Comparison of the effect of upper body-ergometry aerobic training vs treadmill training on central cardiorespiratory improvement and walking distance in patients with claudication. Walk2Bactive: A randomised controlled trial of a physical activity-focused behavioural intervention beyond pulmonary rehabilitation in chronic obstructive pulmonary disease. Enhancing exercise tolerance and physical activity in COPD with combined pharmacological and non-pharmacological interventions: PHYSACTO randomised, placebo-controlled study design P300, N400, aerobic fitness, and maximal aerobic exercise. Potential effect of 6 versus 12-weeks of physical training on cardiac autonomic function and exercise capacity in chronic obstructive pulmonary disease. The relationship of age and cardiovascular fitness to cognitive and motor processes. Maintaining Physical Fitness and Function in Alzheimer’s Disease Cardiorespiratory fitness and cognitive functioning following short-term interventions in chronic stroke survivors with cognitive impairment: a pilot study The impact of noninvasive ventilation during the physical training in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD). Supervised exercise training improves exercise cardiovascular function in idiopathic pulmonary fibrosis. Changes in cardiorespiratory fitness, psychological wellbeing, quality of life, and vocational status following a 12 month cardiac exercise rehabilitation programme. Aerobic exercise training does not alter vascular structure and function in chronic obstructive pulmonary disease A web-based physical activity intervention benefits persons with low self-efficacy in COPD: results from a randomized controlled trial Influence of the resistance training on heart rate variability, functional capacity and muscle strength in the chronic obstructive pulmonary disease. Exercise therapy, cardiorespiratory fitness and their effect on brain volumes: A randomised controlled trial in patients with schizophrenia and healthy controls Interval versus Continuous High-Intensity Exercise in Chronic Obstructive Pulmonary Disease Determinants and outcomes of change in physical activity in COPD
BACKGROUND Supervised treadmill-walking exercise programs have been proven to be a highly effective in improving walking distance in peripheral arterial disease ( PAD ) patients with lifestyle-limiting claudication . Limited information is available on the contributions of central cardiorespiratory functions for improving these patients ' walking capacity with exercise training . METHODS This study r and omized 28 participants ( 21 men ; age , 65.6 years ; 92.7 % smoking history , 36.6 % with diabetes ) with lifestyle-limiting PAD-related claudication to 3 hours/week of supervised exercise training for 12 weeks  , using arm-ergometry ( n = 10 ) or treadmill-walking ( n = 10 ) vs a usual-care control group ( n = 8) . Cardiorespiratory function measurements were assessed before and after training at a submaximal workload and at the onset of claudication ( pain-free walking distance [ PFWD ] ) and at maximal walking distance [ ( MWD ] ) . Changes in these functions from baseline were analyzed among the groups with analysis of covariance . Associations between variables were determined by Pearson 's partial correlations . RESULTS The mean baseline demographic , medical , and exercise variables were similar among the groups . There were similar significant differences in the submaximal double product ( heart rate × systolic blood pressure ) and at MWD , ventilatory threshold , ventilatory oxygen uptake ( VO(2 ) ) at onset of claudication , and VO(2 ) peak in response to training in both exercise groups vs the control group . Statistically significant , moderate correlations ( r = 0.60 - 0.68 ) were found between changes in all cardiorespiratory variables and changes in PFWD or MWD . CONCLUSION Improvements in cardiorespiratory function after arm-ergometry or treadmill-training were significantly associated with improvements in both PFWD and MWD , providing supporting evidence of systemic contributions to exercise training-related improvements in walking capacity seen in patients with claudication The aim of this study was to investigate the impact of a physical activity (PA)-focused behavioural intervention during and after  pulmonary rehabilitation ( PR ) on PA levels ( primary aim ) , health-related outcomes and self-efficacy ( secondary aims ) of patients with COPD . Thirty-two patients were r and omly assigned to an experimental group ( EG ) or control group ( CG ) . The EG received a PA-focused behavioural intervention during PR ( 3 months ) and follow-up support ( 3 months ) . The CG received PR ( 3 months ) . Daily PA was collected : number of steps ; time spent in moderate-to-vigorous PA ( MVPA ) , total PA and sedentary activities ( SA ) . Secondary outcomes comprised exercise capacity , muscle strength , health-related quality of life ( HRQOL ) and self-efficacy . Measures were collected at baseline , 3 and 6 months . Compared with the CG , the EG improved the number of steps ( p = 0.006 ) and time spent in MVPA ( p = 0.007 ) , total PA ( p = 0.014 ) and SA ( p = 0.018 ) at 3 months . Differences were maintained after follow-up support ( 0.025 ≤ p ≤ 0.040 ) , except for SA ( p = 0.781 ) . Exercise capacity , muscle strength and HRQOL were increased at 3 and 6 months ( p ≤ 0.002 ) with no between-group differences ( 0.148 ≤ p ≤ 0.987 ) . No changes were observed in self-efficacy ( p = 0.899 ) . A PA-focused behavioural intervention during and after PR may improve patients ' PA levels . Further research is warranted to assess the sustainability of the findings 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 Electrophysiological effects of aerobic fitness and maximal aerobic exercise were investigated by comparing P300 and N400 before and after a maximal cycling test . Event-related potentials ( ERPs ) were obtained from 20 students divided into two matched groups defined by their aerobic fitness level ( cyclists vs. sedentary subjects ) . The session of postexercise ERPs was performed immediately after body temperature and heart rate returned to preexercise values . At rest , no significant differences were observed in ERP parameters between cyclists and sedentary subjects . This finding argued against the hypothesis that ERP modifications may be directly assumed by aerobic fitness level . The postexercise session of ERPs showed a significant P300 amplitude increase and a significant P300 latency decrease in all subjects . Similarly , N400 effect increased significantly after the maximal exercise in all subjects . ERP changes were of the same magnitude in the two groups . The present study argues for a general arousing effect of maximal aerobic exercise , independently of the aerobic fitness level BACKGROUND Exercise is an important part of chronic obstructive pulmonary disease ( COPD ) treatment . However , it is not know about the minimum effective time of physical training that could beneficially modify the cardiac autonomic modulation ( CAM ) and exercise capacity in these patients . AIM To contrast the potential effects of a physical training program ( PTP ) , for 6 versus 12 weeks , on CAM by linear and nonlinear heart rate variability ( HRV ) indices and exercise capacity in COPD patients . DESIGN Prospect i ve r and omized controlled trial . SETTING Outpatient pulmonary rehabilitation . POPULATION Twenty moderate-to-severe COPD patients were r and omly assigned to either a training group ( N.=10 ) or a control group ( N.=10 ) . METHODS HRV at rest and during submaximal test was determined by linear ( rMSSD and SDNN ) and non-linear indices ( SD1 , SD2 and sample entropy [ SE ] ) . In addition , key responses were obtained during  cardiopulmonary exercise testing ( CPET ) , the walking distance ( WD ) during the six minute walking test and submaximal constant speed testing ( CST ) . PTP consisted of 30 minutes of aerobic exercise training on a treadmill , 3 times per week at 70 % of CPET peak speed rate . Patients were evaluated on baseline , 6 and 12 weeks . RESULTS Significant improvements in HRV indices , WD , as well as , other physiological responses were observed after 6 weeks of the PTP and maintained until 12 weeks ( P<0.05 ) . However , after 12 weeks , the SD1 index demonstrated an additional improvement compared with 6 weeks ( P<0.05 ) . Peak oxygen uptake and dioxide carbon production improved only after 12 weeks ( P<0.05 ) . Interestingly , the 6th week-baseline delta ( 6th week-baseline ) of WD , SDNN and SE were significantly higher than 12th week-6th week delta ( P<0.05 ) . CONCLUSION These results indicate that beneficial changes on cardiac autonomic modulation in conjunction with improvement in submaximal functional capacity occur in the first 6 weeks of PTP in moderate to severe COPD . CLINICAL REHABILITATION IMPACT Short-term rehabilitation ( 6 weeks ) is an effective sufficient time to beneficially modify important outcomes as cardiac modulation and exercise capacity in COPD patients Older and younger aerobically trained and sedentary adults participated in an S1-S2-S3 paradigm design ed to elicit event-related potential ( ERP ) and behavioral responses to determine the influence of cardiovascular fitness on cognitive and motor processes . The paradigm provided warning ( S1 ) as to the difficulty level of an upcoming decision task ( S2 ) . Participants had to decide the taller of two bars on presentation of S2 but hold their response until S3 , to which they indicated their choice motorically . Results revealed age-related differences for ERP measures as older participants showed increased amplitude of the stimulus preceding negativity ( SPN ) prior to S2 , and longer latencies and equipotentiality of P3 in response to S2 . Fitness effects were also observed for the contingent negative variation ( CNV ) with decreased amplitude for fit relative to sedentary individuals . Age interacted