Efficacy of aerobic training and resistance training combined with external diaphragm pacing in patients with chronic obstructive pulmonary disease: A randomized controlled study

Objective: To evaluate the efficacy of aerobic training, resistance training combined with external diaphragm pacing in patients with chronic obstructive pulmonary disease. Design: Randomized controlled trial. Setting: The Fourth Rehabilitation Hospital of Shanghai, China. Participants: 82 (67.0 +/- 6.5 years, 59.8% male) patients with stable chronic obstructive pulmonary disease were randomized to intervention group 1 (n = 27), intervention group 2 (n = 28), and control group (n = 27). Intervention: Intervention group 1 received aerobic and resistance training, while intervention group 2 received additional external diaphragm pacing. Control group received aerobic training only. Main measures: 1-year follow-up of physical activity, body composition, respiratory function and diaphragm function. Results: Intervention groups 1 and 2 showed statistically improvements in the difference value compared with control group in terms of 6-min walk distance (-95.28 +/- 20.09 and -101.92 +/- 34.91 vs -63.58 +/- 23.38), forced expiratory volume in 1 s (-0.042 +/- 0.027 and -0.130 +/- 0.050 vs -0.005 +/- 0.068), fat-free mass (-2.11 +/- 3.74 and -3.82 +/- 3.74vs 0.28 +/- 1.49) and chronic obstructive pulmonary disease assessment test value (2.16 +/- 0.85 and 2.38 +/- 1.02 vs 1.50 +/- 0.93). Intervention group 2 showed significant difference in arterial oxygen pressure (-4.46 +/- 3.22 vs -1.92 +/- 3.45), diaphragm excursion during deep breaths (-0.82 +/- 0.74 vs -0.38 +/- 0.29), and diaphragm thickness fraction (-8.77 +/- 3.22 vs -4.88 +/- 2.69) compared with control group. Conclusion: The combination of aerobic training, resistance training, and external diaphragm pacing obtained significant improvements in physical activity, respiratory function, body composition, arterial oxygen pressure, and diaphragm function in patients with chronic obstructive pulmonary disease.