Eccentric Cycle Exercise in Severe COPD: Feasibility of Application

Abstract

Eccentric cycling may present an interesting alternative to traditional exercise rehabilitation for patients with advanced COPD, because of the low ventilatory cost associated with lengthening muscle actions. However, due to muscle damage and soreness typically associated with eccentric exercise, there has been reluctance in using this modality in clinical populations. This study assessed the feasibility of applying an eccentric cycling protocol, based on progressive muscle overload, in six severe COPD patients with the aim of minimizing side effects and maximizing compliance. Over 5 weeks, eccentric cycling power was progressively increased in all patients from a minimal 10-Watt workload to a target intensity of 60% peak oxygen consumption (attained in a concentric modality). By 5 weeks, patients were able to cycle on average at a 7-fold higher power output relative to baseline, with heart rate being maintained at ∼85% of peak. All patients complied with the protocol and presented tolerable dyspnea and leg fatigue throughout the study; muscle soreness was minimal and did not compromise increases in power; creatine kinase remained within normal range or was slightly elevated; and most patients showed a breathing reserve > 15 L.min(-1). At the target intensity, ventilation and breathing frequency during eccentric cycling were similar to concentric cycling while power was approximately five times higher (p = 0.02). This study showed that an eccentric cycling protocol based on progressive increases in workload is feasible in severe COPD, with no side effects and high compliance, thus warranting further study into its efficacy as a training intervention.

Eccentric Ergometer Training Promotes Locomotor Muscle Strength but Not Mitochondrial Adaptation in Patients with Severe Chronic Obstructive Pulmonary Disease

“…Indeed, we have previously shown that the ventilatory requirements to eccentric cycling in patients with severe COPD were similar to conventional CET despite the former exercise being performed at an average 5-times higher mechanical power (Rocha Vieira et al, 2011). Although the feasibility of this modality for severe COPD patients has been established (Rooyackers et al, 2003; Rocha Vieira et al, 2011), the impact of EET on muscle strength and cellular adaptation has not been investigated. Furthermore, whereas previous reports in healthy elderly subjects and patients with coronary artery disease suggest that EET induces signaling pathways involved in promoting muscle hypertrophy but not oxidative capacity (Zoll et al, 2006; Mueller et al, 2011), these mitochondrial measures have not been examined in COPD patients to date.…”

“…The training protocol was set at three sessions per week of 30 min at a target intensity that was derived from our previous feasibility trial (Rocha Vieira et al, 2011): for the concentric group, the target cycling power was 60–80% peak workrate achieved during the baseline incremental cardiopulmonary exercise test; for the eccentric group, target intensity was equivalent to four times the power output corresponding to 60–80% peak workrate of the baseline incremental cardiopulmonary exercise test (in the concentric mode). According to our feasibility study, this estimation allowed for both the EET and CET groups to exercise at a similar relative HR intensity.…”

“…As such, EET is an appealing modality because it offers the possibility of overloading the muscle to levels necessary to induce adaptation without also overloading the respiratory system (Rooyackers et al, 1997; Rocha Vieira et al, 2011). Indeed, we have previously shown that the ventilatory requirements to eccentric cycling in patients with severe COPD were similar to conventional CET despite the former exercise being performed at an average 5-times higher mechanical power (Rocha Vieira et al, 2011). Although the feasibility of this modality for severe COPD patients has been established (Rooyackers et al, 2003; Rocha Vieira et al, 2011), the impact of EET on muscle strength and cellular adaptation has not been investigated.…”

Moderate Load Eccentric Exercise; A Distinct Novel Training Modality

“…He could demonstrate that eccentric exercise reduces ventilation by 35% at 50% of the maximal work capacity his patients were able to sustain. Rocha Vieira et al (2011) used 5 weeks of progressive moderate eccentric exercise training up to a workload representing 60% of the peak oxygen consumption reached concentrically. His progressive protocol allowed patients to work with minimal muscle soreness, dyspnea, and muscle fatigue.…”

Physiological Comparison of Concentric and Eccentric Arm Cycling in Males and Females

“…Consequently, lower limb eccentric training has been applied to populations for whom high-intensity training is contraindicated such as the elderly [11]–[13] and COPD patients [14]. Further, eccentric training generates extensive mechanical muscle tension [15] which is associated with activation of mitogen-activated protein kinases [16].…”