Exercise training in COPD patients: the basic questions

Abstract

Pulmonary rehabilitation programmes aim at improving exercise capacity, activities of daily living, quality of life and perhaps survival in patients with chronic obstructive pulmonary disease (COPD). Recently, well-designed studies investigated and confirmed the efficacy of comprehensive pulmonary rehabilitation programmes, including exercise training, breathing exercises, optimal medical treatment, psychosocial support and health education. In the present overview, the contribution of exercise training in clinical practice to the demonstrated effects of pulmonary rehabilitation is discussed by means of six basic questions. These include: 1) the significance of exercise training; 2) the optimal intensity for exercise training; 3) prescribing training modalities; 4) the effects of exercise training combined with medication, nutrition or oxygen; 5) how training effects should be maintained; and 6) where the rehabilitation programme should be performed: in-patient, out-patient or homecare? First, exercise training has been proven to be an essential component of pulmonary rehabilitation. Training intensity is of key importance. High-intensity training (>70% maximal workload) is feasible even in patients with more advanced COPD. In addition, the effects on peripheral muscle function and ventilatory adaptations are superior to low-intensity training. There is, however, no consensus on the optimal training modalities. Both walking and cycling improved exercise performance. Since peripheral muscle function has been recognized as an important contributor to exercise performance, specific peripheral muscle training recently gained interest. Improved submaximal exercise performance and increased quality of life were found after muscle training. The optimal training regimen (strength or endurance) and the muscle groups to be trained, remain to be determined. Training of respiratory muscles is recommended in patients with ventilatory limitation during exercise. The additional effects of anabolic-androgenic drugs, oxygen and nutrition are not well-established in COPD patients and need further research. In order to maintain training effects, close attention of the rehabilitation team is required. The continuous training frequency necessary to maintain training effects remains to be defined. At this point in time, out-patient-based programmes show the best results and guarantee the best supervision and a multidisciplinary approach. Future research should focus on the role of homecare programmes to maintain improvements.

Limiting Factors of Exercise Performance 1 Year After Lung Transplantation

“…The usefulness of resistance training, as a supplement to conventional aerobic exercise, has been clearly shown in patients with COPD and CF. [27][28][29][30] It is difficult to determine whether the training stimulus used in previous studies was adequate for providing an improvement in exercise capacity and LT. Therefore, the optimal training strategies for lung transplant recipients remain to be determined in further research.…”

Effective Home-Based Pulmonary Rehabilitation in Patients with Restrictive Lung Diseases

“…Low-intensity exercise or muscle training in COPD patients resulted in modest improvements during a submaximal exercise test, while high-intensity training resulted in improvements during both maximal and submaximal exercise tests (Gosselink et al 1997). However, activities of daily life require submaximal effort more so than they require maximal effort.…”

“…Home-based PR is advantageous in that it requires minimal equipment, is less costly, and gives patients more time to spend with their families (Hernández et al 2000), although it tends to be of a lower training intensity as a result of the limited supervision (Gosselink et al 1997). Low-intensity exercise or muscle training in COPD patients resulted in modest improvements during a submaximal exercise test, while high-intensity training resulted in improvements during both maximal and submaximal exercise tests (Gosselink et al 1997).…”

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

“…7,15,16 Current investigation has not yet identified the critical exercise intensity, 17 but it is established that physiological benefits are achieved with a minimum of 60% W max and that the higher the intensities, the greater the physiological benefits. 10,13,18 Furthermore, it has not been proven conclusively that these physiological benefits would lead to greater improvements in patientcentered outcomes. 7,15,16 Current patient-centered outcomes provide the strongest evidence of the impact of pulmonary rehabilitation programs on patients with COPD 19 by measuring improvement in symptoms, exercise performance, and quality of life, which are the most meaningful changes for the patient.…”

“…6 Although this exercise-based treatment is scientifically established in published guidelines, [7][8][9][10][11][12] there is a wide range of studies presenting diverse exercise-training methodologies in clinical practice. 13,14 Aerobic exercise training is recommended 3-5 times/week for at least 20 sessions of 30 -90 min at 60 -80% maximum work rate (W max ) of continuous or intermittent use of a treadmill, bicycle, step, elliptic, or rowing machine. 7,15,16 Current investigation has not yet identified the critical exercise intensity, 17 but it is established that physiological benefits are achieved with a minimum of 60% W max and that the higher the intensities, the greater the physiological benefits.…”