Adjuvant strategies in exercise performance for patients with chronic obstructive pulmonary disease - COPD

Abstract: Chronic obstructive pulmonary disease (COPD) is a multicomponent disease which affects both the lungs and organs outside the lungs. Patients with moderate to severe COPD are restricted by dyspnoea, especially during physical activities. This results in the patient avoiding such activities only to further impair physical capacity and to exert a negative effect on quality of life. It is, therefore, of great importance to establish strategies that can optimise the effect of physical exercise and enhance physical activity among these patients. This thesis is based on four studies that investigate the effects of a physiotherapy programme on patients requiring long-term oxygen therapy (LTOT) as a result of COPD and chronic hypoxia. In addition, it explores the effects of creatine supplementation in combination with physical training and the effects of the oral intake of glucose on arterial oxygen tension, exercise endurance and oxygen consumption in patients with moderate to severe COPD. It also looks at the influence of spontaneous pursed lips breathing (PLB) on oxygen saturation and walking endurance. To evaluate the effects of a physiotherapy programme (n=20) and the combination of creatine supplementation with physical training (n=23) two different walking tests were used. Activity of daily living and health related quality of life were also assessed. To determine whether or not pursed lips breathing influences exercise endurance (n=32), an endurance shuttle walking test and transcutaneous oxygen saturation were conducted. The effect of oral glucose intake (n=13) was evaluated in respect of arterial blood gas analysis, oxygen uptake, carbon dioxide production, ventilation and endurance time on a bicycle ergometer. Patients with chronic obstructive pulmonary disease receiving long-term oxygen treatment may improve their walking distance, experience less dyspnoea and improve their ability to perform daily activities after a physiotherapy programme. Creatine supplementation in combination with physical training showed no significant improvement in physical performance, muscle strength, pulmonary function and health related quality of life in patients with severe to moderate COPD when compared with physical training alone. However, the creatine group showed significant increased walking time after the eight-week training programme. When spontaneous pursed lips breathing was used the patients walked longer, with a significant difference in oxygen saturation in favour of spontaneous PLB. The technique can be useful to increase walking endurance and reduce oxygen desaturation during walking in patients with moderate to severe COPD. Oral intake of glucose may increase the arterial oxygen tension in COPD patients with slight to moderate hypoxia at rest, paralleled with increased blood lactate. When an oral glucose solution is taken before a bicycle exercise test there appears to be no increase in endurance or improved oxygen saturation. On the contrary, glucose intake may be associated with reduced ventilatory reserves and higher ratings of dyspnoea. Key words: Chronic obstructive pulmonary disease, Long-term oxygen therapy, Physiotherapy, Creatine supplementation, Pursed lips breathing, Arterial oxygen tension, Glucose, Exercise endurance