Efficacy of a physical exercise training programme COPD in primary care: study protocol of a randomized controlled trial Effects of 2 Exercise Training Programs on Physical Activity in Daily Life in Patients With COPD Effects of unsupported upper extremity exercise training in patients with COPD: a randomized clinical trial. Effects of a Community-Based, Post-Rehabilitation Exercise Program in COPD: Protocol for a Randomized Controlled Trial With Embedded Process Evaluation Effects of Combined Aerobic-Strength Training vs Fitness Education Program in COPD Patients. Physical and Functional Impairment During and After Hospitalization in Subjects With Severe COPD Exacerbation Enhancing exercise tolerance and physical activity in COPD with combined pharmacological and non-pharmacological interventions: PHYSACTO randomised, placebo-controlled study design Interval versus Continuous High-Intensity Exercise in Chronic Obstructive Pulmonary Disease The effectiveness of different combinations of pulmonary rehabilitation program components: a randomized controlled trial. Efficacy of an mHealth intervention to stimulate physical activity in COPD patients after pulmonary rehabilitation Two different training programmes for patients with COPD: a randomised study with 1-year follow-up. A controlled study of community-based exercise training in patients with moderate COPD Effects of an Exercise Intervention in Frail Older Patients with Chronic Obstructive Pulmonary Disease Hospitalized due to an Exacerbation: A Randomized Controlled Trial Effects of a brief, pedometer-based behavioral intervention for individuals with COPD during inpatient pulmonary rehabilitation on 6-week and 6-month objectively measured physical activity: study protocol for a randomized controlled trial High intensity physical group training in water--an effective training modality for patients with COPD. Long-term efficacy of intensive cycle ergometer exercise training program for advanced COPD patients A Feasibility Trial of Two Rehabilitation Models in Severe Cardiopulmonary Illness
Background Chronic obstructive pulmonary disease ( COPD ) is recognized as a systemic illness with significant extra-pulmonary features , such as exercise intolerance and muscle weakness . Pulmonary rehabilitation has been shown to be very effective in counteracting these consequences in patients with more advanced COPD . However , limited data is available on the efficacy of a physical exercise training programme in patients with mild to moderate COPD in primary care . Furthermore , it is unknown if improved exercise capacity translates into enhanced daily physical activities . The aim of this paper is to describe the design of a r and omized controlled trial to assess the efficacy of a physical exercise training programme in patients with mild to moderate COPD . Methods / design In this r and omized controlled trial situated in the primary care setting , 102 patients with mild to moderate airflow obstruction ( FEV1 ≥ 50 % of predicted ) , dyspnoea and a physically inactive lifestyle will be r and omized to an intervention or control group . The intervention group receives a 4-month physical exercise training programme at a local physiotherapy practice , which includes exercise training , resistance training , breathing exercises and advises on how to increase the level of physical activity . The control group receives usual care , i.e. advises on how to increase the level of physical activity and a sham treatment at a local physiotherapy practice of which no physiological training stimulus can be expected . Primary outcome is functional exercise capacity at 4-months measured on the six-minute walk distance . Secondary outcomes include peripheral muscle strength , physical activity in daily life , health related quality of life , Medical Research Council ( MRC ) dyspnoea score and patients ’ perceived effectiveness . Follow-up measurement will take place at 6 months after baseline . Discussion This will be one of the first studies to evaluate the efficacy of a physical exercise training programme in patients with mild to moderate COPD completely recruited and assessed in primary care . The results of this trial may give a unique insight into the potential of the implementation of an easy , close-to-home rehabilitation programme . Trial registration The Netherl and s National Trial Register NTR1471 BACKGROUND : The effects of different exercise training programs on the level of physical activity in daily life in patients with COPD remain to be investigated . OBJECTIVE : In patients with COPD we compared the effects of 2 exercise/training regimens ( a high-intensity whole-body endurance- and -strength program , and a low-intensity calisthenics- and -breathing-exercises program ) on physical activity in daily life , exercise capacity , muscle force , health-related quality of life , and functional status . METHODS : We r and omized 40 patients with COPD to perform either endurance- and -strength training ( no. = 20 , mean ± SD FEV1 40 ± 13 % of predicted ) at 60–75 % of maximum capacity ,  or calisthenics- and -breathing-exercises training  ( no. = 20 , mean ± SD FEV1 39 ± 14 % of predicted ) . Both groups underwent 3 sessions per week for 12 weeks . Before and after the training programs the patients underwent activity monitoring with motion sensors , incremental cycle-ergometry , 6-min walk test , and peripheral-muscle-force test , and responded to question naires on health-related quality of life and functional status ( activities