Effetti dell'esercizio fisico combinato ad alta intensità nella terapia del soggetto con broncopneumopatia cronica ostruttiva (BPCO) e predisposto al declino cognitivo

INTRODUCTION Chronic obstructive pulmonary disease ( COPD) is a complex, heterogeneous and multifactorial syndrome, it is responsible of the lung function deteriorations, to which are added extra pulmonary comorbidities that have a significant effects on prognosis. One of the most important comorbidities is the cognitive decline, it affected 77% of the COPD subjects. In these patients, it was observed neuronal damage caused by the reduction of oxygen transport in the brain. The subject with obstructive respiratory disease is characterized by functional impairment due to respiratory symptoms, limiting movement: as shortness of breath and weakness and muscolar fatigue. They determine the exercise intolerance resulting in physical deconditioning with negative effects on quality of life. In the last decade it has become increasingly evident the importance and the effectiveness of physical exercise in the rehabilitation program for BPCO patients. Infact, the training was considered like a non-pharmacological interventions for this disease. The re-training is considered as the most effective intervention to determine and ensure a recovery and to allow the restoration of autonomy levels in patients with obstructive disease, even in severe cases. Different training, with different intensities of work have been tried , but as yet have not defined an optimal protocol for physical reconditioning and improvement of cognitive abilities of patients with COPD. . The purpose of this study was to observe the effects of two different protocols of physical retraining: the first one which combined aerobic and strength exercises (AC); The second one based only on aerobic exercises (AA).Our objective were to determine whether the combined training is more effective than the aerobic training on physical performance , cognitive decline and the quality of life in COPD patients at different stages of the disease. METHODS Total 14 COPD male subjects (68.35 ±9.64), hospitalized in a rehabilitation centre, were recruited for the research. The study was organized in three phases. PHASE 1: 7 COPD male subjects (65 ± 8.26), were recruited: Group 1. It conducted a experimental combined retraining ( aerobic + strength exercises) of high-intensity (AC) PHASE 2: 7 COPD male subjects (69 ±7.39) were recruited : Group 2. It conducted a aerobic retraining of high-intensity (AA). PHASE 3: comparison between the experimental and the aerobic retraining protocol. Both groups were subjected to physical reconditioning for 4 weeks, with a frequency of 5 training sessions per week. For Group 1 retraining experimental program provided two session (one aerobic and one strength) of 30 minutes per day; For Group 2 retraining physical program provided one session (only aerobic) of 30 minutes per day. Before, during (only motor test) and after the retraining protocol, all subjects of groups were evaluated with laboratory test, respiratory tests, physical exercise tests, neuropsychiatric test: mental deterioration battery (MDB) and with a specific questionnaire to assess the quality of life: S. George Questionnaire. RESULTS The results show how both protocols are effective for physical reconditioning and for the improvement of cognitive. In particular Group 1 show significant differences for test of strength of upper-limb and muscular endurance of the upper limbs, the cardio respiratory stair Climb tests, the degree of dyspnea at rest (MRC scale) and the level of SpO2 pulse. Also the percentage of improvement for most variables are greater for the retraining of the combined. For the mental function, both improves both verbal fluency long-term memory and attention, but in T-Test the Groups 1 had major benefits, because it improves also in non-verbal intelligence and constructional apraxia. DISCUSSION The results of the study suggest that both the experimental protocols combined type (AC ) and the aerobic (AA) are effective for physical reconditioning in COPD patients. This confirm the benefits of exercise in this peoples. In addition, it has been demonstrated the feasibility of using a high-intensity training in COPD subjects compared to those recommended by the guidelines for this disease. The Group 1 of AC reaches more significant benefits then Group 2 of AA, this is due to the force component that enhances the muscles, increasing resistance and tolerance to stress; in fact it has a significant improvement of the stair climb. Also important was the increasing values in blood gas analysis, due to the effect of aerobic exercise, which is already at moderate intensity, increased ateriovenous oxygen difference indicating improved metabolic adaptation to exercise of working muscle. Regarding cognitive abilities, improve in the two groups with regard to long-term memory, verbal fluency and attention, this is probably due to the blood flow increases to the brain, especially if exercise is conducted at high intensity. A larger amount of oxygen in the brain increase the size of the hippocampus, which already physiologically tends to decrease with age, this has a positive influence on neuro tropic factor ( BNDF ), which stimulates the proliferation and differentiation of neurons and plays a key role in long-term memory, results in an increase in brain plasticity. CONCLUSIONS The sample studied is still small but the results seem encouraging. The combined training conducted at high intensity (90% Fcmax ), and for the greater benefit of both physical and cognitive performance compared to aerobic exercise, could be a possible effective strategies to optimize them further and faster physical reconditioning and intervention for prevent / delay cognitive decline determined by COPD.