Resistance training as a preconditioning strategy for enhancing aerobic exercise training outcomes in COPD

Abstract

Purpose Aerobic exercise training is a recognized approach for improving functional capacity in COPD. People with greater disease severity often have difficulty achieving higher aerobic exercise training intensity. The effects of resistance training prior to aerobic training were examined to determine if this sequential approach was associated with greater gains in functional status than aerobic training alone or concurrent aerobic and resistance training. Methods Patients were randomized to: 1) sequential resistance then aerobic training (RT-then-AT) (8 weeks resistance training followed by 8 weeks aerobic exercise training), 2) control group (CE-then-AT+RT) (8 weeks of ‘sham’ training followed by 8 weeks concurrent aerobic and resistance training), 3) control group (CE-then-AT) (8 weeks ‘sham’ training followed by 8 weeks aerobic training). Outcomes were assessed at study entry, after week 8, and after week 16: aerobic exercise performance; muscle strength and endurance. Results 75 patients completed training: FEV1 %pred 40±10, V̇O2peak %predicted, 71±22, fat-free mass index 19.5±3.1. RT-then-AT had greater acquisition of peripheral muscle endurance than CE-then-AT+RT and CE-then-AT, but improvements in aerobic exercise performance were similar. Improvements in muscle strength were similar between RT-then-AT and CE-then-AT+RT. Sarcopenia was associated with poorer attendance, and lower aerobic and resistance training volumes. Conclusion Although the sequential approach to resistance and aerobic training yielded a greater increase in muscle endurance and higher resistance training volume compared to concurrent resistance and aerobic training, other training outcomes were similar between the two groups, thus the sequential approach is not clearly superior to the concurrent approach in severe COPD. ClinicalTrials.gov Identifier NCT01058213.

Effects of home‐based lower limb resistance training on muscle strength and functional status in stable Chronic obstructive pulmonary disease patients

“…The physiological outcomes include body composition, pulmonary function (i.e., FEV1%) (Chang et al, 2008) and muscle strength (Maltais et al, 2014). Meanwhile, the functional level outcomes include muscular endurance (one-repetition maximum [1RM] with the same six lifts employed for RT), leg-extension endurance time, 30s chair rise (Covey, Collins, Reynertson, & Dilling, 2014) and exercise tolerance (6-min walking test (Rasekaba, Lee, Naughton, Williams, & Holland, 2009), incremental shuttle test (Covey et al, 2014;Vagaggini et al, 2009), sit-to-stand tests (Vaidya, Chambellan, & de Bisschop, 2017), endurance shuttle walk test (Revill, Morgan, Singh, Williams, & Hardman, 1999), stair climbing test (Villiot-Danger, 2009), step test (Coquart et al, 2015), COPD disease-specific health status [COPD-version of the St. George Respiratory Questionnaire, SGRQ-C]/Chronic Respiratory Disease Questionnaire, CRQ (Nyberg et al, 2015)/COPD Assessment Tool, CAT/ Borg scores).…”

Impact of Resistance Training in Subjects With COPD: A Systematic Review and Meta-Analysis

“…10,11 A combination of resistance and endurance training in COPD has demonstrated a greater improvement in peripheral muscle function compared with endurance training alone. 12 In the past few years, there have been several systematic reviews on the efficacy of resistance training. [13][14][15][16] However, previous meta-analyses focused on whether resistance training is effective in improving skeletal muscle strength and lung function, whereas little data are so far available on other clinically relevant outcomes, such as quality of life, dyspnea, and exercise capacity.…”

Locomotor Muscles in COPD: The Rationale for Rehabilitative Exercise Training

“…Improvement in markers of oxidative metabolism was actually blunted or even absent in COPD which likely explains the lower functional gain observed in patients (Gouzi et al, 2013b). Of note, although both endurance training alone and combined endurance/resistance training substantially increased muscle endurance in Covey et al (2014), the magnitude of improvement was twice larger in the combined modalities group. Using a non-volitional technique, Mador et al (2001) found a blunted decrease in potentiated twitch force post-compared to pre-rehabilitation for the same intensity and duration of exercise, indicting less quadriceps fatigability ( Table 1).…”

“…Data regarding isolated muscle endurance after training in patients with COPD are scarce; however, some few studies reported an increase of 50-60% after 4-8 weeks of aerobic exercise [∼ 40-65% WR peak (Vivodtzev et al, 2010); 50-80% WR peak (Covey et al, 2014)]. Muscle endurance also increased after endurance-oriented resistance training using lowload elastic bands [+10%, (Nyberg et al, 2015)] or simply body mass (Clark et al, 1996).…”

“…Muscle endurance also increased after endurance-oriented resistance training using lowload elastic bands [+10%, (Nyberg et al, 2015)] or simply body mass (Clark et al, 1996). Similarly, combined endurance and resistance training provided significant improvement in muscle endurance; nevertheless, its effect varied substantially among studies [from 20% to almost 100%, (Franssen et al, 2005;Gouzi et al, 2013b;Covey et al, 2014); initial intensity 50-60% WR peak in Franssen et al (2005)]. The magnitude of improvement in muscle endurance was, however, lower in patients with COPD as compared to healthy controls (Gouzi et al, 2013b).…”