<p>Benefits of different intensities of pulmonary rehabilitation for patients with moderate-to-severe COPD according to the GOLD stage: a prospective, multicenter, single-blinded, randomized, controlled trial</p>

Abstract

PurposePulmonary rehabilitation (PR) is essential to manage patients with COPD. The aim of this study was to investigate the appropriate intensity of PR exercise training for patients with moderate-to-severe COPD.Patients and methodsA prospective multicenter randomized controlled trial was conducted from January 2014 to October 2018. The subjects were randomly assigned to three groups with different intensities of PR, according to their maximum oxygen uptake percentage determined by cardiopulmonary exercise testing. After 20 weeks of exercise training, the effects of low-, moderate-, and high-intensity exercise interventions on patients were compared to determine the most appropriate PR prescription.ResultsFor patients with moderate COPD, all the measured parameters were significantly improved in the moderate- and high-intensity PR groups (P<0.01), while there was no significant difference in the frequency of acute exacerbations and the mMRC questionnaire after 20 weeks of PR exercise in the low-intensity PR group. For patients with severe COPD, all variables were also improved in the high-intensity PR group (P<0.05), while the mean differences of pre- and post-PR were lower than those in patients with moderate COPD. Moreover, the Hamilton Anxiety Scale and body mass index showed no significant difference in low-intensity PR group (P>0.05).ConclusionHigh-intensity PR exercise is helpful for patients with moderate to severe COPD. Moderate COPD patients need to receive intensive PR training; the improvement degrees from PR intervention were higher than those of the severe COPD patients. For patients with severe COPD, high-intensity PR exercise may be more beneficial if patients can tolerate it.

Is it possible to reverse frailty in patients with chronic obstructive pulmonary disease?

“…Individuals with COPD experience a loss of muscle strength, particularly in the lower limbs ( 38 ). Lower limb muscle dysfunction is recognized among the common extrapulmonary effects in those with COPD, and it causes a gradual decrease in the activities of daily living ( 39 ). Moreover, patients with COPD usually experience a loss of skeletal muscle strength owing to a vicious cycle of inactivity that also has a close correlation with the occurrence of frailty ( 5 , 40 , 41 ).…”

Recommendation of physical activity for patients with severe COPD: an integrative review

“…Zambom-Ferraresi et al, 15 in turn, compared 12 weeks of resistance training versus combined training (resistance associated to endurance) with a control group, for a sample of 36 patients with moderate to severe COPD and observed increased functional capacity, improved performance of the 6-minute walk test (6MWT') and increased strength of the peripheral muscles of upper and lower limbs. For He et al 3 low intensity exercises do not seem to generate satisfactory effects in severe patients even after 20 weeks of training.…”

“…He et al 3 203 patients with moderate to severe COPD were submitted to 20 weeks of light, moderate and high intensity training with exercise bike and resistance training for upper and lower limbs Critically ill patients submitted to medium and high intensity exercise programs showed improvement in FEV 1 , FEV 1 %, BODE index and 6MWT' Bourne et al 19 90 patients with severe COPD were treated virtually (n=64) and in person (n=26) through an exercise program, for 6 weeks There were similar gains among the groups for increased travel distance at the 6MWT', reduced symptoms and improved quality of life.…”

“…Miki et al 20 conducted the aerobic training of 36 patients with resistance from 60 to 80% of peak oxygen consumption obtained in cycloergometer test. During He et al 3 ' s research, the institution of aerobic training in stationary bicycle considered values ≥70% of peak oxygen consumption as high intensity, values of 50 -70% were classified as moderate intensity and values< 50% characterized as low intensity.…”

“…Among the objectives of these programs are to reduce symptoms, increase exercise tolerance, and increase functionalcapacity. 3 Despite the numerous proven benefits on the effectiveness of rehabilitation programs for patients with COPD, approximately 50% of them refuse to participate and about 30-50% leave the program before itsconclusion. 4 The aim of this study was to describe the main benefits achieved by including high-intensity physical training in pulmonary rehabilitation programs for patients with severe COPD.…”