.0001) was observed, as well as an increase in the inspiratory capacity isotime percentage (IC, 8.8%, p = 0.001), in the Ti isotime (29.3%, p = 0.022) and in the Ti/Tot isotime (37.4%, p = 0.0004). Also, Te isotime was reduced (26%, p = 0.009) and IC isotime was increased (p = 0.01) after ULE. In LL group (N = 14), training increased VT/Ti isotime (66.86%, p = 0.0005) after ULE. Also, after ULE a decrease in Ti isotime (27.9%, p = 0.015) and in Ti/Tot isotime (22.74%, p = 0.00016) were observed. A moderate correlation was observed between Δ respiratory rate and ΔIC after ULE, only for post-training in UL group (r = -0.53 , p < 0.001). Comparing both groups in relation to their responses to ULE, only in the UL group was a reduction observed in Te isotime (p = 0.049) and VT/Ti (p = 0.0015), higher Ti isotime (p = 0.0019), Ti/tot isotime (p = 0.000076) and IC isotime (% predictive, p = 0.01). UL training modified ventilatory response to ULE and it also reduced air trapping in COPD patients.

The effects of lower limb training combined with hyperbaric oxygen on motor function in a paretic lower limb and on ability in the activities of daily living among hemiplegic stroke survivors / 中华物理医学与康复杂志

Objective To investigate the effects of lower limb training combined with hyperbaric oxygen on motor function in a paretic lower limb and on the ability in the activities of daily living (ADL) of hemiplegic stroke survivors. Methods A total of 297 hemiplegic stroke patients received routine interventions and then were randomly divided into 3 groups. The hyperbaric oxygen group accepted hyperbaric oxygen, the training group accepted lower limb training, and the treatment group accepted both hyperbaric oxygen and lower limb training. Evalnations were carried out pretreatment and 30 d post treatment to assess the function of the paretic lower limb and ADL ability with the Fugl-Meyer assessment ( FMA), a modified Barthel index (MBI) , Berg's balance scale (BBS) and the timed up and go test (TUGT). Results FMA, MBI, BBS and TUGT scores in all 3 groups improved significantly compared with pretreatment. On the 30th day post treatment, the scores in the treatment group were significantly better than in the other two groups. Conclusions Lower limb training combined with hyperbaric oxygen can significantly improve motor function in the paretic lower limbs of stroke patients and their ADL performance.