with fitness for P3 latency to S2 as older sedentary individuals showed the longest latency followed by older fit and both younger groups . No significant group differences were observed for reaction time ( RT ) to S3 . Therefore , physical fitness is associated with attenuation of cognitive decline in older individuals and greater economy of motor preparation for both young and older participants Background : Little is known about how aerobic exercise affects physical functioning in persons with Alzheimer ’s disease ( AD ) . Methods : This pilot study used a 1-group repeated measures design to examine the feasibility and impact of a 6-month individualized moderate intensity cycling intervention on cardiorespiratory fitness and lower extremity function in 8 participants aged 81.4 ± 3.58 . Cardiorespiratory fitness was measured using the shuttle walk and modified YMCA cycle ergometer tests , and lower extremity function was measured using the Short Physical Performance Battery ( SPPB ) at baseline , 3 months and 6 months . Results : The YMCA test showed a significant reduction in heart rate at stage 2 ( 103.4 vs 90.9 vs 91.6 ; P = .01 ) , while no significant changes were observed in the shuttle walk and SPPB tests . Conclusions : Persons with AD are able to improve cardiorespiratory conditioning from aerobic exercise . R and omized , controlled trials are needed to confirm these findings . Implication s for future research are detailed This study , a quasi-experimental , one-group pretest – post-test design , evaluated the effects on cognitive functioning and cardiorespiratory fitness of 8-week interventions ( aerobic exercise alone and aerobic exercise and cognitive training combined ) in patients with chronic stroke and cognitive impairment living in the community ( participants : n=14 , 61.93±9.90 years old , 51.50±38.22 months after stroke , n=7 per intervention group )  . Cognitive functions and cardiorespiratory fitness were evaluated before and after intervention , and at a 3-month follow-up visit ( episodic memory : revised-Hopkins Verbal Learning Test ; working memory : Brown – Peterson paradigm ; attention omission and commission errors : Continuous Performance Test ; cardiorespiratory fitness : peak oxygen uptake during a symptom-limited , grade d exercise test performed on a semirecumbent ergometer ) . Friedman ’s two-way analysis of variance by ranks evaluated differences in score distributions related to time ( for the two groups combined ) . Post-hoc testing was adjusted for multiple comparisons . Compared with before the intervention , there was a significant reduction in attention errors immediately following the intervention ( omission errors : 14.6±21.5 vs. 8±13.9 , P=0.01 ; commission errors : 16.4±6.3 vs. 10.9±7.2 , P=0.04 ) , and in part at follow-up ( omission errors on follow-up : 3.4±4.3 , P=0.03 ; commission errors on follow-up : 13.2±7.6 , P=0.42 ) . These results suggest that attention may improve in chronic stroke survivors with cognitive impairment following short-term training that includes an aerobic component , without a change in cardiorespiratory fitness . R and omized – controlled studies are required to confirm these findings OBJECTIVE To evaluate the influence of physical training with or without noninvasive ventilation at 2 levels of pressure in the airways ( BiPAP ) in patients with chronic obstructive pulmonary disease . METHODS Eighteen patients with FEV(1 ) = 34 + /- 8 % of predicted values , mean age of 68 + /- 9 years were r and omly distributed into 2 groups , one group performing physical training on a treadmill and the other group performing physical training associated with BiPAP ( physical training+B ) , for 30 minutes , 3 times a week for 12 weeks . The training velocity was based on a test of cardiopulmonary force performed pre- and postintervention , which registered the values for heart rate , systolic blood pressure , diastolic blood pressure , peripheral oxygen saturation , blood lactate , sensation of dyspnea , respiratory muscle strength , and analysis of gases expired such as oxygen consumption and the production of carbon dioxide . RESULTS For both groups , there was a significant improvement in dyspnea and peripheral oxygen saturation at identical levels of physical exercise , in distance walked during the physical training , and in respiratory muscle strength ( P < 0.05 ) . Only the physical training+B group had a significant improvement in heart rate , systolic blood pressure , and oxygen consumption after training ( P < 0.05 ) . Significant reductions of blood lactate were observed at identical levels of exercise in physical training+B when compared to isolated physical training ( from 1.3 + /- 0.7 mMol/L versus 2.5 + /- 0.9 mMol/L , ( P < 0.05 ) , respectively ) . CONCLUSION Physical training associated with BiPAP enhanced the oxidative muscular capacity and could be an adjunctive recourse for physical rehabilitation in patients with chronic obstructive pulmonary disease BACKGROUND Idiopathic pulmonary fibrosis ( IPF ) is a chronic , progressive and fatal interstitial lung disease associated with cardiovascular impairments which compromise exercise tolerance and worsen prognosis . AIM To examine the effect of participating in supervised exercise training ( ET ) program on cardiovascular function in patients with IPF . DESIGN A r and omized controlled study . SETTING Outpatient hospital . POPULATION Thirty-two IPF patients ( 68±8 years ) . METHODS An ET group ( N.