Efficacy of a physical exercise training programme COPD in primary care: study protocol of a randomized controlled trial Exercise training in COPD: how to distinguish responders from nonresponders. Early Rehabilitation Exercise Program for Inpatients During an Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A RANDOMIZED CONTROLLED TRIAL Rehabilitation of patients with chronic obstructive pulmonary disease. Exercise twice a week is not sufficient! Interval versus Continuous High-Intensity Exercise in Chronic Obstructive Pulmonary Disease Strength training increases maximum working capacity in patients with COPD--randomized clinical trial comparing three training modalities. Enhancing exercise tolerance and physical activity in COPD with combined pharmacological and non-pharmacological interventions: PHYSACTO randomised, placebo-controlled study design Long-term efficacy and effectiveness of a behavioural and community-based exercise intervention (Urban Training) to increase physical activity in patients with COPD: a randomised controlled trial Interval training as an alternative modality to continuous exercise in patients with COPD Effects of Combined Aerobic-Strength Training vs Fitness Education Program in COPD Patients. [Exercise training in chronic obstructive pulmonary disease. Comparative study of aerobic training of lower limbs vs. combination with upper limbs]. Effectiveness of a combined exercise training and home-based walking programme on physical activity compared with standard medical care in moderate COPD: a randomised controlled trial. A controlled study of community-based exercise training in patients with moderate COPD Effects of a Community-Based, Post-Rehabilitation Exercise Program in COPD: Protocol for a Randomized Controlled Trial With Embedded Process Evaluation Effects of an Exercise Intervention in Frail Older Patients with Chronic Obstructive Pulmonary Disease Hospitalized due to an Exacerbation: A Randomized Controlled Trial Water-based exercise in COPD with physical comorbidities: a randomised controlled trial The effects of resistance training on functional outcomes in patients with chronic obstructive pulmonary disease
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 PURPOSE Pulmonary rehabilitation programs consistently have improved exercise capacity , quality of life , and symptoms over the past decade . Although training has been shown to be an essential component of the rehabilitation program , individual patients do not always benefit to the same extent . The present study was design ed to investigate which patients were achieving significant benefit of exercise training . METHODS Forty-nine stable out patients with moderate to severe COPD ( FEV1 37 (15)%pred ) were evaluated before and after 12 weeks of exercise training ( 3 times per week ) . Responders in exercise capacity were defined as having 15 % increase in maximal workload and /or 25 % increase in walking distance , while responders in quality of life showed an improvement of at least 10 points on the chronic respiratory disease question naire . With multivariate discriminant analysis , responders were distinguished from nonresponders based upon their initial characteristics . RESULTS Thirty-two patients were responders in terms of improved exercise capacity . Ventilatory reserve ( VE/MVV ) , inspiratory muscle strength ( Plmax ) , and peripheral muscle strength ( h and grip force and quadriceps force ) were significant predictors of the training response ( P < 0.05 ) ( accuracy 80 % P < 0.001 ) . Although the explained variance was modest , patients that were clearly ventilatory limited and had normal skeletal muscle strength were not likely to benefit from exercise training in terms of exercise capacity . No physiologic variables predicted whether a patient would increase quality of life after exercise training . CONCLUSION Patients with reduced exercise capacity who experience less ventilatory limitation to exercise and more reduced respiratory and peripheral muscle strength  are more likely to improve with exercise training . Improvements in quality of life after exercise training were significant but remained unpredictable with variables included in the present trial PURPOSE : To determine whether an early rehabilitation program was safe and feasible for patients during an acute exacerbation of chronic obstructive pulmonary disease ( COPD ) . METHODS : In this phase 1 r and omized controlled trial , patients with an acute exacerbation of COPD admitted to the hospital were r and omly allocated to a low-intensity exercise group , a moderate- to high-intensity exercise group , or a control group , who received routine physical therapy . In addition to routine physical