Physiological Response to Moderate Exercise Workloads in a Pulmonary Rehabilitation Program in Patients With Varying Degrees of Airflow Obstruction

doi:10.1378/chest.116.5.1200

Chest

Volume 116, Issue 5, November 1999, Pages 1200-1207

https://doi.org/10.1378/chest.116.5.1200 Get rights and content

Study objectives

To investigate whether a 12-week pulmonary rehabilitation program that includes moderately intensive exercise training performed twice weekly can induce a training effect in patients with a wide variation of airflow limitation.

Participants

Sixty patients with COPD (38 men) with a mean± SD FEV₁ % predicted of 55.1 ± 19.8 (range, 0.51 to 2.99). All patients performed identical incremental symptom-limited cycle ergometer testing before and after a 12-week study period.

Measurements and results

After 12 weeks, the patients demonstrated a significant (p < 0.05) increase in the peak values for work rate (WR; 77 ± 30 vs 91 ± 36 W) and oxygen uptake (1.14 ± 0.45 vs 1.20 ± 0.52 L/min). Furthermore, at a given WR during incremental symptom-limited cycle ergometer testing, there were significant (p < 0.05) reductions in minute ventilation (42.4 ± 16.1 vs 37.0 ± 13.6 L/min), carbon dioxide output (1.13 ± 0.49 vs 1.03 ± 0.42 L/min), ventilatory equivalent for oxygen (37.6 ± 8.1 vs 36.0 ± 6.3), and heart rate (135 ± 15 vs 128 ± 16 beats/min). None of the observed physiologic changes correlated with FEV₁ % predicted.

Conclusions

A pulmonary rehabilitation program performed twice weekly with moderate exercise workloads can lead to a physiologic training response irrespective of the degree of airflow limitation.

Section snippets

Patients

Outpatients with COPD were referred to the rehabilitation program by their attending chest physicians at the Sunderland Royal Hospital. Prior to entering the program, all patients met the following criteria: (1) a FEV₁ < 70% predicted and a FEV₁/FVC < 65%; (2) nonsmokers for a minimum of 2 months; (3) their medical therapy had been optimized; and (4) no clinical evidence of exercise-limiting cardiovascular or neuromuscular diseases. The patients enrolled into the study were clinically and

Results

Although the training and nontraining control groups were not prospectively randomized, they were well matched for all variables other than age (Table 1). Among the 60 patients assigned to the training group over the 12-week period, 20 patients improved on their baseline training prescription by 50%, 27 patients improved by 25%, and 13 patients did not improve. The percentage attendance for the training cohort throughout the study was 90 ± 9.

There was significant improvement in exercise

Discussion

This study provides evidence that a 12-week pulmonary rehabilitation program with moderate exercise workloads performed twice weekly can lead to a physiologic training response irrespective of the degree of airflow limitation. Furthermore, in contrast to other studies,⁴, ⁵, ⁶, ⁷ there was a significant but very modest clinical impact on ventilatory capacity.

The improvements in exercise tolerance were manifest not only by attainment of higher peak exercise responses (in WR,

e, and

o₂), but also

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Cited by (56)