of daily living , pulmonary functional status , and dyspnea ) . RESULTS : Time spent active and energy expenditure in daily life were not significantly altered in either group . Exercise capacity and muscle force significantly improved only in the endurance- and -strength group . Health-related quality of life and functional status improved significantly in both groups . CONCLUSIONS : Neither training program significantly improved time spent active or energy expenditure in daily life . The training regimens similarly improved quality of life and functional status . Exercise capacity and muscle force significantly improved only in the high-intensity endurance- and -strength group BACKGROUND Current guidelines on pulmonary rehabilitation ( PR ) recommend upper extremity exercise training ( UEET ) in patients with COPD . However , the literature still questions the effectiveness of systematic UEET in this population . We studied the effects of 15 sessions of unsupported UEET on functional exercise capacity , the ability to perform activities of daily living ( ADL ) , and symptoms perceived during activities involving arms in patients with COPD . METHODS We conducted a r and omized trial that consisted of 3 weeks of inpatient PR , comparing the short-term effects of unsupported UEET plus PR ( intervention group ) to those of PR alone ( control group ) . A change in the 6-min ring test ( 6MRT ) was the primary outcome ; the ADL field test ( four shuttle stations ) , the dyspnea score as assessed by the Medical Research Council scale , the London Chest Activity of Daily Living scale ( LCADL ) , and the distance walked in 6 min served as secondary outcomes of the study . At the 6-month follow-up , we repeated the 6MRT and the LCADL . RESULTS Fifty patients with COPD were r and omly assigned to the two groups and completed the study . At the end of the study period , patients in the intervention group improved in the 6MRT and ADL field test compared with those patients in the control group ( p = 0.018 and p = 0.010 , respectively ) with reduced perception of fatigue ( p < or= 0.006 ) . At the 6-month follow-up , 6MRT ( p = 0.001 ) and LCADL ( p = 0.039 ) scores were still significantly better in the intervention group compared with the control group . CONCLUSIONS Our trial corroborates the effectiveness of unsupported UEET in specifically improving functional exercise capacity of patients with COPD . Moreover , it also provides evidence that this training modality may ameliorate and maintain the patients ' autonomy over and above st and ard PR . TRIAL REGISTRATION Clinical Trials.gov Identifier : NCT00825032 Background : Chronic obstructive pulmonary disease ( COPD ) is a leading cause of death across the world and will become increasingly common with an aging population . Pulmonary rehabilitation ( PR ) is an evidence -based , nonpharmacological intervention for individuals with COPD , targeting the secondary impairments of the disease . Although the benefits of participation in PR are well established , improvements in exercise tolerance and health status typically deteriorate following discharge . Challenges with long-term adherence to recommended exercise regimens are thought to explain much of this decline . Therefore , we developed a community-based exercise maintenance program for patients with COPD following discharge from PR . Objectives This manuscript ( 1 ) outlines the intervention , ( 2 ) describes how its effectiveness is being evaluated in a pragmatic r and omized controlled trial , and ( 3 ) summarizes the embedded process evaluation aim ing to underst and key barriers and facilitators for implementation in new environments . Methods Participating centers refer eligible individuals with COPD following discharge from their local PR program . Consenting patients are assigned to a year-long community exercise program or usual care using block r and omization and stratifying for supplemental oxygen use . Patients in the intervention arm are asked to attend an exercise session at least twice per week at their local community facility where their progress is supervised by a case manager . Each exercise session includes a component of aerobic exercise , and activities design ed to optimize balance , flexibility , and strength . All study participants will have access to routine follow-up appointments with their respiratory physician , and additional health care providers as part of their usual care . Assessment s will be completed at baseline ( post-PR ) , 6 , and 12 months , and include measures of functional exercise capacity , quality of life , self-efficacy , and health care usage . Intervention effectiveness will be assessed by comparing functional exercise capacity between intervention and control groups . A mixed- methods process evaluation will be conducted to better underst and intervention implementation , guided by Normalization Process Theory and the Consoli date d Framework for Implementation Research . Results Based on results from our pilot work , we anticipate a maintenance of exercise capacity and improved health-related quality of life in the intervention group , compared with a decline in exercise capacity in the usual care group . Discussion Findings from this study will improve our underst and ing of the effectiveness of community-based exercise programs for maintaining benefits following PR in patients with COPD and provide information on how best to implement them . If effective , the intervention represents an opportunity to