Physical Training Fails to Improve Ventilatory Muscle Endurance in Patients with Chronic Obstructive Pulmonary Disease

doi:10.1378/chest.81.4.440

Chest

Volume 81, Issue 4, April 1982, Pages 440-443

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We examined the effect of arm and kg exercise training on ventilatory muscle performance in 15 patients with symptomatic COPD. Eight patients trained their arms while seven trained their tegs for six weeks. Before and after the training we measured exercise and pulmonary function including the maximal sustained ventilatory capacity (MSVC). After training there was no significant change in spirometric values and lung volumes. The mean endurance workload performed for 20 minutes increased significantly in both the arm and leg trained groups (14.4 ± 2.4 to 24.8 ± 2.5W, P < 0.01, and 26.1 ± 2.4 to 44.4 ± 2.5 W, P < 0.01, respectively). Despite the increase in endurance, no significant change was noted in the MSVC (46 ± 5 to 51 ± 5 for the arm trainers and 36 ± 2 to 39 ± 1 for the leg trainers). We conclude that nonventilatory muscle exercise such as arm and leg cycling does not improve ventilatory muscle endurance, and that increased exercise endurance may occur independent of changes in ventilatory muscle endurance.

Section snippets

MATERIALS AND METHODS

We recruited 15 patients with COPD⁸ who suffered from dyspnea on minor exertion. They were free of other disabling diseases and demonstrated minimal or no evidence of reversibility of airway obstruction by history or by pulmonary function testing (increase of FEV₁ less than 20 percent after inhaled isoproterenol). The experimental protocol was approved by our Institutional Committee on Human Experimentation, and informed consent was obtained from all patients.

We performed standard spirometric

RESULTS

The lung volumes, spirometric indices, and MSVC values are shown in Table 1. There was no significant differences between the arm trained and the leg trained group and no significant difference in the before and after training values for lung function and ventilatory muscle endurance. Figure 1 illustrates the individual best pretraining and posttraining MSVC values for each patient. In general, there were small individual increases, and the overall mean increased slightly, but the difference

DISCUSSION

We have shown that neither arm nor leg endurance training produced increases in ventilatory muscle endurance in patients with COPD. This is contrary to the findings of Keens et al,⁴ who found that upper extremity endurance exercise produced improved ventilatory muscle endurance in children with cystic fibrosis. The response to training is determined by several factors, including the frequency, intensity and duration of training.¹⁰ These factors are probably of importance in explaining the

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There are more references available in the full text version of this article.