therapy , patients in the exercise group had to participate in an exercise program . The program consisted of twice-daily aerobic and resistance exercise sessions . Primary outcomes were the number and classification of adverse events and program adherence . RESULTS : In 174 exercise sessions , there was 1 serious adverse event of arrhythmia in the low-intensity exercise group that resolved within 1 hour . There were 12 other minor adverse events involving 5 patients with no significant differences between groups . Patients completed an average of 80 % of their scheduled sessions with no significant between-group differences . The exercise groups improved significantly in walking distance ; however , no significant between-group differences were observed . CONCLUSIONS : There was preliminary evidence that it was safe and feasible to implement an exercise program for patients during an acute exacerbation of COPD . Additional studies with larger sample sizes are required to accurately evaluate program effectiveness Several studies of chronic obstructive pulmonary disease ( COPD ) have shown that pulmonary rehabilitation , consisting of at least three training sessions a week , improves exercise performance and health status . This study investigates feasibility , effect and economic aspects of a rehabilitation programme consisting of two sessions a week for 8 weeks . Twenty-four patients with moderate COPD were r and omized to rehabilitation and 21 to placebo .  Patients were assigned to an 8-week programme of exercise plus education ( Exercise group ) or conventional community care ( Placebo group ) . The rehabilitation program was carried out in a hospital outpatient setting and consisted of 16 h exercise and 13.5 h of education . The exercise group received physiotherapy and education twice a week . Seven patients did not complete the programme . The characteristics of the 38 COPD - patients at baseline were the following : ( mean + /- SD ) forced expiratory volume in 1 sec ( FEV1 ) 1.1+/-0.4 1 ( 47 % of predicted ) , 6-min walking distance ( 6MWD ) 413+/-75 m , score of St. George 's Respiratory Question naire ( SGRQ ) 44+/-21 . Health-status , assessed by SGRQ and The Psychological General Well-being ( PGWB ) Index , did not improve . Rehabilitation result ed in an insignificant improvement in the 6MWD [ 29 m ( 95 % confidence interval : -8 -66 m ) ] . We conclude that a rehabilitation program consisting of exercise and education twice a week for 8 weeks had no effect on exercise performance and well being in patients with moderate COPD 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 BACKGROUND AND OBJECTIVE Skeletal muscle dysfunction contributes to exercise limitation in patients with chronic obstructive pulmonary disease ( COPD ) .  Strength training increases muscle strength and muscle mass , but there is an ongoing debate on the additional effect concerning the exercise capacity . The purpose of this study was to compare the effects of three different exercise modalities in patients with COPD including endurance training ( ET ) , progressive strength training ( ST ) and the combination of strength training and endurance training ( CT ) . DESIGN A prospect i ve r and omized trial . METHODS Thirty-six patients with COPD were r and omly allocated either to ET , ST , or CT .  Muscle strength , cardiopulmonary exercise testing , lung function testing and quality of life were assessed before and after a 12-week training period . RESULTS Exercise capacity ( Wmax ) increased significantly in all three training groups with increase of peak oxygen uptake ( VO2peak ) in all three groups , reaching statistical significance in the ET group and the CT group . Muscle strength ( leg press , bench press , bench pull ) improved in all three training groups , with a higher improvement in the ST ( + 39.3 % , + 20.9 % , + 20.3 % ) and the CT group ( + 43.3 % , + 18.1 % , + 21.6 % ) compared to the ET group ( + 20.4 % , + 6.4 % , + 12.1 % ) . CONCLUSIONS Progressive strength training alone increases not only muscle strength and quality of life , but also exercise capacity in patients with COPD , which may have implication s in prescription of training modality . CLINICAL TRIALS.GOV IDENTIFIER : NCT01091623 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 There is a need to increase and maintain physical activity in patients with chronic obstructive pulmonary disease ( COPD ) . We assessed 12-month efficacy and effectiveness of the Urban Training intervention on  physical activity  in COPD patients . This r and omised controlled trial ( NCT01897298 ) allocated 407 COPD patients from primary and hospital setting s 1:1 to usual care  ( n=205 ) or Urban Training  ( n=202 ) . Urban