Effect of different exercise programs on lung function in people with chronic obstructive pulmonary disease: A network meta-analysis of RCTs
2024, Annals of Physical and Rehabilitation Medicine
Chronic obstructive pulmonary disease (COPD) has systemic consequences and causes structural abnormalities throughout the respiratory system. It is associated with a high clinical burden worldwide.
A network meta-analysis was performed to determine the effects of exercise programs on lung function measured by forced expiratory volume in the first second (FEV1), FEV1 as a percentage of the predicted value (FEV1%) and forced vital capacity in people with COPD.
A literature search was performed to March 2023. Randomized controlled trials on the effectiveness of exercise programs on lung function in people with COPD were included. A standard pairwise meta-analysis and a network meta-analysis for direct and indirect comparisons between intervention and control/nonintervention groups were carried out to calculate the standardized mean difference and 95 % CI. The risk of bias was assessed using the Cochrane Risk of Bias tool and the Grading of Recommendations, Assessment, Development, and Evaluation tool was used to assess the quality of the evidence.
35 studies with a total sample of 2909 participants were included in this network meta-analysis. The highest standardized mean difference was for active mind body movement therapy programs versus control for FEV1 and FEV1% (0.71; 95 % CI 0.32 to1.09; and 0.36; 95 % CI 0.15 to 0.58, respectively), and pulmonary rehabilitation+active mind body movements therapies versus control for forced vital capacity (0.45; 95 % CI 0.07 to 0.84).
active mind body movement therapy programs were the most effective type of exercise program to improve lung function measured by FEV1 and FEV1%; pulmonary rehabilitation+active mind body movements therapies had the greatest effects on FVC in people with COPD. Exercise programs in which the abdominal muscles are strengthened could improve lung emptying, helping to overcome airway resistance in people with COPD.
Change in V˙O<inf>2peak</inf> in Response to Aerobic Exercise Training and the Relationship With Exercise Prescription in People With COPD: A Systematic Review and Meta-analysis
2020, Chest
Despite the wide-ranging benefits of pulmonary rehabilitation, conflicting results remain regarding whether people with COPD can improve their peak oxygen uptake ( $\dot{V}$ O_2peak) with aerobic training.
The goal of this study was to investigate the effect of aerobic training and exercise prescription on $\dot{V}$ O_2peak in COPD.
A systematic review was performed by using MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases for all studies measuring $\dot{V}$ O_2peak prior to and following supervised lower-limb aerobic training in COPD. A random effects meta-analysis limited to randomized controlled trials comparing aerobic training vs usual care was conducted. Other study designs were included in a secondary meta-analysis and meta-regression to investigate the influence of program and patient factors on outcome.
A total of 112 studies were included (participants, N = 3,484): 21 controlled trials (n = 489), of which 13 were randomized (n = 288) and 91 were uncontrolled (n = 2,995) studies. Meta-analysis found a moderate positive change in $\dot{V}$ O_2peak (standardized mean difference, 0.52; 95% CI, 0.34-0.69) with the intervention. The change in $\dot{V}$ O_2peak was positively associated with target duration of exercise session (P = .01) and, when studies > 1 year duration were excluded, greater total volume of exercise training (P = .01). Similarly, the change in $\dot{V}$ O_2peak was greater for programs > 12 weeks compared with those 6 to 12 weeks when adjusted for age and sex. However, reported prescribed exercise intensity (P = .77), training modality (P > .35), and mode (P = .29) did not affect $\dot{V}$ O_2peak. Cohorts with more severe airflow obstruction exhibited smaller improvements in $\dot{V}$ O_2peak (P < .001).
Overall, people with COPD achieved moderate improvements in $\dot{V}$ O_2peak through supervised aerobic training. There is sufficient evidence to show that programs with greater total exercise volume, including duration of exercise session and program duration, are more effective. Reduced effects in severe disease suggest alternative aerobic training methods may be needed in this population.
PROSPERO; No.: CRD42018099300; URL: https://www.crd.york.ac.uk/prospero/
Physiologic response to the 6-minute walk test of chronic obstructive pulmonary disease patients
2014, Fisioterapia
Analizar la respuesta fisiológica asociada a la ejecución del TM6 m en pacientes con enfermedad pulmonar obstructiva crónica chilenos.
En este estudio descriptivo, de temporalidad transversal, 30 pacientes (70,97 ± 8,89 años), con un compromiso espirométrico moderado (%VEF₁ = 58,83 ± 7,92) realizaron el TM6 m. En cada minuto de prueba se monitorearon la frecuencia cardiaca (FC), saturación arterial de oxígeno (SatO₂), sensación subjetiva al esfuerzo (SSE) y fatiga de extremidades inferiores (EEII). Además, se continuó registrando las variables 4 min posterior a la realización del test.
Los pacientes recorrieron un 106,63% ± 22,16 de la distancia predicha. La SSE y la fatiga de EEII aumentaron de forma significativa en la realización del TM6 m (p < 0,05). En promedio, los pacientes utilizaron cerca de un 50% de su reserva de FC sin reportar cuadros de desaturación. Tras los 4 min de reposo postest la FC no alcanza valores basales.
El TM6 m genera aumentos significativos en la respuesta cronotrópica cardiaca, SSE y de fatiga de MMII, que se mantienen incluso posterior a los 4 minutos de reposo posterior a la ejecución de la prueba, reflejando alteraciones funcionales que van más allá del rendimiento neto en la prueba en términos de distancia recorrida.
To analyze the physiological response associated to the application of the 6 MWT in Chilean COPD patients.
In this descriptive, cross-sectional study, 30 patients (70.97 ± 8.89 years), with moderate ventilatory impairment (%FEV1 = 58.83 ± 7.92) completed the 6 MWT. Heart rate (HR), partial arterial saturation (SpO2), rating of perceived effort (RPE), and fatigue of lower limbs (LL) were measured at each minute of the test. In addition, these variables were recorded at 4 minutes after completing the test.
The patients completed 106.63% ± 22.16 of the predicted distance. RPE and fatigue of LL increased significantly (P < .05). On average, the subjects used approximately 50% of their HR reserve without exhibiting desaturations. After 4 minutes of post-test rest, HR did not reach pre-test levels.
6 MWT generates significant increases in the cardiac chronotropic response, RPE and LL fatigue that remains higher, even after four minutes of post-test rest. This could reflect functional alterations that go beyond the performance measured just in terms of distance covered.
