Exercise training in COPD: What is it about intensity?

Abstract

Most of the current guidelines for pulmonary rehabilitation recommend higher, over lower, intensity exercise training for COPD. Typically, we consider intensity of exercise training to be a key component of any exercise training programme. Whilst studies of young individuals have demonstrated that higher exercise training intensity results in greater improvements in exercise capacity, the evidence for older patients is not so clear cut. In COPD, there is limited evidence regarding the optimal intensity of exercise training. Using both physiological (peak exercise capacity) and patient-centred (e.g. quality of life) outcomes, it remains inconclusive if higher intensity exercise training bestows any greater benefit than low-intensity exercise. If we examine the data from interval training studies, which used both high-and low-intensity interval and continuous exercise, we are able to generate more data for comparison. Unfortunately, these data are challenging to interpret due to heterogeneity in how interval training was prescribed. However, when we normalize the interval training data for training volume and examine the change in peak cycling power, there is a relationship between training intensity and increase in peak power (W peak , r = 0.68, P < 0.05). Hence, whilst there is an inconclusive amount of evidence to support this intervention based on studies that only examined high-versus lowintensity continuous exercise, the additional data from interval training studies would suggest that higher intensity may be superior in terms of increases in W peak . Future studies should focus on establishing a threshold and an optimal training intensity for COPD.

Year in review 2016: Chronic obstructive pulmonary disease and asthma

“…Underlying issues regarding exercise and physical activity among COPD patients were highlighted during 2016 in two invited reviews . In light of variations in the duration of rehabilitation programmes and the need to maximize efficacy, Morris et al . analysed the effect of aerobic exercise intensity on functional and physiological outcomes.…”

“…analysed the effect of aerobic exercise intensity on functional and physiological outcomes. Although evidence demonstrates that high intensity (>80% peak power (W peak )) continuous and interval exercise provides greater physiological benefits, moderate intensity (60–80% W peak ) may be better tolerated and provides patient‐centred improvements in function and quality of life . Hence, in order to promote adherence, Morris et al .…”

“…Underlying issues regarding exercise and physical activity among COPD patients were highlighted during 2016 in two invited reviews. 37,38 In light of variations in the duration of rehabilitation programmes and the need to maximize efficacy, Morris et al 37 analysed the effect of aerobic exercise intensity on functional and physiological outcomes. Although evidence demonstrates that high intensity (>80% peak power (W peak )) continuous and interval exercise provides greater physiological benefits, moderate intensity (60-80% W peak ) may be better tolerated and provides patient-centred improvements in function and quality of life.…”

“…Although evidence demonstrates that high intensity (>80% peak power (W peak )) continuous and interval exercise provides greater physiological benefits, moderate intensity (60-80% W peak ) may be better tolerated and provides patient-centred improvements in function and quality of life. 37 Hence, in order to promote adherence, Morris et al recommend that exercise therapy be individualized based on patient goals and attitudes. Furthermore, in response to well-recognized barriers to participation in moderate-to-vigorous exercise, Cavalheri et al 38 reviewed the benefits of light physical activity as a strategy to decrease sedentary behaviour in COPD patients.…”

Acceptability and validity of a home exercise diary used in home‐based pulmonary rehabilitation: A secondary analysis of a randomised controlled trial

“…Home‐based exercise models are largely unsupervised by health care professionals . Without the direct supervision, evaluating patients' engagement in exercise programmes or adherence to treatment plans at home could be difficult . Furthermore, exercise training models are complex in nature and often combine different approaches (eg, behavioural change strategies combined with an exercise plan) .…”