Training consisted of a baseline motivational interview , advice to walk on urban trails design ed for COPD patients in outdoor public spaces and other optional components for feedback , motivation , information and support ( pedometer , calendar , physical activity brochure , website , phone text messages , walking groups and a phone number ) . The primary outcome was 12-month change in steps·day−1 measured by accelerometer . Efficacy analysis ( with per- protocol analysis set , n=233 classified as adherent to the assigned intervention ) showed adjusted ( 95 % CI ) 12-month difference + 957 ( 184–1731 ) steps·day−1 between Urban Training and usual care . Effectiveness analysis ( with intention-to-treat analysis set , n=280 patients completing the study at 12 months including unwilling and self-reported non-adherent patients ) showed no differences between groups . Leg muscle pain during walks was more frequently reported in Urban Training than usual care , without differences in any of the other adverse events . Urban Training , combining behavioural strategies with unsupervised outdoor walking , was efficacious in increasing physical activity after 12 months in COPD patients , with few safety concerns . However , it was ineffective in the full population including unwilling and self-reported non-adherent patients . Urban Training in COPD increased physical activity after 12 months but not in self-reported non-adherent patients Underst and ing of what constitutes a training load adequate to induce training effects in patients with chronic obstructive pulmonary disease ( COPD ) is still evolving . The present study investigated whether interval training ( IT ) is effective in terms of inducing measurable improvements in physiological response and compared its effects on exercise tolerance ( ET ) and quality of life to those of continuous training ( CT ) . Thirty-six COPD patients , with a forced expiratory volume in one second of 45±4 % of the predicted value ( mean±sem ) , were r and omly assigned to CT ( exercise at 50 % of baseline peak work-rate ) or IT ( work for 30 s at 100 % of peak work-rate alternating with 30‐s rest intervals ) groups that cycled 40 min·day−1 and 2 days·week−1 for 12 weeks . After training , both groups showed significantly improved ET ( IT , 57±6 to 71±8 W ; CT , 57±5 to 70±6 W ) and total quality -of-life score of the Chronic Respiratory Disease Question naire ( IT , 77±3 to 88±2 ; CT , 78±3 to 93±2 ) . At identical levels of exercise , minute ventilation was significantly reduced ( IT , 35.8±2.5 to 31.7±2.5 L·min−1 ; CT , 36.4±2.7 to 32.5±2.7 L·min−1 ) . The magnitude of improvement in these variables was not significantly different among groups . The present data exp and on the principles of exercise prescription for chronic obstructive pulmonary disease patients by demonstrating that interval training elicits substantial training effects , which are similar in magnitude to those produced by continuous training at half the exercise intensity but double the exercise time 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 A prospect i ve , r and omized and controlled study has been performed in 28 patients with severe COPD . A group of 14 has been trained with their lower limbs ( LL ) , while another similar group of 14 patients was also trained with their upper limbs ( UL ) . Results showed improvement in both groups in the endurance test for LL , dyspnea scale , efficiency and muscular working capacity . A considerable improvement was observed in the oxygen uptake at the anerobic threshold ( VO2AT ) which suggests a training effect , expressed through an improvement in exercise tolerance . Only the group who trained UL showed a remarkable improvement in the dyspnea scale , endurance test and maximal static mouth pressure , showing a better intrinsic working capacity and participation of the UL muscles producing those manoeuvres . At the end of training , quality of life was significantly increased and the hospitalization rate was lower in both groups . According to these findings , it is suggested that patients with severe COPD included in training programmes add UL exercises to the LL usually carried out OBJECTIVE To estimate the effectiveness of a 10-week combined exercise training and home-based walking programme on daily physical activity ( PA ) compared with st and ard medical care in patients with moderate chronic obstructive pulmonary disease ( COPD ) . DESIGN R and omised controlled trial . SETTING Primary care physiotherapy . PARTICIPANTS Consecutive patients with stable COPD at Gold Stage II with a score of two or more on the Medical Research Council Dyspnoea Scale . INTERVENTION Ten-week combined exercise training and home-based walking programme compared with st and ard medical care . MAIN OUTCOMES At baseline and after 10 weeks , daily PA was evaluated by accelerometry using three levels of intensity and expressed as metabolic equivalent of task . In addition , daily activities ( Physical Activity Scale for the Elderly ) , functional exercise capacity ( 6-minute Walk Test ) , health-related quality of life ( Chronic Respiratory Question naire ) and exercise self-efficacy ( Exercise Self-Regulatory Efficacy Scale ) were measured . RESULTS Fifty-two patients { 34 females ; mean age 70.2 [ st and ard deviation ( SD ) 9.5 ] years ; mean forced expiratory volume in 1second 67 % ( SD 9.2 ) of predicted } were r and omised .  