transition patients from institutionally-based rehabilitative management to community-based care . The results of the process evaluation will contribute to the science of translating evidence -based programs into regular practice We compared the effects of a new physical activity education program approach ( EDU ) , based on a periodically supervised protocol of different exercise modalities vs traditionally supervised combined strength-endurance training ( CT ) on health-related factors in patients with stable chronic obstructive pulmonary disease ( COPD ) . Twenty-eight COPD patients without comorbidities were r and omly assigned to receive either EDU or CT . CT was continuously supervised to combine strength-endurance training ; EDU was taught to progressively increase the rate of autonomous physical activity , through different training modalities such as Nordic walking , group classes and circuit training .  Body composition , walking capacity , muscle strength , flexibility and balance , total daily energy expenditure and quality of life were evaluated at baseline , after 28 weeks training period ( 3d/week ) and after a 14-week follow-up . No adverse events occurred during the interventions . After training , CT and EDU similarly improved walking capacity , body composition and quality of life . However , after 14 weeks of follow-up , such improvements were not maintained . Only in CT , muscle strength and flexibility improved after training but returned to baseline after follow-up . EDU , similar to CT , can effectively and safely improve health-related parameters in COPD patients . EDU could be an attractive alternative to traditional supervised training for improving quality of life in COPD patients BACKGROUND : COPD exacerbations are frequent events that have a negative impact on the lives of patients . The aims of this study were to analyze physical and functional impairment during hospital stay in subjects hospitalized due to COPD exacerbation and to assess the physical and functional impact of hospitalization at a 1-month follow-up in patients with severe COPD . METHODS : This was a prospect i ve observational study on a sample of 52 subjects hospitalized due to COPD exacerbation . The assessment s were performed at baseline , discharge , and 1-month follow-up . The outcome measures were dyspnea , muscle strength , functional capacity , and postural steadiness . RESULTS : Quadriceps strength [ 1.036 ( P = .043 ) kg mean difference ] and the one-leg stance test [ 1.04 ( P = .02 ) and 0.73 ( P = .032 ) s mean difference right and left leg ] showed significant impairment during hospitalization . Dyspnea perception improved significantly ( P = .004 ) during hospitalization . Additionally , strength in the upper and lower limbs [ 4.04 ( P = .002 ) and 1.23 ( P = .038 ) kg mean difference ] , functional capacity [ 3.0 number of steps mean difference ( P = .032 ) ] , and the one-leg stance test [ 2.12 ( P = .006 ) and 0.53 ( P = .047 ) s mean difference right and left leg ] showed significant impairment 1-month follow-up . CONCLUSIONS : Hospitalization due to COPD exacerbation leads to physical and functional impairment in patients ; impairment is greater at 1-month follow-up . It would be interesting to conduct physical therapy interventions to prevent the impairment Introduction Chronic obstructive pulmonary disease ( COPD ) is associated with exercise limitation and physical inactivity , which are believed to have significant long-term negative health consequences for patients . While a number of COPD treatments and exercise training programmes increase exercise capacity , there is limited evidence for their effects on physical activity levels , with no clear association between exercise capacity and physical activity in clinical trials . Physical activity depends on a number of behaviour , environmental and physiological factors . We describe the design of the PHYSACTO trial , which is investigating the effects of bronchodilators , either alone or with exercise training , in combination with a st and ardised behaviour-change self-management programme , on exercise capacity and physical activity in patients with COPD . It is hypothesised that bronchodilators in conjunction with a behaviour-change self-management programme will improve physical activity and that this effect will be amplified by the addition of exercise training . Methods and analysis Patients are being recruited from 34 sites in Australia , New Zeal and , the USA , Canada and Europe . Patients receiving a multicomponent intervention design ed to support behaviour change related to physical activity are r and omised to four treatment arms : placebo , tiotropium , tiotropium+olo date rol , and tiotropium+olo date rol+exercise training . The primary outcome is improvement in exercise capacity after 8 weeks , measured by endurance time during a shuttle walk test . The secondary outcome is improvement in physical activity , including objective accelerometer assessment and patient-reported functioning using the Functional Performance Inventory — Short Form and the novel hybrid PROactive instrument . Additionally , the influence of moderating variables ( ie , factors influencing a patient 's choice to be physically active ) on increases in physical activity is also explored . Ethics and dissemination The study has been approved by the relevant Institutional Review Boards , Independent Ethics Committee and Competent Authority according to national and international regulations . The findings of the