A randomised controlled trial of supplemental oxygen versus medical air during exercise training in people with chronic obstructive pulmonary disease: supplemental oxygen in pulmonary rehabilitation trial (SuppORT) (Protocol) Behaviour-change intervention in a multicentre, randomised, placebo-controlled COPD study: methodological considerations and implementation Functional and psychosocial effects of health qigong in patients with COPD: a randomized controlled trial. Effects of interval and continuous exercise training on autonomic cardiac function in COPD patients Outcome of pulmonary rehabilitation in patients after acute exacerbation of chronic obstructive pulmonary disease. Effects of theophylline and ipratropium bromide on exercise performance in patients with stable chronic obstructive pulmonary disease Clinical characteristics, response to exercise training, and outcomes in patients with heart failure and chronic obstructive pulmonary disease: findings from Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing (HF-ACTION). Water-based exercise in COPD with physical comorbidities: a randomised controlled trial Maintenance of inspiratory muscle training in COPD patients: one year follow-up Benefits and costs of home-based pulmonary rehabilitation in chronic obstructive pulmonary disease - a multi-centre randomised controlled equivalence trial Study design for a randomised controlled trial to explore the modality and mechanism of Tai Chi in the pulmonary rehabilitation of chronic obstructive pulmonary disease A comparison of autogenic drainage and the active cycle of breathing techniques in patients with chronic obstructive pulmonary diseases. Exercise training restores uncoupling protein-3 content in limb muscles of patients with chronic obstructive pulmonary disease. Non-anaemic iron deficiency impairs response to pulmonary rehabilitation in COPD. Randomized trial of non-invasive ventilation combined with exercise training in patients with chronic hypercapnic failure due to chronic obstructive pulmonary disease. Oxygen compared to air during exercise training in COPD with exercise-induced desaturation Effects of an animated diagram and video-based online breathing program for dyspnea in patients with stable COPD Does unsupported upper limb exercise training improve symptoms and quality of life for patients with chronic obstructive pulmonary disease? How should we train the upper limbs? The effects of elastic tubing-based resistance training compared with conventional resistance training in patients with moderate chronic obstructive pulmonary disease: a randomized clinical trial Maintaining benefits following pulmonary rehabilitation: a randomised controlled trial Potential effect of 6 versus 12-weeks of physical training on cardiac autonomic function and exercise capacity in chronic obstructive pulmonary disease. Ground-based walking training improves quality of life and exercise capacity in COPD
Background Oxygen desaturation during exercise is common in people with chronic obstructive pulmonary disease ( COPD ) . The aim of the study is to determine , in people with COPD who desaturate during exercise , whether supplemental oxygen during an eight-week exercise training program is more effective than medical air ( sham intervention ) in improving exercise capacity and health-related quality of life both at the completion of training and at six-month follow up . Methods / Design This is a multi-centre r and omised controlled trial with concealed allocation , blinding of participants , exercise trainers and assessors , and intention-to-treat analysis . 110 people with chronic obstructive pulmonary disease who demonstrate oxygen desaturation lower than 90 % during the six-minute walk test will be recruited from pulmonary rehabilitation programs in seven teaching hospitals in Australia . People with chronic obstructive pulmonary disease on long term oxygen therapy will be excluded . After confirmation of eligibility and baseline assessment , participants will be r and omised to receive either supplemental oxygen or medical air during an eight-week supervised treadmill and cycle exercise training program , three times per week for eight weeks , in hospital outpatient setting s. Primary outcome measures will be endurance walking capacity assessed by the endurance shuttle walk test and health-related quality of life assessed by the Chronic Respiratory Disease Question naire . Secondary outcomes will include peak walking capacity measured by the incremental shuttle walk test , dyspnoea via the Dyspnoea-12 question naire and physical activity levels measured over seven days using an activity monitor . All outcomes will be measured at baseline , completion of training and at six-month follow up . Discussion Exercise training is an essential component of pulmonary rehabilitation for people with COPD . This study will determine whether supplemental oxygen during exercise training is more effective than medical air in improving exercise capacity and health-related quality of life in people with COPD who desaturate during exercise . Trial registration Australian New Zeal and Clinical Trials Registry ACTRN12612000395831 , 5th Introduction Chronic obstructive pulmonary disease is generally progressive and associated with reduced physical activity . Both pharmacological therapy and exercise training can improve exercise capacity ; however , these are often not sufficient to change the amount of daily physical activity a patient undertakes . Behaviour-change self-management programmes are design ed to address this , including setting motivational goals and providing social support . We present and discuss the necessary method ological considerations when integrating behaviour-change interventions into a multicentre study . Methods and analysis PHYSACTO is a 12-week phase IIIb study assessing the effects on exercise capacity and physical activity of once-daily tiotropium+olo date rol 5/5 µg with exercise training , tiotropium+olo date rol 5/5 µg without exercise training , tiotropium 5 µg or placebo , with all pharmacological interventions administered via the Respimat