PA , adjusted for baseline differences , increased significantly in the intervention group compared with the control group , by 26.1minutes/day [ 95 % confidence interval ( CI ) 7.3 to 44.9 ] . The increase in functional capacity between groups was clinical ly relevant ( 34.0 m , 95 % CI 2.3 to 65.6 ) in favour of the intervention group . CONCLUSIONS A combined exercise training and home-based walking programme in primary care physiotherapy improved PA in patients with moderate COPD . Clinical trial registration number NL24766.018.08 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 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 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 L and -based exercise is often difficult for people with chronic obstructive pulmonary disease ( COPD ) who have coexisting obesity or musculoskeletal or neurological conditions . This r and omised controlled trial aim ed to determine the effectiveness of water-based exercise training in improving exercise capacity and quality of life compared to l and -based exercise training and control ( no exercise ) in people with COPD and physical comorbidities . Participants referred to pulmonary rehabilitation were r and omly allocated to a water-based exercise , l and -based exercise or the control group . The two exercise groups trained for 8 weeks , completing three sessions per week . 45 out of 53 participants ( mean±sd age 72±9 years ; forced expiratory volume in 1 s 59±15 % predicted ) completed the study . Compared to controls , water-based exercise training  significantly increased 6-min walking distance , incremental and endurance shuttle walk distances , and improved Chronic Respiratory Disease Question naire ( CRDQ ) dyspnoea and fatigue . Compared to l and -based exercise training , water-based exercise training significantly increased incremental shuttle walk distance ( mean difference 39 m , 95 % CI 5–72 m ) , endurance shuttle walk distance ( mean difference 228 m , 95 % CI 19–438 m ) and improved CRDQ fatigue  . Water-based exercise training was significantly more effective than l and -based exercise training and control in increasing peak and endurance exercise capacity and improving aspects of quality of life in people with COPD and physical comorbidities Aerobic exercise training is used for rehabilitation in patients with chronic obstructive pulmonary disease ( COPD ) , although it has little effect on muscle weakness and atrophy . Resistance training may be a useful addition to aerobic programs for these patients . The purpose of the present study was to investigate the effects of resistance training in addition to aerobic training on functional outcomes in patients with COPD . Seventeen COPD patients enrolled in an aerobic-based program that met twice a week were assigned to a 12-week control/aerobic [ CON : n=8 ; 63 ( 8) years ; mean ( SD ) ] or a resistance/aerobic group [ RES : n=9 ; 61 ( 7 ) years ] . RES trained an additional twice a week on 12 resistance machines , performing three sets of 8–12 repetitions at 32–64 % of their one-repetition maximum ( 1-RM ) lifts . RES ( P<0.05 ) increased upper ( 36 % ) and lower ( 36 % ) body strength , as well as lean body mass ( 5 % ) , while CON showed little to no change . The 12-min walk distance increased ( P<0.05 ) in only the RES [ 676 ( 219 ) to 875 ( 172 ) m ] . Measurements of three of the eight tasks of activities of daily living improved in RES ( P<0.05 ) compared to CON . This study demonstrated that progressive resistance training was well tolerated and improved functional outcomes in COPD patients that were currently involved in an aerobic training program
Meta- analysis revealed few clinical ly relevant and statistically significant benefits of " add-on " therapies on exercise performance compared with exercise training .
The aim of this review was to identify the effectiveness of therapies added on to conventional exercise training to maximise exercise capacity in patients with chronic obstructive pulmonary disease ( COPD ) .