Physiologic benefits of exercise training in rehabilitation of patients with severe chronic obstructive pulmonary disease.

Abstract

We determined the effect on exercise tolerance and physiological exercise responses of rigorous rehabilitative exercise training in chronic obstructive pulmonary disease (COPD). Fifteen men and 10 women (mean age, 68 +/- 6 yr; FEV1, 0.93 +/- 0.27 L) participated in a rehabilitation program with an exercise component of three per week 45-min sessions of cycle ergometer training for 6 wk with exercise intensity kept near maximal targets. Before and after rehabilitation, patients performed an incremental test and a constant work rate (CWR) test at 80% of the peak work rate in the preprogram incremental test. Ventilation (V(E)) and gas exchange were measured breath by breath; arterialized venous blood was analyzed for blood gas determinations and lactate. Rehabilitation yielded an average increase in peak work rate in the incremental test of 36% (p < 0.001), and in the duration of the CWR test of 77% (p < 0.001). In the CWR test, the kinetics of O2 uptake, CO2 output, V(E), and heart rate were markedly slower than those of healthy subjects. After training, mean response time decrease averaged 17, 22, 34, and 29%, respectively (p < 0.02), evidence of a physiologic training effect. Further, for identical CWR tasks, V(E) was 10% lower (p < 0.02) after training, attributable to altered breathing pattern: tidal volume increased by 8% and respiratory rate decreased by 19%, yielding lower V(D) /V(T) (0.46 versus 0.53 p < 0.005). Rigorous exercise training for patients with severe COPD yields more efficient exercise breathing pattern and lower V(E); this is associated with improved exercise tolerance.

Recommendations on the use of exercise testing in clinical practice

“…These findings suggest an improvement in aerobic metabolism [255,269] and are in agreement with the observation of a significant increase in oxidative enzyme levels (16-40%) in the quadriceps femoris muscle after a strenuous exercise programme [261]. Positive cardiac adaptation at submaximal exercise, identified by a lower fC, has been demonstrated in controlled [255][256][257]270] and uncontrolled [261,271] studies.…”

“…7) has also been used to detect improvements in oxygen transport and/or skeletal muscle metabolism after a specific intervention [255,271,272]. The V9O 2 kinetics reflect the overall efficiency of the oxygen transport system including muscle oxidative capacity and, in COPD, seem to be influenced by the oxygen delivery to the working muscles [273].…”

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.…”

Efeitos de programa de exercícios físicos direcionado ao aumento da mobilidade torácica em pacientes portadores de doença pulmonar obstrutiva crônica

“…Goldstein et al (26) e Casaburi et al (27) mostraram que pacientes com DPOC submetidos a um programa de treinamento físico aeróbio apresentaram melhora na capacidade de exercício após períodos de treinamento entre 1,5 e dois meses. É interessante notar que no nosso estudo apenas um paciente teve diminuição da distância percorrida em seis minutos e que ele apresentou também queda da mobilidade da caixa torácica após o treinamento, embora não tenha havido nenhuma explicação clínica para justificar a piora deste paciente.…”