Endurance training in patients with chronic obstructive pulmonary disease: A comparison of high versus moderate intensity

M, Gimenez; Servera, Emilio; Vergara, Pedro; Bach, John R.; Polu, J. M.

doi:10.1053/apmr.2000.0810102

Cited by 20 publications

(22 citation statements)

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“…International guidelines present evidence of physiological benefits associated with higher aerobic training intensities, 41 in accordance with historical studies by Casaburi et al, 42 Maltais et al, 43 Puente-Maestu et al, 44 and Gimenez et al, 45 but also more recently by Lacasse et al, 32 Laviolette et al, 28 Bernard et al, 34 Montes de Oca et al, 36 Dourado et al, 37 Arnardóttir et al, 38 Foglio et al, 39 Normandin et al, 40 and Hsieh et al 46 Those studies reported improvements in the 6MWT, incremental exercise test, and constant-load exercise test with a pulmonary rehabilitation program but without any evidence of significant differences in these outcomes as an effect of the aerobic training intensities applied. On the other hand, more research is needed focusing on patients' goals.…”

Section: Effect Of Aerobic Training Intensity On Exercise Tolerancesupporting

confidence: 66%

Pulmonary Rehabilitation in COPD: Effect of 2 Aerobic Exercise Intensities on Subject-Centered Outcomes—A Randomized Controlled Trial

et al. 2015

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BACKGROUND: Exercise training is an important component of pulmonary rehabilitation, but it remains questionable how training intensity affects patient-centered outcomes. The aim of this study was to compare the effects of 2 aerobic training intensities on health-related quality of life (HRQOL), symptom control, and exercise tolerance in subjects with COPD. METHODS: Thirtyfour subjects with mild to very severe COPD participated in an equivalence/non-inferiority randomized controlled trial with a parallel group blinded to 60 or 80% maximum work rate (W max ) aerobic training intensity. The intervention was an out-patient pulmonary rehabilitation program conducted 3 times/week for 8 weeks. Outcomes were assessed with the St George Respiratory Questionnaire (primary outcome), Mahler's dyspnea index, London Chest Activity of Daily Living scale, 6-min walk test, and constant-load and incremental exercise tests. RESULTS: Subjects were randomly allocated to aerobic training intensity of 60% W max (group 1, n ‫؍‬ 17) or 80% W max (group 2, n ‫؍‬ 17). Although there were significant improvements in all outcomes for both groups, there were no between-group differences in mean change in the St George Respiratory Questionnaire (P ‫؍‬ .31, 95% CI ؊12.0 to 3.9), Mahler's dyspnea index (P ‫؍‬ .38), London Chest Activity of Daily Living scale (P ‫؍‬ .92), 6-min walk test (P ‫؍‬ .50, 95% CI 6.2-71.1), constant-load exercise test (P ‫؍‬ .50), and incremental exercise test (P ‫؍‬ .12). There was only one exercise-related adverse event of cardiac symptoms. CONCLUSIONS: Aerobic training intensity of at least 60% W max has a positive impact on COPD patient-centered outcomes, with no additional benefit of increasing intensity to 80% W max in HRQOL, symptom control, and exercise tolerance, challenging the present clinical attitude of rehabilitation professionals. (ClinicalTrials.gov registration NCT01944072.)

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Section: Effect Of Aerobic Training Intensity On Exercise Tolerancesupporting

confidence: 66%

Pulmonary Rehabilitation in COPD: Effect of 2 Aerobic Exercise Intensities on Subject-Centered Outcomes—A Randomized Controlled Trial

et al. 2015

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“…Maltais et al also demonstrated physiologic gains in aerobic fitness following 12 weeks of exercise training (30 min/day, 3 days/ week) at a work rate corresponding to 80 percent of the VO 2 max in persons with severe COPD (FEV 1 36 ± 11% predicted) [44]. Similar improvements in physiologic parameters of aerobic fitness following high-but not lowintensity endurance training have been confirmed in several additional studies [139][140][141][142].…”

