Social and economic disadvantage appears to have a significant consistent impact on COPD mortality and morbidity. These findings point to the need for public health strategies and research to address socioeconomic status disparity in individuals with COPD.

Rationale The SenseWear armband (SAB) is designed to measure energy expenditure (EE). In people with chronic obstructive pulmonary disease (COPD), EE estimated using the SAB (EE SAB ) is a popular outcome measure. However, a detailed analysis of the measurement properties of the SAB in COPD is lacking. Objective To examine the sensitivity of EE SAB , agreement between EE SAB and EE measured via indirect calorimetry (EE IC ), and its repeatability in COPD. Methods 26 people with COPD (forced expiratory volume in 1 s (FEV 1 )¼49618% predicted; 15 males) spent 6 min in five standardised tasks that comprised supine, sitting, standing and two walking speeds. A subgroup (n¼12) walked using a rollator. Throughout each task, measurements of EE SAB and EE IC were collected. The protocol was repeated on a second day. Results EE SAB increased between standing and slow walking (2.4, metabolic equivalents (METs) 95% CI 2.2 to 2.7) as well as slow and fast walking (0.5 METs, 95% CI 0.3 to 0.7). Considering all tasks together, the difference between EE SAB and EE IC was À0.2 METs (p¼0.21) with a limit of agreement of 1.3 METs. The difference between days in EE SAB was 0.0 METs with a coefficient of repeatability of 0.4 METs. Rollator use increased the variability in EE SAB , compromising its repeatability and agreement with EE IC . Conclusions EE SAB was sensitive to small but important changes. There was fair agreement between EE SAB and EE IC , and measurements of EE SAB were repeatable. These observations suggest that the SAB is useful for the evaluation of EE in patients with COPD who walk without a rollator.

BackgroundIn patients with chronic obstructive pulmonary disease (COPD), interval exercise has gained recent attention as a possible means of achieving greater physiological training effects compared with continuous exercise. The primary aim of this systematic review was to compare the effects of interval versus continuous training on peak oxygen uptake, peak power, 6 minute walk test (6MWT) distance and health-related quality of life in individuals with COPD. Methods Randomised controlled trials comparing the effects of interval versus continuous training in patients with COPD were identified after searches of six databases and reference lists of appropriate studies in May 2009. Two reviewers independently assessed study quality. Weighted mean differences (WMD) with 95% CIs were calculated using a random effects model for measures of exercise capacity and health-related quality of life. Results: Eight randomised controlled trials, with a total of 388 patients with COPD, met the inclusion criteria. No significant differences were found for peak power (WMD 1 W, 95% CI À1 to 3) or peak oxygen uptake (WMD À0.04 l/min, 95% CI À0.13 to 0.05) between interval and continuous training. The WMD for the Chronic Respiratory Questionnaire dyspnoea score was À0.2 units (95% CI À0.5 to 0.0). There was no difference in 6MWT distance between groups (WMD 4 m, 95% CI À15 to 23). Conclusions Interval and continuous training modalities did not differ in their effect on measures of exercise capacity or health-related quality of life. Interval training may be considered as an alternative to continuous training in patients with varying degrees of COPD severity.

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Summary at a glance:In patients with moderate COPD, the six-minute walk test, incremental shuttle walk test and endurance shuttle walk test elicited a similar peak rate of oxygen uptake and heart rate response as a ramp cycle ergometry test, demonstrating that both self-and externally-paced field tests progress to high intensities. 4 ABSTRACTBackground and objective: Field and laboratory-based tests are used to measure exercise

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