Reducing Dynamic Hyperinflation Through Breathing Retraining
Reducing Dynamic Hyperinflation Through Breathing Retraining
This study will compare the effects of exercise training and breathing retraining (using
 metronome tones) to exercise training only. Exercise training lasts 12 weeks.
Dynamic hyperinflation limits exercise tolerance in chronic obstructive pulmonary disease
 (COPD). To limit dynamic hyperinflation during exercise and thus improve exercise tolerance,
 we successfully developed a visual-auditory ventilation-feedback system. The system retrains
 patient's breathing pattern during exercise. The goal of the current proposal was to develop
 a user-friendly ventilation-feedback technique with a novel auditory feedback system. We
 reasoned that the proposed feedback system plus exercise training would be superior to
 exercise training alone while having the potential for an easier application into clinical
 practice. Hypotheses: The primary hypothesis is that the exercise duration of patients with
 moderate-to-severe COPD who successfully complete a 12-week program of breathing retraining
 plus exercise will be longer than that of patients who complete a 12-week program of
 treadmill exercise training alone. We also hypothesized that the primary predictor of
 improved exercise duration will be a reduction in dynamic hyperinflation and to a lesser
 extent, improvement in peripheral muscle function. Lastly, we hypothesize that dyspnea will
 be reduced in patients assigned to breathing retraining plus exercise when compared to
 exercise training alone. Methods: The proposed study was a randomized controlled clinical
 trial. 119 patients with moderate-to-severe COPD were randomized into breathing retraining
 plus exercise or exercise training alone. Both groups received 12-weeks of treadmill exercise
 training three times weekly. The breathing retraining plus exercise group also received
 auditory feedback to decrease respiratory rate and prolong exhalation. The goal of breathing
 retraining was to reduce exercise-induced dynamic hyperinflation. Follow-up testing was
 completed at 6, 12, and 24 weeks. Testing included a pulmonary function test, symptom-limited
 and constant workrate treadmill tests, six-minute walk, dyspnea measurements, testing of
 respiratory muscle strength and endurance, and quadriceps muscle endurance testing. Analysis:
 Measures of central tendency will be used to describe the study sample. A two-sample t-test (
 = 0.05) was used to analyze changes from baseline to 12-weeks between the breathing
 retraining plus exercise group and exercise training alone group. In data analysis,
 intention-to-treat principles were used. Since several measures will be taken on each
 patient, mixed-models analysis will be used to compare changes over time between the two
 groups. Multiple regression analysis will be employed to determine the predictors of improved
 exercise performance.
Inclusion Criteria:

 -  40 yr of age

 -  FEV1 70%

 -  FEV1/FVC < 70%

 -  RV/TLC 120%

 -  mean SpO2 90% at peak exercise (w/ or w/o O2)

 -  Able to hear metronome sounds Lives near Hines, IL (Chicagoland area)

 Exclusion Criteria:

 -  Respiratory infection/exacerbation within the previous four weeks

 -  Exercise limiting heart disease (+ stress test or other indicators of heart disease or
 complaints of angina during the stress test)

 -  Primary asthma

 -  Congestive heart failure (New York Heart Association Class III or IV)

 -  Exercise-limiting peripheral arterial disease (stops exercise due to intermittent
 claudication)

 -  Stops exercise due to arthritic pain in the knee or hips (self-report)

 -  Inability to walk on the treadmill

 -  Pregnancy

 -  Any unforeseen illness or disability that would preclude exercise testing or training

 -  Participation in a formal exercise program within the previous 12 weeks