Effect Of Water-based Liuzijiue Exercise On Skeletal Muscle Dysfunction In Patients With COPD

Objective This randomized controlled trial aimed to determine the effectiveness of water-based liuzijue training on respiratory muscle and peripheral skeletal muscle dysfunction compared with land-based liuzijue training and control(no exercise)in patients with stable chronic obstructive pulmonary disease(COPD).Methods Patients who were referred to the outpatient of pulmonary rehabilitation,the room of lung function and the wards in the hospital at Yue-yang hospital of Shanghai University of Traditional Chinese Medicine during March 2015 to March 2016,would be included in the study if they had a confirmed diagnosis of COPD according to the Global Initiative for Chronic Obstructive Lung Disease(GOLD).The patients were randomly allocated to the water-based liuzijue group,land-based liuzijue group and control group,each group had 20 cases.The program consists of 6 forms of liuzijue according to the General Administration of Sport of China,including ?xu”,“he”,“hu”,“si”,“chui”,“xi”,which emphasized the elements of breathing,range of motion on limbs,and the mind-body coordination.The water-based and land-based liuzijue training groups attended a single 60-min exercise twice a week,led by the same physiotherapist for 12 weeks.In order to maintain the same exercise intensity,participants were encouraged to exercise at an intensity rating of four to six on the modified Borg scale for dyspnea and perceived exertion.The water-based liuzijue training group exercised in a swimming pool with water temperature of 32±2?.Water-based Liuzijue training participants who exercise in the standing position able to choose the most comfortable level of water immersion,which the level always between the xiphoid and the clavicle for each participant.And there is a respiratory clinician who was responsible to monitoring the physical condition of patients during exercise.Respiratory muscle strength,exercise capacity,upper and lower limbs isokinetic muscle strength were assessed before and after the exercise intervention.Results 1.respiratory muscle strength After 3months intervention,the MIP significantly improved in land-based liuzijue group from 4.01±1.48 to 4.43±1.28(p<0.01)and in water-based liuzijue group from 4.03±1.34 to 5.68±1.51(p<0.01).In which water-based exercise training increased MIP(p<0.01)was significantly higher than the land-based liuzijue groups and the control group.From baseline to 12 weeks,patients in the land-based liuzijue group had mean increase in MEP,from 4.98±1.22 to 6.60±1.75(p<0.01).Similar improvements were observed in water-based liuzijue group(from 4.84±1.88 to 6.61±2.27,p<0.05).And a significant difference between groups was found when each of the exercise groups was compared with the control group(p<0.05).2.exercise capacity The water-based liuzijue training group was the only group to achieve asignificant within-group change in 6MWD(from 395.57±63.93 to 486.10±78.52,p<0.01),and a significant difference between-group was found between the water-based liuzijue training group and the control group in 6MWD.3.upper and lower limbs isokinetic muscle strength From baseline to 12 weeks,both water-based liuzijue training group and land-based liuzijue training group were significantly improved peak power(PP)in elbow flexor(p<0.01),average power(AP)in elbow extensor and total work(TW)in elbow extensor(p<0.01),respectively.The patients in water-based training groups had a mean increase in average power(AP)in elbow flexor and total work(TW)in elbow flexor(p<0.01),and significantly improved compared with control group(p<0.05).Performance in knee extensor of peak torque(PT)and peak torque to body weight(PT/WT)also increased in both water-based liuzijue training group and land-based liuzijue training group(p<0.05),whereas PT was significantly decreased in the control group(p<0.05).The land-based liuzijue training group produced a significant positive effect on knee extensor of PP(p<0.05),knee extensor of AP(p<0.05)and knee extensor of TW(p<0.05).The water-based liuzijue training group also produced a significant positive effect on knee extensor of PP(p<0.01),knee extensor of AP(p<0.01)and knee extensor of TW(p<0.01).But the water-based liuzijue training group was the only group which achieved a significant within-group change in knee flexion of TW(p<0.01).Conclusion 1.Water-based liuzijue training was significantly more effective than land-based liuzijue training and control in increasing and improving respiratory muscle strength in patients with COPD.2.After 3months of water-based liuzijue exercises,patients with COPD have no obvious improvement in elbow extensor and flexor strength,but have a positive improvement in elbow extensor and flexor function.Both liuzijue exercise and water-based liuzijue exercise not only have a benefit to improve knee extensor strength,but also increase knee extensor function.And water-based liuzijue exercise are more effective in improving knee flexor function.3.This study has proved that the safety of aquatic environment for exercise in patients with COPD and indicates water-based liuzijue training is an effective method for COPD.So water-based liuzijue training could be applied in the hospital,community and rehabilitation agency.