The Effect of Respiratory Training on Exercise Tolerance in COPD

Not Applicable

• Conditions: Pulmonary Disease, Chronic Obstructive
• Interventions: Other: Sham intervention; Other: Normocapnic hyperpnoea intervention

• Registration Number: NCT04201522
• Lead Sponsor: Laval University

Brief Summary

Exercise intolerance is one of the key disabling factors in patients with chronic obstructive pulmonary disease (COPD). Although multifactorial, exercise intolerance involves physiological interactions between respiratory and locomotor muscles that may contribute to further reducing exercise tolerance in COPD. The respiratory muscle work during exercise is closely related to breathing and could induce respiratory muscle fatigue in patients with COPD.

Respiratory muscle training is an intervention strategy that is sometimes proposed for some patients with COPD, especially whose with inspiratory muscle weakness. It was reported that inspiratory muscle training improves inspiratory muscle endurance and strength, dyspnea and exercise tolerance. There are two types of inspiratory muscle training, inspiratory muscle training against a resistive loading and normocapnic hyperpnoea. The advantage of normocapnic hyperpnoea compared to resistive training is the possibility to simulate the exercise ventilation level while maintaining stable the partial pressure of arterial carbon dioxide and end-tidal pressure of carbon dioxide and to solicit the inspiratory and expiratory muscles together, which could increase respiratory muscle tolerance and avoid their fatigue during whole-body exercise.

Therefore, the aim of this project is to study the effect of normocapnic hyperpnoea training on exercise tolerance in patients with COPD.

We hypothesize that greater improvement in cycling exercise tolerance will be observed following 6-weeks normocapnic hyperpnoea training compared to a sham intervention in patients with COPD.

Detailed Description

Not available

Study Timeline

• Study Start: 2017-03-14
• Study First Submitted: 2019-11-26
• Status Verified: 2019-12
• Study First Submitted QC: 2019-12-16
• Last Update Submitted: 2019-12-16
• Study First Posted: 2019-12-17
• Last Update Posted: 2019-12-17
• Primary Completion: 2020-12
• Study Completion: 2021-02

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 40

Inclusion Criteria

• Age ≥ 40 years;
• Chronic airflow obstruction : FEV1/FVC < 0.7, FEV1 of 30 to 80% predicted, after bronchodilation;

Exclusion Criteria

• Inability to perform a cycling exercise;
• Diagnosed of one of more comorbidities that may limit exercise tolerance : cardiovascular, metabolic, endocrine, gastrointestinal, renal, neurological or rheumatologically disease;
• Recent COPD exacerbation (< 3 months);
• Recent cancer;
• A daily dose of Prednisone > 10 mg;
• Hypoxemia at rest or during exercise: PaO2 < 60 mmHg or SpO2 ≤ 88%;
• Body mass index > 30 kg/m²;
• Pregnancy;
• Skinfold at intercostal or vastus lateralis muscle > 1.5 cm.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Sham intervention	Sham intervention	The effect of 6-weeks of respiratory training with normocapnic hyperpnoea on exercise tolerance in the training group compared to the sham group.
Training intervention	Normocapnic hyperpnoea intervention	The effect of 6-weeks of respiratory training with normocapnic hyperpnoea on exercise tolerance

Primary Outcome Measures

Name	Time	Method
Change in exercise tolerance (time [seconds])	Baseline (week 0), 7 weeks	Constant workrate cycling exercise time at 75% of power peak.

Secondary Outcome Measures

Name	Time	Method
Change in respiratory muscle strength (pressure [cm H2O])	Baseline (week 0), 7 weeks	Maximal inspiratory and expiratory pressures will be assessed with a portable manometer before and at end the constant workrate cycling exercise.
Change in cardiac output (flow [L/min])	Baseline (week 0), 7 weeks	Arterial blood pressures and cardiac output will be non-invasively measured by a finger photoplethysmography device during the constant workrate cycling exercise
Isometric muscle strength (force [Kg])	Baseline (week 0), 7 weeks	Maximum voluntary isometric contraction with twitch tension induced by supramaximal magnetic stimulation of the femoral nerve will be realized before and 15 minutes after the constant workrate cycling exercise.
Change in muscle oxygenation (from baseline [%])	Baseline (week 0), 7 weeks	Deoxyhemoglobin/myoglobin concentrations measured by near-infrared spectroscopy of intercostal and vastus lateralis muscle during the constant workrate cycling exercise
Minute ventilation responses (flow [L/min])	Baseline (week 0), 7 weeks	Minute ventilation during the constant workrate cycling exercise will be determined using a portable gas analysis system.

Trial Locations

Locations (1)

Institut universitaire de cardiologie et de pneumologie de Québec; 🇨🇦 Québec, Canada