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Effectiveness of a physiotherapy program in chronic obstructive pulmonary disease
2012, Fisioterapia
Los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) sufren un deterioro progresivo en su capacidad física como consecuencia de la pérdida de fuerza y resistencia muscular; esto va a influir en su calidad de vida. La fisioterapia ayuda a mejorar la capacidad física y calidad de vida relacionada con la salud (CVRS).
El objetivo de este estudio fue estudiar la efectividad de un programa ambulatorio de fisioterapia respiratoria aplicado a pacientes con EPOC sobre la capacidad física, CVRS, la función pulmonar, la flexibilización de tórax inferior (FTI) y la disnea.
Se ha realizado un estudio de intervención prospectivo de serie de casos con medición del pre y postensayo. Se incluyó de forma consecutiva a 42 pacientes con EPOC (estadios II, III y IV de la clasificación GOLD). Los pacientes realizaron un programa de fisioterapia durante 7 semanas que incluía: educación, ejercicios respiratorios y entrenamiento muscular periférico de baja intensidad.
Mostraron una mejoría en la capacidad física (prueba de la marcha de 6 min (p = 0,01), CVRS determinada con el Chronic Respiratory Questionnaire (CRQ) (p = 0,01), FTI medida con cinta métrica (p = 0,01), en la función pulmonar medida con la FEV₁ (p = 0,01) y la disnea medida con la escala Medical Research Chronic (MRC) (p = 0,01).
El estudio muestra que un programa de fisioterapia respiratoria produce una mejoría en la capacidad física, CVRS, disnea, función pulmonar y flexibilización de tórax.
Patients with chronic obstructive pulmonary disease (COPD) experience progressive worsening of their physical capacity due to loss of muscle strength and resistance, which in turn affects their quality of life. Physiotherapy helps to improve physical capacity and thus health-related quality of life (HRQoL). This study has aimed to determine the effectiveness of an outpatient program of respiratory physiotherapy for patients with COPD on their physical capacity, HRQoL, pulmonary function, lower chest flexibility (LCF), and dyspnea.
We conducted a prospective, intervention study in a series of cases with pre- and post-trial measurements. The study included 42 consecutive patients with COPD (stages II, III and IV of the GOLD classification). The patients underwent a 7-week physiotherapy program that included education, respiratory exercises and low-intensity peripheral muscle training.
Improvements were seen in physical capacity (6 minute walk test; P=.00), HRQoL as determined with the Chronic Respiratory Questionnaire (P=.00), LCF measured with a metric tape (P=.00), pulmonary function as measured by the FEV₁ (P=.01), and dyspnea as measured with the Medical Research Chronic scale (P=.00)
This study shows that a respiratory physiotherapy program improves physical capacity, HRQoL, dyspnea, pulmonary function and chest flexibility.
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.
How should we measure arm exercise capacity in patients with COPD? A systematic review
2012, Chest
Citation Excerpt :
The measurement properties evaluated were construct validity, test-retest reliability, and responsiveness (Table 2). Arm ergometry was used in 21 studies18,21–40 to assess either peak arm exercise capacity or endurance during supported exercises. The cranking frequency ranged from 40 to 70 revolutions per min, and load increments varied from 2.5 W to 15 W every 1 or 2 min.
There are no recommendations on how to measure arm exercise capacity in individuals with COPD. The objectives of this study were (1) to synthesize the literature on measures of arm exercise capacity in individuals with COPD, (2) to describe the psychometric properties and the target construct of each measure, and (3) to make recommendations for clinical practice and research.
Studies conducted in patients with COPD that included a measure of arm exercise capacity were identified after searches of five electronic databases (PubMed, CINAHL, EMBASE, PEDro, and Cochrane Library) and reference lists of pertinent articles. One reviewer performed data extraction, and two assessed the quality of the studies that described measurement properties, using the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) checklist.
Of 654 reports, 41 met the study criteria. Five types of arm exercise tests were identified: arm ergometry, ring shifts, dowel lifts, proprioceptive neuromuscular facilitation, and activities of daily living. Four studies assessed the measurement properties of the unsupported upper-limb exercise test (UULEX), the 6-min pegboard and ring test (6PBRT), a test involving weight shifts, and the grocery-shelving task (GST). Validity studies were of fair to good quality, whereas reliability studies were of poor quality.
Arm ergometry may be the best method for measuring peak supported arm exercise capacity and endurance. The UULEX, 6PBRT, and GST may better reflect activities of daily living and should be the tests of choice to measure peak unsupported arm exercise capacity (UULEX) and arm function (6PBRT and GST).
Benefits of a home-based pulmonary rehabilitation program for patients with severe chronic obstructive pulmonary disease
2007, Archivos de Bronconeumologia
The benefits of a domiciliary program of pulmonary rehabilitation for patients with severe to very severe chronic obstructive pulmonary disease (COPD) are uncertain. We aimed to assess the short- and medium-term efficacy of such a program in this clinical setting.
Patients with severe COPD (stages III-IV, classification of the Global Initiative for Chronic Obstructive Lung Disease) and incapacitating dyspnea (scores 3-5, Medical Research Council [MRC] scale) were randomized to a control or domiciliary rehabilitation group. The 9-week supervised pulmonary rehabilitation program included educational sessions, respiratory physiotherapy, and muscle training in weekly sessions in the patient's home. We assessed the following variables at baseline, 9 weeks, and 6 months: lung function, exercise tolerance (3-minute walk test), dyspnea (MRC score), and health-related quality of life with the Chronic Respiratory Questionnaire (CRQ).