The effect of exercise training on pulmonary function and aerobic capacity in adults with burn
2012, Burns
Citation Excerpt :
Alison et al. found that exercise improved PF (FEV1 and FVC) in patients with cystic fibrosis [26], whereas Orenstein et al. found no improvement in PF in patients with cystic fibrosis following exercise training [27]. Similarly, inconsistent findings have been found for patients with chronic obstructive pulmonary disease [28,29]. Of relevance, exercise training has previously been reported to improve PF in children recovering from burns [15].
Pulmonary function (PF) is compromised in some individuals following burn, which may result in impaired aerobic capacity. Exercise training improves PF and exercise capacity in children recovering from burns, yet it is unknown if adults will demonstrate the same response.
9 burn injured participants (%TBSA 42 ±18.38, 6.56 years ±3.68 post injury) and 9 matched controls participated in a 12-week goal directed interval training and resistance exercise programme. PF was measured using spirometry, and a graded exercise test quantified peak oxygen consumption $({\dot{V}}_{O_{2peak}})$ , both prior to and following the exercise training. The Canadian Occupational Performance Measure assessed the participant's goal attainment.
Burn injured participants had significantly lower PF (FEV₁/FVC ratio) than the healthy controls both prior to and following the exercise intervention (F(1,16) = 8.93, p = 0.009). Exercise training did not improve PF in either group, however both groups had a significant improvement in their ${\dot{V}}_{O_{2peak}}$ , maximal minute ventilation, and work achieved on a graded exercise test (F(1,16) = 19.325, p < 0.001), (F(1,16) = 51.417, p < 0.001) and (F(1,16) = 36.938, p < 0.001), respectively, following the exercise training. All participants achieved their occupational performance goals.
Although the exercise training did not alter PF, both aerobic capacity and occupational performance were improved.
Pulmonary function, exercise capacity and physical activity participation in adults following burn
2011, Burns
To determine the relationship between pulmonary function, aerobic exercise capacity and physical activity participation in adults following burn.
Eight burn injured males aged 20–55 years (%TBSA 33.3 ± 18.7, 5.1 years ± 1.8 post injury), and 30 healthy adult controls participated. Pulmonary function was assessed during rest via spirometry. A graded exercise test measuring peak oxygen consumption (VO_2peak) and oxygen saturation (S_pO₂) was conducted, and physical activity was assessed via the Older Adult Exercise Status Inventory (OA-EI).
No significant correlation was observed between resting pulmonary function, aerobic capacity and physical activity participation for burn injured patients or controls. Two burn injured patients presented with obstructive ventilatory defects, and one displayed a restrictive ventilatory defect. Burn injured patients had a significantly lower VO_2peak (p < 0.001) and time to fatigue (p = 0.026), and a greater degree of oxygen desaturation (p = 0.063, Effect Size = 1.02) during a graded exercise test. Burn injured patients reported significantly less participation in leisure-related activity > 9 METs (p = 0.01), and significantly greater participation in work-related activity (p = 0.038), than healthy controls.
Compromised lung function, decreased aerobic capacity and reduced participation in leisure-related physical activity may still exist in some adults, even up to 5 years post injury. Limitations and long term outcomes of cardiopulmonary function and physical fitness need to be considered in the prescription of exercise rehabilitation programmes following burn.
Effect of pulmonary rehabilitation on peripheral muscle fiber remodeling in patients with COPD in GOLD stages II to IV
2011, Chest
Citation Excerpt :
Furthermore, although patients with COPD in stage III did not increase fiber type I distribution post training, they did increase the proportion of type IIa fibers that also exhibit oxidative characteristics. In addition, our findings extend those published by Vogiatzis et al21 and Niederman et al,22 who showed that the degree of change in peak and submaximal exercise performance on the bicycle ergometer is not related to the magnitude of airflow impairment quantified as percentage of predicted FEV1. Our findings of no significant differences in the degree of improvement of exercise tolerance and vastus lateralis muscle morphology and typology across GOLD stages may be due to our use of an exercise protocol that adheres to the principles of exercise training.
In most patients with COPD, rehabilitative exercise training partially reverses the morphologic and structural abnormalities of peripheral muscle fibers. However, whether the degree of improvement in muscle fiber morphology and typology with exercise training varies depending on disease severity remains unknown.
Forty-six clinically stable patients with COPD classified by GOLD (Global Initiative for Obstructive Lung Disease) as stage II (n = 14), III (n = 18), and IV (n = 14) completed a 10-week comprehensive pulmonary rehabilitation program consisting of high-intensity exercise three times weekly.
At baseline, muscle fiber mean cross-sectional area and capillary density did not significantly differ between patients with COPD and healthy control subjects, whereas muscle fiber type I and II proportion was respectively lower (P < .001) and higher (P < .002) in patients with GOLD stage IV compared with healthy subjects and patients with GOLD stages II and III. Exercise training improved, to a comparable degree, functional capacity and the St. George Respiratory Questionnaire health-related quality of life score across all three GOLD stages. Vastus lateralis muscle fiber mean cross-sectional area was increased (P < .001) in all patient groups (stage II: from 4,507 ± 280 μm² to 5,091 ± 271 μm² [14% ± 3%]; stage III: from 3,753 ± 258 μm² to 4,212 ± 268 μm² [14% ± 3%]; stage IV: from 3,961 ± 266 μm² to 4,551 ± 262 μm² [17% ± 5%]), whereas all groups exhibited a comparable reduction (P < .001) in type IIb fiber proportion (stage II: by 6% ± 2%; stage III: by 6% ± 1%; stage IV: by 7% ± 1%) and an increase (P < .001) in capillary to fiber ratio (stage II: from 1.48 ± 0.10 to 1.81 ± 0.10 [23% ± 5%]; stage III: from 1.29 ± 0.06 to 1.56 ± 0.09 [21% ± 5%]; stage IV: from 1.43 ± 0.10 to 1.71 ± 0.13 [18 ± 3%]). The magnitude of changes in the aforementioned variables did not differ across GOLD stages.
Functional capacity and morphologic and typologic adaptations to rehabilitation in peripheral muscle fibers were similar across GOLD stages II to IV. Pulmonary rehabilitation should be implemented in patients at all COPD stages.

