Please select the eligibility criteria that correspond to the clinical trial below.
Title: Exacerbation and Training - Study; a Randomized Controlled Study of the Effect of Resistance Training in Acute Exacerbations of COPD
Brief Summary: When patients with chronic obstructive lung disease (COPD) are admitted to the hospital with a severe exacerbation they lose muscle strength. This muscle weakness predisposes these patients to further hospital admissions. Resistance training is a potent countermeasure to prevent and treat muscle weakness. In the setting of an acute exacerbation this intervention however has not been validated.

The present study aims at investigating the safety and efficacy of resistance training (3x8 quadriceps extensions per day) to prevent muscle weakness. End points are quadriceps muscle strength and hospital readmission and functional status at discharge. Using the minimally invasive needle muscle biopsy technique described by Bergström the effects of resistance training on the skeletal muscle will be analyzed in detail.

After giving informed consent, patients will be randomized on admission into usual care or usual care plus resistance training. Patients will be followed-up using the clinical pathway for COPD (10 days). After one month patients will attend the outpatient clinic for a follow-up visit. Besides the measurement prescribed in the clinical path for COPD (including arterial blood gas measures, lung function, functional investigation of the patients), patients will undergo muscle strength measures and venous blood will be drawn for the analysis of systemic inflammatory and growth factors. Half of the patients will receive a resistance training program. At the end of the hospital admission, a needle biopsy of the vastus lateralis muscle will be obtained.


Options:
A: Inclusion criteria:

1. diagnosed with moderate COPD with moderate acute exacerbation
2. over 65 years of age
3. conscious clear
4. with shortness of breath or dyspnea that was not caused by heart disease, pneumothorax, or pulmonary edema
5. had received bronchodilator aerosol therapy or antibiotic treatment, but had not been treated with an antitussive

Exclusion Criteria:

1. unstable vital signs
2. blood oxygen concentration lower than 90%
3. unstable psychological status, hemoptysis, pneumothorax, pulmonary edema, or using the respirator
B: Inclusion criteria:

* COPD exacerbation, admitted to the respiratory units
* Informed consent
* Age \< 80
* No critical comorbidity compromising outcome up to one month.
* No suspect of malignancy

Exclusion criteria:

* Patient is involved in a rehabilitation program with a frequency \>1/wk during one month after inclusion in the study
* NIMV or ICU on admission
* Patient scheduled for procedure (LTX/LVRS) within one month after discharge
* Readmission \<14 days after previous hospitalization
* Significant pathology that would hinder the participation in resistance training (gonarthrosis, arthritis to be judged by the investigator)
* Clinical signs of pulmonary hypertension
C: Inclusion Criteria:

* All patients admitted to King's College Hospital with a clinical diagnosis of acute exacerbation of COPD. Patients with radiological and microbiological evidence of pneumonia with co-existing COPD will also be included.

Exclusion Criteria:

* Significant co-morbidity that could limit exercise training \& testing: Patients unable to walk due to a comorbid neuromuscular or rheumatological condition; patients with severe sensory and cognitive impairment; patients with unstable angina or aortic valve disease in which exercise could be dangerous.
* Attendance at a pulmonary rehabilitation programme in the preceding year.
D: Inclusion Criteria:

* Patients must be ≥40 years old
* Clinical diagnosis of COPD or pulmonary function testing reflecting an FEV1/FVC ratio of \<0.70
* Current or previous smoker with at least 10 pack-years of cigarette smoking
* Recently hospitalized for an exacerbation of COPD

Exclusion Criteria:

* Patients with a high likelihood of being lost to follow-up or contact (patients with active chemical dependency, are planning to move out of the state, are not living in the healthcare area, or have no telephone at home).
* Patents with characteristics that can confound the analysis of the primary outcome (patients who are living in a nursing home, have unresectable lung cancer, or have another advanced neoplasm).
* Patients with an inability to provide good data or follow commands (patients who are disoriented, have a severe neurologic or psychiatric condition).
* Patients with an inability to do mild exercise, such as cycling or walking, when their COPD is stable (patients who have orthopedic-neurologic problems; patients who have severe heart failure, characterized by an ejection fraction of \<20% or by New York Heart Association Class IV disease; patients who should be at complete rest, confined to a bed or chair; or patients in whom any physical activity brings on discomfort and in whom symptoms occur at rest).

Answer: B