Thirty-eight patients with a mean (SD) age of 68 (6) years were enrolled. The mean MRC score was 4 (0.8) and mean forced expiratory volume in 1 second was 29% of reference. Twenty-nine patients completed the study (6 months). Distance covered on the walk test increased significantly in the rehabilitation group (P=.001) and the difference was maintained at 6 months. Dyspnea also improved significantly with rehabilitation (P≤.05), but the reduction was not evident at 6 months. Statistically significant improvements in symptoms related to 2 CRQ domains were detected between baseline and 9 weeks: dyspnea (3.1 [0.8] vs 3.6 [0.7]; P=.02) and fatigue (3.7 [0.8] vs 4.2 [0.9]; P=.002). A clinically relevant but not statistically significant change in mastery over disease was detected (from 4.3 to 4.9). All improvements were maintained at 6 months.
Home-based pulmonary rehabilitation for patients with severe to very severe COPD and severe functional incapacity leads to improvements in exercise tolerance and health-related quality of life that are maintained at 6 months.
Los beneficios de la rehabilitación respiratoria domiciliaria (RRD) en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) de grado grave-muy grave son controvertidos. Nuestro objetivo ha sido evaluar la eficacia a corto y medio plazo de un programa de RRD en pacientes con EPOC grave.
Se trata de un estudio prospectivo y aleatorizado en pacientes con EPOC grave (estadios III y IV de la clasificación GOLD) y disnea invalidante —; puntuación de 3 a 5 en la escala del Medical Research Council (MRC)—, distribuidos en grupo control y grupo RRD. El programa de rehabilitación respiratoria fue de 9 semanas y consistía en educación, fisioterapia respiratoria y entrenamiento muscular con supervisión semanal en domicilio. Evaluamos en situación basal, a las 9 semanas y a los 6 meses la función pulmonar, la capacidad de ejercicio (prueba de la marcha de 3 min), la disnea (MRC) y la calidad de vida relacionada con la salud, determinada con el Chronic Respiratory Questionnaire (CRQ).
Participaron en el estudio 38 pacientes, con una edad media ± desviación estándar de 68 ± 6 años (puntuación MRC: 4 ± 0,8; volumen espiratorio forzado en el primer segundo: 29% del valor de referencia), y 29 completaron el seguimiento a los 6 meses. En el grupo RRD se incrementó significativamente la distancia recorrida en la prueba de la marcha de 3 min (p = 0,001), resultado que se mantuvo a los 6 meses. La disnea mejoró significativamente tras la RRD (p ≤ 0,05), pero dicha mejoría desapareció a los 6 meses. Se observó una mejoría clínica y estadísticamente significativa en 2 dominios del CRQ, el de disnea (3,1 ± 0,8 frente a 3,6 ± 0,7; p = 0,02) y el de fatiga (3,7 ± 0,8 frente a 4,2 ± 0,9; p = 0,002), y tan sólo clínica (4,3 frente a 4,9) en el control de la enfermedad, mejorías que se mantuvieron a los 6 meses.
La RRD en pacientes con EPOC grave-muy grave y alta incapacidad funcional aporta beneficios en la calidad de vida relacionada con la salud y la capacidad de ejercicio, que pueden mantenerse hasta los 6 meses.
Exercise training during rehabilitation of patients with COPD: A current perspective
2004, Patient Education and Counseling
Patients with chronic obstructive pulmonary disease (COPD) suffer frequently from physiologic and psychological impairments, such as dyspnea, peripheral muscle weakness, exercise intolerance, decreased health-related quality of life (HRQOL) and emotional distress. Rehabilitation programmes have shown to result in significant changes in perceived dyspnea and fatigue, utilisation of healthcare resources, exercise performance and HRQOL. Exercise training, which consists of whole-body exercise training and local resistance training, is the cornerstone of these programmes. Regrettably, the positive effects of respiratory rehabilitation deteriorate over time, especially after short programmes. Hence, attention should be given to the aftercare of these patients to prevent them to revert again to a sedentary lifestyle. On empirical basis three possibilities seem to be clinically feasible: (1) continuous outpatient exercise training; (2) exercise training in a home-based or community-based setting; or (3) exercise training sessions in a group of asthma and COPD patients.
Dyspnoea in COPD: Can inspiratory muscle training help?
2004, Australian Journal of Physiotherapy
Chronic obstructive pulmonary disease (COPD) is a progressive, common and costly condition. Dyspnoea frequently limits activity and reduces health-related quality of life. In addition to impaired lung function, peripheral muscle deconditioning and respiratory muscle dysfunction also contribute to dyspnoea and reduced exercise capacity. Pulmonary rehabilitation using whole body exercise training improves peripheral muscle function and reduces dyspnoea but does not improve respiratory muscle function. Providing that adequate training intensities are utilised, specific loading of the inspiratory muscles with commercially available hand-held devices can improve inspiratory muscle strength and endurance. Several studies have investigated the effects of inspiratory muscle training on dyspnoea in COPD subjects. Results of these studies are conflicting, most likely reflecting methodological shortcomings including insufficient training load, insensitive outcome measures, and inadequate statistical power. This paper describes the origin of dyspnoea in COPD, with particular attention given to the role of inspiratory muscle dysfunction in its genesis and its possible amelioration through inspiratory muscle training.

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: This study was supported in part by a grant from the California Lung Association. Dr. Kendregan was supported by a grant from the Emphysema Foundation of America.

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Chest

Clinical InvestigationsPhysical Training Fails to Improve Ventilatory Muscle Endurance in Patients with Chronic Obstructive Pulmonary Disease

Section snippets

MATERIALS AND METHODS

RESULTS

DISCUSSION

Am J Med

Am J Med

Ventilatory muscle training improves exercise capacity in chronic obstructive pulmonary disease patients

Am Rev Respir Dis

Ventilatory muscle strength and endurance training

J Appl Physiol

Ventilatory muscle endurance training in normal subjects and patients with cystic fibrosis

Am Rev Respir Dis

Exercise in chronic bronchitis

Editorial. Lancet

Clinical Investigations
Physical Training Fails to Improve Ventilatory Muscle Endurance in Patients with Chronic Obstructive Pulmonary Disease