Low intensity peripheral muscle conditioning improves exercise tolerance and breathlessness in COPD

Abstract

L Lo ow w i in nt te en ns si it ty y p pe er ri ip ph he er ra al l m mu us sc cl le e c co on nd di it ti io on ni in ng g i im mp pr ro ov ve es s e ex xe er rc ci is se e t to ol le er ra an nc ce e a an nd d b br re ea at th hl le es ss sn ne es ss s i in n C CO OP PD D ABSTRACT: This randomized, controlled study investigated the physiological effects of a specially designed 12 week programme of isolated conditioning of peripheral skeletal muscle groups. The programme required minimal infrastructure in order to allow continued rehabilitation at home after familiarization within hospital. Forty eight patients, aged 40-72 yrs with chronic obstructive pulmonary disease (COPD) (mean (SD) forced expiratory volume in one second (FEV1) 61 (27)% of predicted normal) were randomly allocated into training (n=32) and control (n=16) groups. Physiological assessments were performed before and after the 12 week study period, and included peripheral muscle endurance and strength, whole body endurance, maximal exercise capacity (maximum oxygen consumption (V ' 'O 2 ,max)) and lung function.The training group showed significant improvement in a variety of measures of upper and lower peripheral muscle performance, with no additional breathlessness. Whole body endurance measured by free arm treadmill walking increased by 6,372 (3,932-8,812) J (p<0.001). Symptom-limited maximal V ' 'O 2 was unchanged. However, the training group showed a reduction in ventilatory equivalents for oxygen and carbon dioxide, both at peak exercise and at equivalent work rate (Wmax).In summary, low intensity isolated peripheral muscle conditioning is well-tolerated, simple and easy to perform at home. The various physiological benefits should enable patients across the range of severity of chronic obstructive pulmonary disease to improve daily functioning.

Effects of 2 Exercise Training Programs on Physical Activity in Daily Life in Patients With COPD

“…Both groups had significant improvement in Saint George's Respiratory Questionnaire score (see Table 4). This is in accordance with previous studies, which also found improved health-related quality of life and dyspnea after either high-intensity 2,28,32 or lowintensity exercise training [5][6][7]27 . Although the enduranceand-strength group had a greater improvement in Saint George's Respiratory Questionnaire score, this difference was not significant, compared to the improvement in the calisthenics-and-breathing group (see Table 4).…”

“…2,4 Programs that include high-intensity exercise (such as endurance and strength training) and lowintensity training (such as callisthenic exercises in the sitting and standing position, moving the upper limbs against gravity) improve outcomes that are relevant to patients (eg, overall dyspnea, functional performance, and health status). 2,[5][6][7] On the other hand, high-intensity programs tend to result in deeper physiological improvements, being especially efficient in increasing exercise capacity and muscle force. 2 However, an important issue not yet investigated is whether different exercise training programs result in different post-program effects on the level of physical activity in daily life in this population.…”

Does creatine supplementation enhance the effects of physical training during pulmonary rehabilitation in COPD?

“…Given that deconditioning is one of the principal causes of muscle dysfunction, exercise training is a logical step to improve physical performance. The role of exercise training in pulmonary rehabilitation is well established and is known to improve exercise capacity and health status in patients with chronic lung disease [7,8]. These improvements are partly due to metabolic adaptations in the peripheral muscles.…”

Treinamento de força para pacientes com doença pulmonar obstrutiva crônica

“…Duas intensidades de treinamento de força são apresentadas na literatura: o treinamento de moderada a alta intensidade baseado em intensidades relativas (50-90%) de uma repetição máxima (maior quantidade de carga que pode ser mobilizada em uma amplitude total de determinado movimento -1RM) (2,19,20) (Tabela 1), e o treinamento com pesos leves ou com a própria resistência dos segmentos corporais (21)(22)(23)(24) (Tabela 2). A Tabela 3 apresenta os delineamentos e resultados dos principais ensaios clínicos envolvendo pacientes com DPOC.…”

“…Os autores atribuíram tais resultados ao fato de que o exercício de pressão das pernas exige atividade significativa dos músculos abdominais, os quais são fundamentais para a expiração forçada (20) . Quanto ao treinamento de baixa intensidade, Clark et al (21) avaliaram os efeitos do treinamento em 48 pacientes com DPOC randomizados em grupo de treinamento ou grupo controle não exercitado. O grupo de treinamento foi submetido a seqüência de exercícios isoinerciais durante 12 semanas (2x/semana) (Tabela 2), o qual mostrou melhora significativa da força e resistência musculares e do tempo de endurance em esteira rolante.…”