comparing the effects of nmes and endurance training in patients with severe copd patients
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
COMPARING THE EFFECTS of NMES and COMPARING THE EFFECTS of NMES and ENDURANCE TRAINING IN PATIENTS WITH ENDURANCE TRAINING IN PATIENTS WITH
SEVERE COPD PATIENTSSEVERE COPD PATIENTS
Pınar ERGÜN MD, Dicle KAYMAZ MD, Ebru ÇANAK , Neşe DEMİRCİ
Atatürk Chest Disease and Chest Surgery Center
PULMONARY REHABLİTATION and ULMONARY REHABLİTATION and HOME CARE UNITHOME CARE UNIT
Exercise training in COPDExercise 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.
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
Chest 2006;129;1540-48
Respiratory Medicine 2007;101:1236-43
AIM;AIM;
To compaire the level of improvement of NMES and endurance training in patients with severe COPD
exercise capacity muscle strengthdyspnea health related quality of lifephsycohological statusbody composition
METOD; METOD;
Patients: 50 COPD
GOLD Stage IV PR Programme:Multidisciplinary, outpatient
Exercise training: NMES and Endurance
METOD;METOD;
DYSPNEA : MRC, BORG scale CRDQ dyspnea domaineExercise capacity: SWT ESWT
Peripheral muscle strength: Manuel muscle test
HRQOL: SGRQ
Phsycohological status: HAD skalası
Body composition : BMI, FFM,FFMI
STUDY DESIGN
DEĞERLENDİRME
50 olgu
EVALUTİON
50 patient
RANDOMISATION
NMES
25 patient, 20 session
Endurance
25 patient, 10 week
OUTCOME EVALUATION
n= 23
OUTCOME EVALUATİON
n= 25
Drop outs
2 patient
NMES Protocol;NMES Protocol;NMES SESSION;Bilateral,Quadriceps; 9X5cm,Deltoid; 5X5cm surfaca electrodesDuration: 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.
ENDURANCE TRAINING;ENDURANCE TRAINING;
•2 days in week , survised, 10 week
•15 min cycling ; 15 min cycling ;
%50 Peak W
•15 min treadmill; 15 min treadmill;
%85 Peak VO2
Parameters NMES
(n=25)
ENDURANCES
(n=25)
Year 63,25 ± 10,10 62,81± 7,18
Smoking 42,26 ± 30,83 44,98 ± 24,24
FVC % predicted 45,13 ± 12,99 49,40 ± 13,20
FEV1 % predicted 25,92 ± 7,26 27,33 ± 8,20
FEV1/FVC 51,08 ± 14,20 39,85 ± 6,84
MRC 4,30 ± 0,87 3,81 ± 0,83
CRDQ- Dyspnea 9,78 ± 2,90* 11,88 ± 3,82*
Eercise BORG 3,60 ±1,26 3,40 ± 0,88
BMI (kg/m2) 21,85 ± 5,83 22,40 ± 4,23
FFM (kg) 44,43 ±6,23** 49,47 ± 6,27* *
FFMI(kg/m2) 16,97 ± 1,90** 17,93 ± 1,94**
ISWT(m) 90,65 ± 87,72 158 ± 88,33
ESWT (min) 3,02 ± 5,51 4,53 ± 5,22
SGRQ-Total 69,40 ±16,23 60,00 ± 18,67
SGRQ-Symptom 68,99 ± 14,85 64,86 ± 17,77
SGRQ-Activity 87,47 ± 15,93 78,01±20,42
SGRQ-impact 58,93 ± 20,77 47,83 ± 23,03
HAD-Depression 10,08 ± 2,50 8,77 ± 2,51
HAD- Anxiety 9,39 ± 3,38 8,66 ± 3,17
Deltoid right /left 3,86 ± 0,75 / 3,82 ± 0,77 4,44 ± 0,75 / 4,44 ± 0,75
Quadriceps right / left 4,04 ± 0,82 / 4,04 ± 0,82 4,33 ± 0,6 / 4,33 ± 0,6
Tabel-1: Demographic characteristics
*p<0.05
**p<0.001
0
100
200
300
400
500
600
700
Başlangıç Son Başlangıç Son
nmes endurans
Exercise capacity: SWT
p<0.001p<0.001
Increases in exercise capacity for NMES and Endurance groups is simillar , there were not any statisticaly meaningfull differance in the gainings.
0
5
10
15
20
25
Başlangıç Son Başlangıç Son
nmes endurans
ENDURANCE CAPACITY; ENDURANS SHUTTLE WALK TESTENDURANCE 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.
5
0
1
2
3
4
DeltoidRight Left
QuadricepsRight Left
NMES
Right Left Right Left Deltoid Quadriceps ENDURANCE
Before
After
PERIPHERAL MUSCLE SRENGTH; Manuel Muscle Test
P<0,01P>0,05
P<0,01 P P<0,05 P<0,01
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).
0
5
10
15
20
25
b s b s b s b s b s b s b s b s
nmes endurans nmes endurans nmes endurans nmes endurans
Mrc Borg iş Borg egzersiz KSHA dispne
DYSPNEA SENSATIONDYSPNEA SENSATION
MRC ist
p<0,001p<0,05
p<0,001
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.
p>0,05
p>0,05
0102030405060708090
100n
mes
end
ura
ns
nm
es
end
ura
ns
nm
es
end
ura
ns
nm
es
end
ura
ns
toplam semptom aktivite impact
Başlangıç Son
HRQOL; SGRQHRQOL; SGRQ
etkilenim
p>0.05
p<0.001 p<0.001
p<0.001
p<0.001
Increases in HRQOL for NMES and Endurance groups except the symptom domain is simillar , there were not any statisticaly meaningfull differance in the gainings.
0
2
4
6
8
10
12
Başlangıç Son Başlangıç Son
nmes endurans
HAD anksiyete HAD depresyon
PHSYCOLOGIC STATUS; Anxiety/Depression; 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.
21,2
21,4
21,6
21,8
22
22,2
22,4
22,6
22,8
23
Başlangıç Son
nmes
endurans
BMI
40
42
44
46
48
50
52
54
56
Başlangıç Son
nmes
endurans
FFM
14
16
18
20
Başlangıç Son
nmes
endurans
FFMI
BODY COMPOSITIONBODY COMPOSITION
BKİ Kg/m² YVK Kg YVKİ Kg/m²
There were not statitistically meaninfull changes in the body composition for the two groups.
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
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.