trial will be disseminated through relevant peer- review ed journals and international conference presentations . Trial registration number NCT02085161 Context Exercise training improves quality of life in patients with chronic obstructive pulmonary disease , but many of these patients can not tolerate continuous exercise . The effects of intermittent exercise are not known . Contribution The authors r and omly assigned 100 in patients with chronic obstructive pulmonary disease in a 3-week respiratory rehabilitation program to receive either high-intensity continuous exercise or high-intensity exercise alternating with low-intensity exercise ( interval exercise ) . After 5 weeks , the 2 groups had similar respiratory symptoms in daily activities and 6-minute walking distance , but the interval exercise group adhered better to the exercise protocol . Caution s The study focused on initiation of exercise and not on outpatient or home-based maintenance of exercise . Implication s For pulmonary rehabilitation , interval exercise is as effective as continuous high-intensity exercise and is better tolerated . The Editors Low exercise capacity is an important systemic manifestation of advanced chronic obstructive pulmonary disease ( COPD ) associated with poor health-related quality of life , exacerbations , and death ( 14 ) . Physical exercise , therefore , represents an important element of COPD management ( 5 , 6 ) . If performed under supervision during respiratory rehabilitation , exercise training improves health-related quality of life and may improve prognosis ( 79 ) . Dyspnea and leg fatigue limit the ability of patients with COPD to exercise , and patient response to exercise is highly variable ( 10 ) . It is challenging to find endurable exercise programs that are still effective . Current guidelines recommend endurance exercise at constant and high intensity ( 70 % of maximum exercise capacity ) ( 11 , 12 ) . For example , if a patient achieves 100 watts in an incremental exercise test , workload would be set at 70 watts for the entire exercise session of at least 20 minute 's duration . Strong evidence from r and omized trials shows that patients achieve clinical ly important improvements of health-related quality of life and exercise capacity with a continuous exercise protocol ( 1316 ) . However , patients with severe COPD are often unable to tolerate continuous exercise ( 17 ) , which can be frustrating for them and can limit their long-term adherence to exercise programs . Effective alternatives to continuous exercise are required to offer this important intervention to more patients with COPD . The American Thoracic Society and the European Respiratory Society state , on the basis of 2 r and omized trials ( 18 , 19 ) , that interval exercise may be an alternative . The benefits of interval exercise may be similar to those of continuous training , but this method is associated with less dyspnea ( 11 , 12 ) . Although studies indicated that interval exercise is well tolerated ( 1821 ) , evidence about its effectiveness relative to continuous exercise is inconclusive ; previous trials had method ological limitations and were small ( 22 ) . Because of perceived better tolerability of interval exercise , r and omized trials should be explicitly design ed to show that interval exercise is no less effective ( clinical noninferiority ) ( 22 ) . Thus , the aim of our trial was to assess whether interval exercise is no less effective than high-intensity continuous exercise in patients with severe COPD and whether patient tolerance of the interval exercise protocol is superior to that of continuous exercise . Methods Design Overview We conducted a r and omized , controlled noninferiority trial to compare the effects of interval exercise with those of high-intensity continuous exercise in patients with severe COPD . We previously described the detailed study protocol ( 23 ) and report this trial following the recommendations of the extended Consoli date d St and ards of Reporting Trials ( CONSORT ) statement for noninferiority and equivalence trials ( 24 ) . Setting The trial took place in a public rehabilitation clinic , Klinik Barmelweid , in Aargau , Switzerl and . The ethics committee of the Kantonsspital Aarau , Aargau , Switzerl and , approved the study protocol , and all study participants provided written informed consent . Participants We screened patients admitted to the respiratory medicine unit and included consecutive patients following inclusion criteria similar to those of previous respiratory rehabilitation trials ( 7 ) : COPD as defined by FEV1FVC ratio less than 70 % of predicted , FEV1 less than 50 % of predicted after bronchodilation corresponding to Global Initiative for Chronic Obstructive Lung Disease ( GOLD ) stage III to IV ( 5 ) , and German as first or daily language . Exclusion criteria included cardiovascular , musculoskeletal , or neurologic disorders that inhibited physical exercise or the performance of exercise tests ( 6 ) . We also excluded patients who had received a diagnosis of cancer ( excluding skin cancer ) within the past 2 years and were undergoing treatment . R and omization and Interventions A third party not involved in the execution of the trial ( DatInf GmbH , Tuebingen , Germany ) provided online central r and omization using a computerized minimization procedure , thereby ensuring concealment of r and omization ( 25 ) . Stratification variables were exercise capacity ( 6-minute walking distance < 300 or 300 meters ) , the presence of affective disorders ( Hospital Anxiety Depression Scale scores < or 8) , stability of pulmonary condition ( stable or exacerbation within the last 8 weeks ) , and the need for oxygen at rest ( Pao 2 < 55 mm Hg or 55 mm Hg ) . Patients followed an inpatient respiratory rehabilitation of approximately 3 week 's duration that included 12 to 15 exercise sessions . On weekdays , patients usually participated in 1 exercise session .  