Comparison of two training programmes in chronic airway limitation patients: standardized versus individualized protocols

Abstract

This study tested the effect of two methods of training, one individualized at the heart rate corresponding to the gas exchange threshold (GET) and the other at the heart rate corresponding to 50% of maximal heart rate reserve, on maximal and submaximal cardiorespiratory response in 24 patients with chronic airway limitation (CAL).The patients were randomly assigned to either the individualized training group (IT; n=12) or the standardized training group (ST; n=12). The training programme consisted of 4 weeks of stationary bicycle exercise, 5 days·week -1 .Before reconditioning began, the target level based on heart rate was not significantly different between groups (109±4 versus 110±3 beats·min -1 , in IT and ST, respectively). Post-training, a significant increase in symptom-limited oxygen uptake (V 'O 2 ,sl) and maximal O 2 pulse was found in IT, whereas ST exhibited no significant change. In each group, GET was statistically increased in much the same way as V 'O 2 ,sl, with a higher increase in IT (p<0.01) than ST (p<0.05). Nevertheless, IT exhibited a concomitant and gradual decrease in minute ventilation (V 'E), carbon dioxide production (V 'CO 2 ), and venous lactate concentration ([La]), whereas ST presented no significant change in these parameters (intergroup p<0.01). Breathing pattern was also altered after IT, at the same metabolic level and at the same ventilation level (intergroup p<0.05). Cardiac responses were modified in the two groups. At the same metabolic level, a significantly lower cardiac frequency was found both for IT and ST (intragroup p<0.05 after training). In contrast, the increase in O 2 pulse was only significantly higher in IT after training.These data show the greater efficiency of an individualized training protocol based on determination of gas exchange threshold as compared to a standardized protocol, in improving exercise performance, when applied to a patient group. Despite an apparently similar target training level, the individualized method clearly optimized the physiological training effects in patients with chronic airway limitation and, more particularly, decreased their ventilatory requirement.

Changes in Balance after Rehabilitation Program in Patients with COPD and in Healthy Subjects

“…The rehabilitation program that we used was well tolerated by most patients. Its benefits on dyspnea, exercise tolerance and quality of life of COPD patients have been clearly shown [33]. No adverse effects were noted during the training program.…”

“…A significant effect of individualized training on dyspnea peak and the maximal heart rate in 6MWT was shown after rehabilitation program. This could be explained, firstly by improved physical conditions and by very good response to exercise, which supports a decreased sensation of dyspnea [33], Secondly, by some physiological changes, like better cardiac adaptation, decrease in lactic acid production and reduction in metabolic cost of exercise [60].…”

A Comparison of Twice- Versus Once-Weekly Supervision During Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease

“…6,7,[20][21][22] It remains unclear how much supervision is necessary for these benefits to be achieved. Although self-monitored exercise may lead to health benefits, the physiologic benefits exhibited with supervised high-intensity exercise or with individualized exercise protocols may be superior.…”

“…Although self-monitored exercise may lead to health benefits, the physiologic benefits exhibited with supervised high-intensity exercise or with individualized exercise protocols may be superior. 8,20,21 It has been hypothesized that greater long-term improvements in a home-based pulmonary rehabilitation program compared with a hospital outpatient program could be attributed to the promotion of greater patient adherence by exercising in a familiar environment; this would result in less reliance on supervision from health care professionals. 22 If a threshold exists from which there is no added NOTE.…”

Influência do tabagismo atual na aderência e nas respostas à reabilitação pulmonar em pacientes com DPOC

“…One of the common eligibility criteria for a PR program is the exclusion of current smokers 1,3 , based on the assumptions that such patients would be less adherent to PR 5,6 and that the potential gains would be lower than those observed in non-smokers because of the harmful effects of smoking on pulmonary function 7 and the skeletal muscle 8 . Additionally, it is known that smokers are less likely to initiate and maintain regular physical activity 9,10 .…”