=15 ) participated in a 12-week twice a week 60-minute supervised exercise program while a control group ( N.=17 ) received usual care . At baseline and after the 12-week intervention all patients underwent resting echocardiography , cardiopulmonary exercise testing and N-terminal pro-brain natriuretic peptide ( NT-proBNP ) assessment s. RESULTS The ET group significantly improved peak values of exercise cardiovascular indexes while the control group showed a trend of deterioration in the outcomes . The mean difference between the groups ( 95 % CI ) for circulatory power was 638 mLO2/kg/min/mmHg ( 95 % CI : 197 - 1080 ) ( P=0.006 ) , cardiac power output 0.3 W ( 95 % CI : 0.1 to 0.6 ) ( P=0.041 ) , and stroke work 312 mL/beat/mmHg ( 95 % CI : 52 - 573 ) ( P=0.02 ) . No significant differences between groups were detected in most echocardiography measures and NT-proBNP . Changes in exercise cardiovascular indexes showed significant correlation with improvements in functional capacity , dyspnea and quality of life among ET group . CONCLUSIONS Participation in supervised ET program  can improve exercise cardiovascular function in patients with IPF , however resting cardiac evaluations seem to be less sensitive to detect such changes . CLINICAL REHABILITATION IMPACT These findings underscore the utility of supervised ET for cardiovascular enhancement which may also be clinical ly beneficial in reducing the cardiovascular morbidity and mortality in IPF patients OBJECTIVE To examine and evaluate improvements in cardiorespiratory fitness , psychological wellbeing , quality of life , and vocational status in postmyocardial infa rct ion patients during and after a comprehensive 12 month exercise rehabilitation programme . SUBJECTS The sample population comprised 124 patients with a clinical diagnosis of myocardial infa rct ion ( 122 men and two women ) . INTERVENTIONS 62 patients were r and omly allocated to a regular weekly aerobic training programme , three times a week for 12 months , and compared with 62 matched controls who did not receive any formal exercise training . A five year follow up question naire/interview was subsequently conducted on this population to determine selected vocational/lifestyle changes . RESULTS Significant improvements in cardiorespiratory fitness ( p < 0.01 - 0.001 ) , psychological profiles ( p < 0.05 - 0.001 ) , and quality of life scores ( p < 0.001 ) were recorded in the treatment population when compared with their matched controls . Although there were no significant differences in mortality , a larger percentage of the regular exercisers resumed full time employment and they returned to work earlier than the controls . Controls took lighter jobs , lost more time from work , and suffered more non-fatal reinfa rct ions ( p < 0.05 - 0.01 ) . CONCLUSIONS Regularly supervised and prolonged aerobic exercise training improves cardiorespiratory fitness , psychological status , and quality of life . The trained population also had a reduction in morbidity following myocardial infa rct ion , and significant improvement in vocational status over a five year follow up period NEW FINDINGS What is the central question of this study ? Chronic obstructive pulmonary disease ( COPD ) is associated with endothelial dysfunction , arterial stiffness and systemic inflammation , which are linked to increased cardiovascular disease risk . We asked whether periodized aerobic exercise training could improve vascular structure and function in patients with COPD . What is the main finding and its importance ? Eight weeks of periodized aerobic training did not improve endothelial function , arterial stiffness or systemic inflammation in COPD , despite improvements in aerobic capacity , blood pressure and dyspnoea . Short-term training programmes may not be long enough to improve vascular-related cardiovascular risk in COPD . Chronic obstructive pulmonary disease ( COPD ) has been associated with endothelial dysfunction and arterial stiffening , which are predictive of future cardiovascular events . Although aerobic exercise improves vascular function in healthy individuals and those with chronic disease , it is unknown whether aerobic exercise can positively modify the vasculature in COPD . We examined the effects of 8 weeks of periodized aerobic training on vascular structure and function and inflammation in 24 patients with COPD ( age , 69 ± 7 years ; forced expiratory volume in 1 second as a percentage of predicted ( FEV1 % pred ) , 68 ± 19 % ) and 20 matched control subjects ( age , 64 ± 5 years ; FEV1 % pred , 113 ± 16 % ) for comparison . Endothelial function was measured using brachial artery flow-mediated dilatation , whereas central and peripheral pulse wave velocity , carotid artery intima-media thickness , carotid compliance , distensibility and β-stiffness index were measured using applanation tonometry and ultrasound . Peak aerobic power ( V̇O2 peak ) was measured using an incremental cycling test . Upper and lower body cycling training was performed three times per week for 8 weeks , and design ed to optimize vascular adaptation by increasing and sustaining vascular shear stress . Flow-mediated dilatation was not increased in COPD patients ( + 0.15 ± 2.27 % , P = 0.82 ) or control subjects ( + 0.34 ± 3.20 % , P = 0.64 ) and was not different between groups ( P = 0.68 ) . No significant improvements in central pulse wave velocity ( COPD , + 0.30 ± 1.79 m s-1 versus control subjects , -0.34 ± 1.47 m s-1 ) or other markers of vascular structure or function were found within or between groups . The V̇O2 peak increased significantly in COPD and control subjects , and was greater in control subjects ( 1.6 ± 1.4 versus 4.1 ± 3.7 ml kg min-1 , P = 0.003 ) , while blood pressure and dyspnoea were reduced in COPD patients ( P < 0.05 ) . These findings demonstrate that 8 weeks of aerobic training improved cardiorespiratory fitness and blood pressure in COPD but had little effect on other established markers of cardiovascular disease risk Promoting  physical activity ( PA ) is of top priority in chronic obstructive pulmonary disease ( COPD ) . This study examines the influence of an internet-delivered intervention on the relationship between exercise self-efficacy and changes in PA , physical health , and exercise capacity in COPD . 112 U.S. Veterans with COPD were r and omized to either a comparison ( pedometer alone ) or an intervention group ( pedometer plus access to an internet-mediated PA intervention ) . There was a significant interaction between baseline exercise self-efficacy and r and omization group on change in PA . In the comparison group , there was a significant relationship between higher baseline exercise self-efficacy and greater change in PA , whereas in the intervention group , improvements in PA were independent of level of baseline self-efficacy . Similar patterns were found with physical health and exercise capacity as outcomes . The use of an internet-mediated intervention significantly benefited persons with COPD who had low baseline self-efficacy to increase PA  and  physical health . Clinical trial registration The r and omized clinical trial was registered on Clinical Trials.gov ( NCT01772082 ) BACKGROUND The chronic obstructive pulmonary disease ( COPD ) is associated with the strength and resistance decreasing in addition to the dysfunction on autonomic nervous system ( ANS ) . The aerobic training isolated or in association with the resistance training showed evidence of beneficial effects on an autonomic modulation of COPD ; however , there are no studies addressing the effect of isolated resistance training . AIMS This study aims at investigating the influence of resistance training on an autonomic modulation through heart rate variability ( HRV ) , functional capacity and muscle strength in individuals with COPD . DESIGN Clinical series study . SETTING Out patients . POPULATION The study involved 13 individuals with COPD . METHODS The experimental protocol was composed by an initial and final evaluation that consisted in autonomic evaluations ( HRV ) , cardiopulmonary functional capacity evaluation ( 6-minute walk test ) and strength evaluation ( dynamometry )  in addition by the resistance training performed by 24 sessions lasted 60 minutes each one and on a frequency of three times a week . The intensity was determined initially with 60 % of one maximum repetition and was progressively increased in each five sessions until 80 % . RESULTS The HRV temporal and spectral indexes analysis demonstrates improvement of autonomic modulation , with significant statistical increases to sympathetic and parasympathetic components of ANS representing by SDNN , LF and HF . In addition , it was observed significant statistical increases to shoulder abduction and knee flexion strength and functional capacity . CONCLUSION The exclusive resistance training performed was able to positively influence the autonomic modulation ; in addition it promoted benefits on cardiorespiratory functional capacity and strength benefits in individuals with COPD . CLINICAL REHABILITATION IMPACT This study could contribute to clinical and professionals research ers that act with COPD , even though the resistance component of pulmonary rehabilitation presents consensual benefits on several healthy indicators parameters . There is no evidence about the effects on HRV before . Moreover , this study showed , on clinical practice , the HRV uses as an ANS activity on sinus node evaluation and highlights further importance on scientific context The objective of this study was to examine exercise effects on global brain volume , hippocampal volume , and cortical thickness in schizophrenia patients and healthy controls . Irrespective of diagnosis and intervention , associations between brain changes and cardiorespiratory fitness improvement were examined . Sixty-three schizophrenia patients and fifty-five healthy controls participated in this r and omised controlled trial .  