Twelve physical therapists worked with an approximately equal number of patients from both treatment groups . Apart from exercise , the rehabilitation program was identical for both groups and included breathing therapy , relaxation therapy , guided walking tours , and patient education ( 23 ) . At discharge , physiotherapists prescribed home-based exercise for each patient . Patients with cycle ergometers at home were instructed to exercise for at least 20 minutes per day . If no cycle ergometers were available , daily walking , swimming , or stair climbing was prescribed . High-Intensity Continuous Exercise Patients r and omly assigned to this intervention exercised on electromagnetically braked cycle ergometers ( Ergometrics 900S , Ergoline , Bitz , Germany ) with a target workload of 70 % or more of maximum exercise capacity ( Figure 1 ) . This exercise protocol has been used in earlier respiratory rehabilitation trials ( 7 ) . To determine maximum exercise capacity , patients pedaled unloaded for 3 minutes at 20 watts to warm up . Then , we used increments of 7.5 watts per minute until patients had to stop because of symptoms or cardiovascular stopping criteria . In each exercise session , patients completed a warm-up period of 2 minutes at 20 % of maximum exercise capacity , high-intensity exercise for 20 minutes , and a run-out phase of 2 minutes ( gradual decrease from 70 % to 0 % ) . If patients could not sustain the workload because of perceived dyspnea ( modified Borg [ 26 ] ratings > 5 on a scale from 0 to 10 ) or because heart rate exceeded safety limits , physical therapists let patients rest for 1 minute before continuing in the assigned phase . If patients had to rest more than twice per session , physical therapists lowered the workload by steps of 10 % of baseline maximum exercise capacity for the following exercise sessions . If workload was too low ( modified Borg ratings < 3 or patients or physical therapists considered the workload to be too low ) , physical therapists increased the workload by steps of 10 % of baseline maximum exercise capacity . Figure 1 . Exercise protocol s. Interval Exercise The target workload for this group was 50 % ( high-intensity intervals ) and 10 % ( low-intensity intervals ) of short-term maximum exercise capacity as determined by a steep ramp test ( 27 , 28 ) . The steep ramp test is an incremental cycle ergometer test in which patients pedal cycle ergometers unloaded for 2 minutes and then at increments of 25 watts every 10 seconds until they can not maintain a pedaling frequency above 50 pedals per minute or their heart rate exceeds the limit set by the normal incremental exercise test . We used the steep ramp test because workload for interval exercise can be underestimated if it is based on normal incremental exercise tests ( 28 ) . Fifty percent of short-term maximum exercise capacity corresponds , on average , to 90 % to 100 % of normal maximum exercise capacity ( 27 ) . We chose a workrecovery ratio of 1:2 that prevents high lactate accumulation and is well tolerated by patients ( 28 ) . In each session , patients had a warm-up period of 2 minutes at 10 % of the short-term maximum exercise capacity and then exercised for 20 minutes alternating between high-intensity intervals for 20 seconds and low-intensity intervals for 40 seconds ( Figure 1 ) . Patients also had a slowdown period of 2 minutes before completing the training session . We adjusted the exercise load for each patient individually if workload was too high or too low as described earlier ; physiotherapists lowered or increased the workload by steps of 10 % of short-term maximum exercise capacity , but the length of intervals remained constant ( 23 ) . Outcomes and Measurements Our primary outcome for effectiveness was the difference from baseline in Chronic Respiratory Question naire ( CRQ ) scores 5 weeks after r and omization as measured by the self-administered German- language version ( 29 , 30 ) with st and ardized dyspnea questions ( 31 ) . The CRQ is a widely used instrument in respiratory rehabilitation and measures dyspnea , fatigue , emotional functioning , and ability to cope with COPD ( 7 , 32 ) . Domain and total ( average of domains ) scores are presented on a Likert-type scale from 1 ( most severe impairment ) to 7 ( no impairment ) . We selected assessment at 5 weeks after r and omization as the primary outcome STUDY OBJECTIVES To study the short-term and long-term effects of combining activity training or lectures to exercise training on quality of life , functional status , and exercise tolerance . DESIGN R and omized clinical trial . SETTING Outpatient pulmonary rehabilitation center . PARTICIPANTS Forty-three out patients with COPD . INTERVENTIONS Patients were r and omized to one of three treatment groups : exercise training alone , exercise training plus activity training , and exercise training plus a lecture series . The mean treatment period was 10 weeks . MEASUREMENT The Chronic Respiratory Disease Question naire , the modified version of the Pulmonary Functional Status and