The impact of exercise reconditioning on breathlessness in severe chronic airflow limitation.

764

581

The aim of this study was to test the hypothesis that use of tiotropium, a new long-acting anticholinergic bronchodilator, would be associated with sustained reduction in lung hyperinflation and, thereby, would improve exertional dyspnoea and exercise performance in patients with chronic obstructive pulmonary disease.A randomised, double-blind, placebo-controlled, parallel-group study was conducted in 187 patients (forced expiratory volume in one second 44 ¡ 13% pred): 96 patients received 18 mg tiotropium and 91 patients received placebo once daily for 42 days. Spirometry, plethysmographic lung volumes, cycle exercise endurance and exertional dyspnoea intensity at 75% of each patient9s maximal work capacity were compared.On day 42, the use of tiotropium was associated with the following effects at pre-dose and post-dose measurements as compared to placebo: vital capacity and inspiratory capacity (IC) increased, with inverse decreases in residual volume and functional residual capacity. Tiotropium increased post-dose exercise endurance time by 105¡40 s (21%) as compared to placebo on day 42. At a standardised time near end-exercise (isotime), IC, tidal volume and minute ventilation all increased, whilst dyspnoea decreased by 0.9¡0.3 Borg scale units.In conclusion, the use of tiotropium was associated with sustained reductions of lung hyperinflation at rest and during exercise. Resultant increases in inspiratory capacity permitted greater expansion of tidal volume and contributed to improvements in both exertional dyspnoea and exercise endurance.

Section: Clinical Significance Of Laboratory Exercise Testing Resultsmentioning

confidence: 52%

Effects of tiotropium on lung hyperinflation, dyspnoea and exercise tolerance in COPD

O’Donnell¹,

Flüge²,

Gerken³

et al. 2004

764

581

“…2). It is likely that the reduction in ventilatory requirement is multifactorial and relates to improved oxidative capacity [4,25], altered breathing pattern [6] and/or improved work efficiency [26]. The significant training-induced increase in LT is probably indicative of improved efficiency of peripheral muscle oxygen extraction [4,27].…”

Section: Discussionmentioning

confidence: 99%

“…2). The reduction in fR by 16 and 15% in the IT and CT groups, respectively, would be expected to reduce thoracic gas entrapment and the rate of expiratory muscle recruitment and result in decreased work of breathing and exertional breathlessness [26]. It is also likely that the reduction in ventilatory requirement following IT is associated with a reduced metabolic requirement and recruitment of active muscle mass [20] and hence an improvement in mechanical efficiency, shown by the reduction in the slope of V9O 2 /WR ( fig.…”

Section: Discussionmentioning

confidence: 99%

Interval training as an alternative modality to continuous exercise in patients with COPD

Vogiatzis¹,

Nanas²,

Roussos³

2002

217

196

Understanding of what constitutes a training load adequate to induce training effects in patients with chronic obstructive pulmonary disease (COPD) is still evolving. The present study investigated whether interval training (IT) is effective in terms of inducing measurable improvements in physiological response and compared its effects on exercise tolerance (ET) and quality of life to those of continuous training (CT).Thirty-six COPD patients, with a forced expiratory volume in one second of 45±4% of the predicted value (mean±sem), were randomly assigned to CT (exercise at 50% of baseline peak work-rate) or IT (work for 30 s at 100% of peak work-rate alternating with 30‐s rest intervals) groups that cycled 40 min·day−1and 2 days·week−1for 12 weeks.After training, both groups showed significantly improved ET (IT, 57±6 to 71±8 W; CT, 57±5 to 70±6 W) and total quality-of-life score of the Chronic Respiratory Disease Questionnaire (IT, 77±3 to 88±2; CT, 78±3 to 93±2). At identical levels of exercise, minute ventilation was significantly reduced (IT, 35.8±2.5 to 31.7±2.5 L·min−1; CT, 36.4±2.7 to 32.5±2.7 L·min−1). The magnitude of improvement in these variables was not significantly different among groups.The present data expand on the principles of exercise prescription for chronic obstructive pulmonary disease patients by demonstrating that interval training elicits substantial training effects, which are similar in magnitude to those produced by continuous training at half the exercise intensity but double the exercise time.

“…the improvement in V9O 2 ,peak after rehabilitation in COPD), particularly in patients with the most advanced disease. In some controlled studies, V9O 2 ,peak increased significantly [255][256][257][258], while other studies failed to observe a significant amelioration [259,260]. hL has also been used as an outcome variable, particularly in CHF patients.…”

Section: Symptom-limited Incremental Testmentioning

confidence: 99%

Recommendations on the use of exercise testing in clinical practice

Palange¹,

Ward²,

Carlsen³

et al. 2006

562

390

Evidence-based recommendations on the clinical use of cardiopulmonary exercise testing (CPET) in lung and heart disease are presented, with reference to the assessment of exercise intolerance, prognostic assessment and the evaluation of therapeutic interventions (e.g. drugs, supplemental oxygen, exercise training). A commonly used grading system for recommendations in evidence-based guidelines was applied, with the grade of recommendation ranging from A, the highest, to D, the lowest.For symptom-limited incremental exercise, CPET indices, such as peak O 2 uptake (V9O 2 ), V9O 2 at lactate threshold, the slope of the ventilation-CO 2 output relationship and the presence of arterial O 2 desaturation, have all been shown to have power in prognostic evaluation. In addition, for assessment of interventions, the tolerable duration of symptom-limited high-intensity constant-load exercise often provides greater sensitivity to discriminate change than the classical incremental test. Field-testing paradigms (e.g. timed and shuttle walking tests) also prove valuable.In turn, these considerations allow the resolution of practical questions that often confront the clinician, such as: 1) ''When should an evaluation of exercise intolerance be sought?''; 2) ''Which particular form of test should be asked for?''; and 3) ''What cluster of variables should be selected when evaluating prognosis for a particular disease or the effect of a particular intervention?''