Abstract
Patients with severe chronic obstructive pulmonary disease (COPD) are unable to exercise at high intensities for sufficiently long periods of time to obtain true physiological training effects. It therefore appears sensible to increase training duration at sub-maximal exercise intensities to optimize the benefit of exercise training. We compared the effects on exercise tolerance of two endurance cycloergometer submaximal exercise protocols with different cumulative training loads (one (G1) versus two (G2) daily 40 min training sessions) both implemented over 20 consecutive days in 149 patients with COPD (forced expiratory volume at first second (FEV1): 39% predicted) admitted to an inpatient pulmonary rehabilitation program. Patients in G2 exhibited greater improvement (p = 0.011) in submaximal endurance time (from 258 (197) to 741 (662) sec) compared to G1 (from 303 (237) to 530 (555) sec). Clinically meaningful improvements in health-related quality of life, 6MWT, and chronic dyspnea were not different between groups. Doubling the volume of endurance training is feasible and can lead to an additional benefit on exercise tolerance. Future studies may investigate the applicability and benefits of this training strategy in the outpatient or community-based pulmonary rehabilitation settings to amplify the benefits of exercise interventions.
Highlights
Exercise training is the cornerstone of pulmonary rehabilitation, with endurance training representing the most commonly implemented modality in this setting for patients with chronic obstructive pulmonary disease (COPD)
In outpatients with COPD, recommended training programs consist of a minimum of 16–20 sessions, each lasting for 30–90 min, that are performed 3–5 times per week, at an intensity equivalent to 60–80% of peak exercise capacity (Wpeak) [2]
From June 2015 to May 2018, 950 COPD patients were evaluated to our pulmonary rehabilitation (PR) program
Summary
Exercise training is the cornerstone of pulmonary rehabilitation, with endurance training representing the most commonly implemented modality in this setting for patients with chronic obstructive pulmonary disease (COPD). The benefits of endurance training in this population are well documented and include reductions in hospitalization and exacerbation rates, sensations of breathlessness during daily activities, and improvements in exercise tolerance, functional capacity, and health-related quality of life [1]. In outpatients with COPD, recommended training programs consist of a minimum of 16–20 sessions, each lasting for 30–90 min, that are performed 3–5 times per week, at an intensity equivalent to 60–80% of peak exercise capacity (Wpeak) [2]. In healthy young individuals there is strong evidence that the higher the endurance training volume, the greater the magnitude of physiological adaptations [4]. There is, a less clear dose–response effect for endurance exercise training volume [5,6]
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