Contrasting breathing retraining and helium-oxygen during pulmonary rehabilitation in COPD: a randomized clinical trial.
BACKGROUND
Breathing-retraining and helium-oxygen (heliox) have been used to improve exercise tolerance in COPD. We hypothesized that, in patients with COPD, exercise duration after exercise-training plus breathing-retraining and oxygen would be longer than after exercise-training plus heliox or after exercise-training plus oxygen alone. We also explored the short-term maintenance of gains in exercise duration after using each technique.


METHODS
Of 192 COPD patients recruited, 103 were randomly assigned to exercise-training plus heliox (n = 33), exercise-training plus breathing-retraining and oxygen (n = 35) and exercise-training and oxygen (n = 35). FiO2 was 0.30 during testing and training in all groups. Patients exercised on a treadmill thrice-weekly for eight weeks. Before, at completion of training, and six-weeks later, patients underwent constant-load treadmill testing.


RESULTS
At completion of training, improvements in exercise duration in the heliox and breathing-retraining groups were not significantly different. Compared to the exercise-training plus oxygen group, exercise duration improved more in the breathing-retraining group (P = 0.008) but not in the heliox group (P = 0.142). Hyperinflation was reduced with breathing-retraining plus oxygen compared to the other two groups. Six-weeks later, improvements in exercise duration were still greater with breathing-retraining than with exercise-training (P = 0.015). In contrast, improvements in exercise duration with heliox did not differ from those in the other two groups.


CONCLUSIONS
In moderate-to-severe COPD, exercise-training combined with either heliox or with breathing-retraining yielded not significantly different improvements in exercise duration - with only the latter being superior to exercise-training. Six-weeks after training, these improvements were still greater after exercise-training plus breathing-retraining than after exercise-training.


BACKGROUND
ClinicalTrials.gov; No.: NCT00123422.
Center for Management of Complex Chronic Care, Physical Performance Laboratory, Research & Development Service, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA; Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA. Electronic address: eileen.collins@va.gov.
Eileen G
EG
Collins
Center for Management of Complex Chronic Care, Physical Performance Laboratory, Research & Development Service, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA.
Christine
C
Jelinek
Center for Management of Complex Chronic Care, Physical Performance Laboratory, Research & Development Service, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA.
Susan
S
O'Connell
Center for Management of Complex Chronic Care, Physical Performance Laboratory, Research & Development Service, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA.
Jolene
J
Butler
Center for Management of Complex Chronic Care, Physical Performance Laboratory, Research & Development Service, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA.
Conor
C
McBurney
Center for Management of Complex Chronic Care, Physical Performance Laboratory, Research & Development Service, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA.
Christopher
C
Gozali
VA Cooperative Studies Program Coordinating Center, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA; School of Public Health, University of Illinois at Chicago, Chicago, IL, USA.
Domenic
D
Reda
Center for Management of Complex Chronic Care, Physical Performance Laboratory, Research & Development Service, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA; Loyola University, Stritch School of Medicine, Maywood, IL, USA.
Franco
F
Laghi
D000368:Aged; D003131:Combined Modality Therapy; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006371:Helium / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D010100:Oxygen / Q000008:administration & dosage*; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000534:rehabilitation*; D012138:Respiratory Therapy / Q000379:methods; D016896:Treatment Outcome; D014797:Vital Capacity / Q000502:physiology
D006371:Helium; C038949:heliox; D010100:Oxygen
COPD; Exercise; Rehabilitation