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: Supported by a grant from the Northern and Yorkshire NHS Executive for Research and Development.

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Chest

Clinical InvestigationsEXERCISEPhysiological Response to Moderate Exercise Workloads in a Pulmonary Rehabilitation Program in Patients With Varying Degrees of Airflow Obstruction

Study objectives

Participants

Measurements and results

Conclusions

Section snippets

Patients

Results

Discussion

Clin Chest Med

Chest

Respir Med

Respir Physiol

Chest

Chest

Clin Chest Med

Pathophysiology of disorders limiting exercise

Peripheral muscle weakness contributes to exercise limitation in COPD

Am J Respir Crit Care Med

Reductions in exercise lactic acidosis and ventilation as a result of exercise training in patients with chronic obstructive lung disease

Am Rev Respir Dis

Exercise training and testing in patients with chronic obstructive pulmonary disease

Basic Respir Dis

Effects of pulmonary rehabilitation on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease

Ann Intern Med

Skeletal muscle adaptation to endurance training in patients with chronic obstructive pulmonary disease

Am J Respir Crit Care Med

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

Am J Respir Crit Care Med

Clinical Investigations
EXERCISE
Physiological Response to Moderate Exercise Workloads in a Pulmonary Rehabilitation Program in Patients With Varying Degrees of Airflow Obstruction