Global brain volumes , hippocampal volume , and cortical thickness were estimated from 3-Tesla MRI scans . Cardiorespiratory fitness was assessed with a cardiopulmonary ergometer test . Subjects were assigned exercise therapy or occupational therapy ( patients ) and exercise therapy or life-as-usual ( healthy controls ) for six months 2h weekly . Exercise therapy effects were analysed for subjects who were compliant at least 50 % of sessions offered . Significantly smaller baseline cerebral ( grey ) matter , and larger third ventricle volumes , and thinner cortex in most areas of the brain were found in patients versus controls . Exercise therapy did not affect global brain and hippocampal volume or cortical thickness in patients and controls . Cardiorespiratory fitness improvement was related to increased cerebral matter volume and lateral and third ventricle volume decrease in patients and to thickening in the left hemisphere in large areas of the frontal , temporal and cingulate cortex irrespective of diagnosis . One to 2h of exercise therapy did not elicit significant brain volume changes in patients or controls . However , cardiorespiratory fitness improvement attenuated brain volume changes in schizophrenia  patients and increased thickness in large areas of the left cortex in both schizophrenia patients and healthy controls 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 Determinants of change in physical activity and outcomes of physical activity promotion are unclear . In this secondary analysis of a r and omised controlled trial of a physical activity intervention , we assess predictors of change in physical activity and the effects of increasing physical activity on chronic obstructive pulmonary disease ( COPD ) measures . Physical activity was promoted in 94 subjects with COPD using the  Omron HJ-720ITC pedometer alone or the pedometer plus a website that provides goal setting , feedback , motivational and educational messages , and social support for 3 months . We assessed forced expiratory volume in 1 s ( FEV1 ) , 6-min walk test ( 6MWT ) distance , depression , social support and markers of systemic inflammation ( C-reactive protein ( CRP ) and interleukin (IL)-6 ) . Data from both groups were combined and subjects categorised as responders ( increased steps per day ) or nonresponders ( decreased steps per day ) . Linear regression models explored predictors of change in physical activity and assessed the effect of response on changes in COPD measures . The cohort of responders ( n=62 ) and nonresponders ( n=32 ) had mean FEV1 1.89±0.64 L ( 63±22 % predicted ) . Baseline steps per day , diagnosis of depression , social support , oxygen use and season significantly predicted change in daily step count . Responders had increases in physical activity ( 2038 steps per day ) , FEV1 ( 308 mL ) and 6MWT distance ( 43.6 m ) , and decreases in CRP ( 7.84 mg·L−1 ) and IL-6 ( 2.73 ng·mL−1 ) compared with nonresponders ( p<0.0001–0.009 ) . History of depression , social support , oxygen use and season predict change in physical activity , and should be routinely assessed in exercise counselling . Increases in physical activity are associated with improvements in lung function , exercise capacity and systemic inflammation . History of depression , social support , oxygen use and season predict change in physical activity in COPD . Response to physical activity promotion is associated with improvements in lung function , exercise capacity and systemic inflammation .
Conclusions drawn from this systematic review suggest that physical activity and cardiorespiratory fitness are associated with P3b modulation during cognitive control and attention tasks .
Acute and chronic physical activity interventions modulate the P3b component , suggesting short- and long-term functional adaptations occurring in the brain to support cognitive processes .
These summary findings suggest physical activity and cardiorespiratory fitness are beneficial to brain function and that P3b may serve as a biomarker of covert attentional processes to better underst and the relationship of physical activity and cognition
Given accumulating evidence indicating that acute and chronic physical activity and cardiorespiratory fitness are related to modulation of the P3b-ERP component , this systematic review provides an overview of the field across the last 30 + years and discusses future directions as the field continues to develop .