Dyspnea Question naire , and the COPD Self-Efficacy Scale were administered at baseline , and 6 , 12 , 18 , and 24 weeks from the beginning of the rehabilitation program . The 6-min walk test was used to measure exercise tolerance . RESULTS Benefits of activity training combined with exercise included less dyspnea ( p < or = 0.04 ) and fatigue ( p < or = 0.01 ) , and increased activity involvement ( p < or = 0.02 ) and total functional status ( p < or = 0.02 ) in the short term compared to comparison treatment groups for comparatively older participants . Compared to the lecture series adjunct , the activity training adjunct result ed in significantly higher gains in total quality of life ( p = 0.04 ) maintained at 24 weeks . Significantly worse emotional function and functional status result ed from the lecture series adjunct in the oldest participants ( p < or = 0.03 ) . Treatment groups did not differ significantly on exercise tolerance or self-efficacy . CONCLUSIONS Evidence for additional benefits of activity-specific training combined with exercise was found . A behavioral method emphasizing structured controlled breathing and supervised physical activity was statistically significantly more effective than didactic instruction in facilitating additional gains and meeting participants ' learning needs Physical inactivity in patients with chronic obstructive pulmonary disease ( COPD ) is associated with poor health status and increased disease burden . The present study aims to test the efficacy of a previously developed mobile (m)Health intervention to improve or maintain physical activity in patients with COPD after pulmonary rehabilitation . A r and omised controlled trial was performed in 32 physiotherapy practice s in the Netherl and s. COPD patients were r and omised into intervention or usual care groups . The intervention consisted of a smartphone application for the patients and a monitoring website for the physiotherapists . Measurements were performed at 0 , 3 , 6 and 12 months . Physical activity , functional exercise capacity , lung function , health-related quality of life and body mass index were assessed . 157 patients started the study and 121 completed it . There were no significant positive effects of the intervention on physical activity ( at 0 months : intervention 5824±3418 steps per weekday , usual care 5717±2870 steps per weekday ; at 12 months : intervention 4819±2526 steps per weekday , usual care 4950±2634 steps per weekday ; p=0.811 ) or on the secondary end-points . There was a significant decrease over time in physical activity ( p<0.001 ) , lung function ( p<0.001 ) and mastery ( p=0.017 ) , but not in functional exercise capacity ( p=0.585 ) . Although functional exercise capacity did not deteriorate , our mHealth intervention did not improve or maintain physical activity in patients with COPD after a period of pulmonary rehabilitation . mHealth intervention does not improve or maintain physical activity in COPD patients after pulmonary rehabilitation PURPOSE To compare the effects on exercise capacity and health related quality of life ( HRQoL ) of two exercise programmes ; one programme including endurance training and one including only resistance training and callisthenics . A second purpose was to find out whether the severity of chronic obstructive pulmonary disease ( COPD ) affected the training response and whether the interventions had a long-term effect . METHODS Sixty-three patients were stratified according to severity of COPD and r and omised to two training groups . Group A had a mixed programme including endurance training . Group B had resistance training and callisthenics . All trained twice weekly for 8 weeks . A symptom-limited ergometer test , 12-min walking test , dynamic spirometry , blood gas analysis at rest and HRQoL were measured before and after the training period . Follow-up tests were conducted at 6 and 12 months after training . RESULTS Forty-two patients fulfilled the trial . In group A ( n=20 ) peak exercise capacity increased by 7W ( P<0.001 ) and 12-min walking distance ( 12MWD ) by 50 m ( P<0.01 ) , whereas group B ( n=22 ) did not change in any of these variables . HRQoL did not change significantly in either group . Training response was similar in patients with moderate and severe disease . One year post-training 12MWD had returned to pre-training level in group A , and below pre-training level in group B ( P<0.05 ) . CONCLUSIONS Exercise capacity in patients with severe and moderate COPD improved by intensive endurance training , two sessions a week for 8 weeks . The improvement was however small and HRQoL did not improve . Severity of illness did not affect response to training . The results indicated that the effects of a short endurance training intervention slowed down decline in baseline functional exercise capacity for 1 year Background The effectiveness of clinic-based pulmonary rehabilitation in advanced COPD is well established , but few data exist for less severe patients treated in alternative setting s. The purpose of this study was to investigate whether a novel , community-based exercise program ( CBE ) was feasible and effective for patients with moderate COPD . Methods Nineteen patients with moderate COPD ( mean FEV1 62 % ) and self-reported exercise impairment were r and omized to 12-weeks of progressive endurance and strength training at a local health club under the guidance of a certified personal trainer , or to continuation of unsupervised habitual physical activity . Outcomes assessed at baseline and 12 weeks included session compliance , intensity adherence , treadmill endurance time , muscle strength , dyspnea , and health status . Results Compliance was 94 % and adherence was 83 % . Comparisons between CBE and control groups yielded the following mean ( SEM ) differences in favor of CBE : endurance time 134 ( 74 ) seconds versus -59 ( 49 ) seconds ( P = 0.041 ) and TDI 5.1 ( 0.8 ) versus -0.2 ( 0.5 ) ( P < 0.001 ) . The CBE group increased muscle strength ( weight lifted ) by 11.8 kilograms per subject per week of training ( P < 0.001 ) . SGRQ was not significantly changed . Conclusions We demonstrated the feasibility and effectiveness of a novel community-based exercise program involving health clubs and personal trainers for patients with moderate COPD .Trial registration Clinical Trials.gov Identifier NCT01985529 ABSTRACT The objective of this study was to determine whether an exercise intervention using a pedal exerciser is able to reduce disability in frail older patients with chronic obstructive pulmonary disease ( COPD ) during hospitalization due to an acute exacerbation . This study was a r and omized , single-blind clinical trial . Fifty-eight frail older patients admitted to hospital due to an acute exacerbation of COPD ( AE COPD ) were included in this study . All patients received st and ard medical and pharmacological care . Patients assigned to the intervention group also received an exercise intervention . The main outcome measures were balance , muscle strength , and exercise capacity . Significant between-group differences were found in muscle strength ( p = 0.028 ) and balance ( p = 0.013 ) after the intervention . All the variables improved significantly ( p < 0.05 ) in the exercise intervention group . In the intervention group , the mean difference in muscle strength between baseline and discharge was 10.47 N. Balance also improved , showing a mean difference of 7.56 seconds on the right leg and 6.57 seconds on the left leg . Exercise capacity improved as well , with a difference of 4.97 st and s between baseline and discharge . All the variables showed impairment in the control group . In conclusion , an exercise intervention using a pedal exerciser during the hospital stay of frail elderly patients with an AE COPD improves muscle strength , balance , and exercise capacity Background Pulmonary rehabilitation programs often fail to substantially enhance long-term physical activity in patients with chronic obstructive pulmonary disease ( COPD ) . The reasons for successful physical activity changes in patients with COPD are not well understood . The need to better underst and the determinants of physical activity in patients with COPD and effective rehabilitation strategies to improve physical activity is evident . Methods / design The STAR study ( Stay Active after Rehabilitation ) investigates , in a r and omized controlled trial , the additional effect of a pedometer-based behavior-change intervention during inpatient pulmonary rehabilitation on objective ly measured physical activity 6 weeks and 6 months post rehabilitation . The intervention uses the behavior-change techniques ( 1 ) instruction on how , where and when to perform the behavior , ( 2 ) prompt goal setting for physical activity , ( 3 ) prompt self-monitoring of behavior , and ( 4 ) feedback on behavior . The primary outcome of physical activity will be measured using a physical activity monitor ( Actigraph wGT3X-BT )  for a period of 7 days , firstly 2 weeks before rehabilitation begins ( t0 ) as well as 6 weeks and 6 months after rehabilitation ( t3 , t4 ) . Additionally , to predict physical activity progression after rehabilitation , a complex personal diagnostics battery , including question naires as well as functional assessment s , is to be carried out at the start and end of rehabilitation ( t1 , t2 ) . This battery is based on the foundational ideas of the Physical Activity-Related health Competence model . Five hundred and two patients with COPD , aged 18 years or older and admitted for an approved pulmonary rehabilitation , will be enrolled in the STAR study . Discussion The STAR study is design ed as a r and omized controlled trial to gain a better underst and ing of the personal determinants of physical activity in patients with COPD and to evaluate a pedometer-based physical activity-change intervention in the context of inpatient pulmonary rehabilitation . The results enable the future identification of patients with COPD who will find it difficult to engage in long-term physical activity after rehabilitation . Based on this , intervention strategies to promote physical activity in the content of pulmonary rehabilitation can be optimized . Trial registration Clinical trials.gov , ID : NCT02966561 . Registered retrospectively after the start of the recruitment in June 2016 on 22 November 2016 . All protocol modifications will be registered in the trial registry The aim of this study was to examine the effect of high intensity physical group training in water and on l and for patients with COPD with regard to physical capacity and health related quality of life ( HRQoL ) . A controlled , semi-r and omised study was conducted where 30 patients were r and omised to training either in water or on l and . Thirteen patients constituted a control group . Forty-three out patients , with moderate to severe COPD ( 27w/16 m ) , from two local hospitals in northern Sweden , were included in the study . High intensity physical group