Section: Outcomes Of High-intensity Endurance Trainingmentioning

confidence: 75%

Exercise training in chronic obstructive pulmonary disease

Rochester¹

2003

JRRD

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Abstract-Exercise and activity limitation are characteristic features of chronic obstructive pulmonary disease (COPD). Exercise intolerance may result from ventilatory limitation, cardiovascular impairment, and/or skeletal muscle dysfunction. Exercise training, a core component of pulmonary rehabilitation, improves the exercise capacity (endurance and, to a lesser degree, maximal work capacity) of patients with COPD in spite of the irreversible abnormalities in lung function. Dyspnea and health-related quality of life also improve following pulmonary rehabilitation. The clinical benefits of exercise rehabilitation last up to 2 years following 8 to 12 weeks of training. Existing evidence-based guidelines recommend that exercise training/pulmonary rehabilitation be included routinely in the management of patients with moderate to severe COPD. Exercise training/ pulmonary rehabilitation may be undertaken in an inpatient, outpatient, or home-based setting, depending on the individual needs of the patient and available resources. The type and intensity of training and muscle groups trained determine the expected outcomes of exercise training. Both high-and lowintensity exercise lead to increased exercise endurance, but only high-intensity training also leads to physiologic gains in aerobic fitness. The rationale for and outcomes of lower-and upper-limb training, as well as ventilatory muscle training, are reviewed, and the potential for anabolic hormone supplementation to optimize the benefits of exercise training is discussed.

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“…In patients with COPD, interval training has been shown capable of inducing physiological training effects [14,[94][95][96][97][98][99][100]. The most common interval training protocol studied in these patients is moderate to high intensity exercise alternated with low-intensity exercise [96,[98][99][100][101][102].…”

Section: Interval Trainingmentioning

confidence: 99%

New strategies to improve exercise tolerance in chronic obstructive pulmonary disease

Ambrosino¹,

Strambi²

2004

Eur Respir J

137

106

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Breathlessness is the most common symptom limiting exercise in patients with chronic obstructive pulmonary disease (COPD). Exercise training can improve both exercise tolerance and health status in these patients, intensity being of key importance. Nevertheless, in these patients extreme breathlessness and/or peripheral muscle fatigue may prevent patients from higher levels of intensity. In this review article the literature concerning the different ways to optimise exercise tolerance in patients with COPD, with the objective of enhancing the tolerance to higher exercise training intensity, is summarised.Continuous positive airway pressure and different modalities of noninvasive positive pressure ventilation (NPPV) may reduce breathlessness and increase exercise tolerance in these patients. Respiratory muscle unloading and reduction in intrinsic positive end-expiratory pressure have been considered among mechanisms underlying these effects. Nevertheless, the role of NPPV in pulmonary rehabilitation, if any, is still controversial. The addition of nocturnal domiciliary NPPV during a daily exercise programme in patients with severe COPD resulted in an improvement in exercise tolerance and quality of life.In patients with severe COPD application of electrical stimulation combined with active limb mobilisation significantly improved muscle strength, and interval training has been shown capable of inducing physiological training effects.Oxygen supplementation in patients who do not desaturate during exercise seems to be the most promising treatment, since it allows for higher exercise intensities and, therefore, superior training efficacy.In conclusion, further studies are needed to define the appropriate patients in order to generalise such interventions. The modalities discussed should be used as adjuncts to a well designed comprehensive respiratory rehabilitation programme.

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Endurance training in patients with chronic obstructive pulmonary disease: A comparison of high versus moderate intensity

Cited by 20 publications

References 0 publications

Pulmonary Rehabilitation in COPD: Effect of 2 Aerobic Exercise Intensities on Subject-Centered Outcomes—A Randomized Controlled Trial

Pulmonary Rehabilitation in COPD: Effect of 2 Aerobic Exercise Intensities on Subject-Centered Outcomes—A Randomized Controlled Trial

Exercise training in chronic obstructive pulmonary disease

New strategies to improve exercise tolerance in chronic obstructive pulmonary disease

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