training in water ( water group ) or on l and ( l and group ) was performed for 12weeks , three times per week , 45min per session . The control group received no intervention . Pre- and post-intervention , all patients performed incremental and endurance shuttle walking tests ( ISWT and ESWT ) ,  cycle ergometer tests  and  responded question naires about HRQoL ( St. Georges Respiratory Question naire -- SGRQ and SF-36 ) . The patients trained with a mean heart rate of 80 - 90 % of peak heart rate . Both training groups increased the distance walked , i.e. l and group in ISWT ( 25 m ) and water group in ESWT ( 179 m ) . The water group increased the distance in ESWT significantly more that both the l and and the control groups . Both training groups increased the time cycled ( 40 - 85s ) and work load ( 10 - 20W ) in the cycle ergometer test . The control group deteriorated in HRQoL according to total score in SGRQ while the training groups remained constant . The water group improved their activity score in SGRQ and their physical health score in SF-36 and those improvements were significant as compared to the l and and the control groups . In conclusion , high intensity physical group training in water is of benefit for patients with COPD . It was in some areas found to be even more effective regarding improvements in physical capacity and experienced physical health compared to the same kind of training on l and Background Exercise training has been incorporated into the international guidelines for the treatment of chronic obstructive pulmonary disease ( COPD ) . However , the long-term efficacy of the training program for patients with advanced COPD has never been evaluated in Thail and . Purpose To determine the long-term efficacy of intensive cycle ergometer exercise program on various clinical parameters of patients with advanced COPD . Material s and methods The patients with advanced COPD were separated into two groups : the intensive ergometer exercise program group and the control group . The clinical parameters of all the patients were assessed at baseline , every month for the first 3 months , and then every 3 months until they had completed the 24-month follow-up . Mann – Whitney U test was used to compare baseline mean differences between the groups . Repeated measure analysis was applied to determine the progress in all parameters during the entire follow-up period . Mean incase imputation method was applied to estimate the parameters of dropout cases . Results A total of 41 patients were enrolled : 27 in the intensive ergometer exercise program group and 14 in the control group . The intensive cycle ergometer exercise program group showed statistically significant improvements in muscle strength ( from month 1 till the end of the study , month 24 ) , endurance time ( from month 1 till the end of measurement , month 12 ) and clinical ly significant improvements in 6-minute walk distance ( from month 2 until month 9 ) , dyspnea severity by transitional dyspnea index ( from month 1 till the end of the study , month 24 ) , and quality of life ( from month 1 till the end of the study , month 24 ) . There was no significant difference in survival rates between the groups . Conclusion The intensive ergometer exercise training program revealed meaningful long-term improvements in various clinical parameters for up to 2 years . These promising results should encourage health care professionals to promote exercise training for patients with advanced COPD who have limited daily activities despite optimal medication control Purpose The purpose of this study was to compare functional capacity and daily activity between two exercise rehabilitation interventions in severe chronic obstructive pulmonary disease ( COPD ) or heart failure with reduced ejection fraction ( HFrEF ) over 6 months . Secondarily , we compared intervention groups on symptoms , depression , quality of life , and cardiopulmonary function . Design / Methods Ninety patients with severe COPD ( n = 63 ) or HFrEF ( n = 27 ) were r and omized to either an exercise adherence intervention or st and ard cardiopulmonary rehabilitation .  Patients were 65-year-old male veterans who had either severe COPD ( FEV1 < 50 % predicted ) or HFrEF ( EF% < 40 % ) . Results There were no statistically significant differences between the intervention groups or COPD or HfrEF groups on functional capacity , daily activity , symptoms , depression , quality of life , or cardiopulmonary function at 6 months . Conclusion In late-stage COPD and HFrEF , functional capacity is not improved with rehabilitation interventions . Clinical Relevance In severe COPD and heart failure , cardiopulmonary rehabilitation conducted at home or in the outpatient setting was not beneficial
Good repeatability ( for the 6MWT and ESWT ) and reproducibility ( for the 6MWT , 12-minute walk test , ISWT , ESWT , and incremental cycle ergometer test ) were reported by most studies assessing these tests , providing patients were familiarized with them beforeh and .
The 6MWT , ISWT , and particularly the ESWT were reported to be sensitive to therapeutic intervention .
Exercise tests are often used to evaluate the functional status of patients with COPD .
However , to the best of our knowledge , a comprehensive systematic comparison of these tests has not been performed .
We systematic ally review ed studies reporting the repeatability and /or reproducibility of these tests , and studies comparing their sensitivity to therapeutic intervention .