inhaler . Patients in all intervention arms receive a behaviour-change self-management programme to provide an optimal environment for translating improvements in exercise capacity into increases in daily physical activity . To maximise the likelihood of success , special attention is given in the programme to : ( 1 ) the Site Case Manager , with careful monitoring of programme delivery ; ( 2 ) the patient , incorporating patient-evaluation/programme-evaluation measures to guide the Site Case Manager in the self-management intervention ; and ( 3 ) quality assurance , to help identify and correct any problems or shortcomings in programme delivery and ensure the effectiveness of any corrective steps . This paper documents the comprehensive methods used to optimise and st and ardise the behaviour-change self-management programme used in the study to facilitate dialogue on the inclusion of this type of programme in multicentre studies . 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 results of this study will be disseminated through relevant , peer- review ed journals and international conference presentations . Trial registration number NCT02085161 CONTEXT The initial gain from a Pulmonary Rehabilitation Program ( PRP ) among patients with chronic obstructive pulmonary disease ( COPD ) begins to fade away 6 months after the completion of a rehabilitation program . One possible reason may be due to the poor compliance of the patients to the existing forms of home exercise program ( e.g. , walking , weight training activities , etc . ) . OBJECTIVES This study tested the efficacy of health qigong ( HQG ) , a traditional Chinese exercise , as an adjunct home exercise program in optimizing the gains obtained from PRP until 6 months after discharge . DESIGN This was a r and omized controlled trial ( RCT ) on a mind-body exercise intervention . PARTICIPANTS Eighty ( 80 ) patients with COPD receiving conventional PRP pulmonary rehabilitation program were r and omized to the HQG intervention  group ( n = 40 ) and control group  ( n = 40 ) . OUTCOME MEASURES Assessment s were undertaken by blinded assessors at baseline , discharge from training , and follow-up ( FU ) at 3 and 6 months . Primary outcomes involved functional capacity scales and secondary outcomes involved quality -of-life scales . RESULTS Intention-to-treat analysis identified trends of improvement in all outcome measures in the HQG group , whereas lesser improvement and trends of deteriorations were identified in the control group . Ancillary analysis using a per- protocol method , however , identified significantly better improvements in functional capacity measures among the HQG at the 6-month FU . CONCLUSIONS This RCT provided some evidence to support the positive effect of HQG as an adjunct home exercise for rehabilitation among people with COPD and to support further related research Both interval ( IT ) and continuous ( CT ) exercise training results in an improvement of aerobic capacity in patients with chronic obstructive pulmonary disease ( COPD ) ; however , their effects on cardiac autonomic function remains unclear . The aim of our study was to evaluate the effect of a supervised CT vs IT on autonomic cardiac function in COPD patients BACKGROUND Pulmonary rehabilitation ( PR ) is an evidence -based intervention in patients with chronic obstructive pulmonary disease ( COPD ) which improves the exercise capacity and quality of life ( QoL ) . METHODS We studied 60 patients after an episode of acute exacerbation of COPD ( AE COPD ) . They were r and omised to receive conventional treatment without pulmonary rehabilitation ( CTWPR ) ( n=30 ) or , st and ard treatment plus a 12-week post-exacerbation pulmonary rehabilitation ( PEPR ) programme in addition . Assessment of exercise capacity by six minute walk test ( 6MWT ) and QoL measured by St George 's Respiratory Question naire ( SGRQ ) were carried out initially and at the end of three months . RESULTS The baseline characteristics of both the groups were found to be similar . There was a statistically significant increase in the six minute walk distance ( 6MWD ) ( increase by 37.9 meters , p < 0.001 ) and a significant decline in the total SGRQ score ( by 3.8 units p < 0.001 ) in the PEPR group compared to CTWPR group . CONCLUSION Early pulmonary rehabilitation in patients with an AE COPD has significant benefits on the QoL and exercise capacity BACKGROUND The effects of theophylline or anticholinergic agents on exercise capacity in patients with chronic obstructive pulmonary disease ( COPD ) remain controversial . The aim of the present study was to compare the effect of an oral theophylline with an inhaled anticholinergic agent and to examine the effects of combined therapy on exercise performance using progressive cycle ergometry . METHODS Twenty one men with stable COPD and a mean ( SD ) forced expiratory volume in one second ( FEV1 ) of 1.00 ( 0.40 ) l were studied .  Theophylline ( 600 or 800 mg daily ) , ipratropium bromide ( 160 μg ) , a combination of both drugs , and placebo were given in a r and omised , double blind , four period crossover design study . Spirometric data , pulse rate , and blood pressure were assessed before and at 90 and 120 minutes after inhalation . Symptom limited progressive cycle ergometer exercise tests ( 20 watts/min ) were performed 90 minutes after each inhalation , and dyspnoea was measured during exercise using the Borg scale . RESULTS The mean ( SD ) serum theophylline concentration was 18.3 ( 6.3 ) μg/ml , and seven patients had side effects during treatment with theophylline . Theophylline and ipratropium bromide produced greater increases in FEV1 , maximal oxygen consumption , maximal minute ventilation , and several dyspnoea ratios than placebo . There were no differences between theophylline and ipratropium bromide except in maximal heart rate . A combination of both drugs produced greater improvements in pulmonary function and exercise capacity than either drug alone . CONCLUSIONS Both high dose theophylline and high dose ipratropium bromide  improved exercise capacity in patients with stable COPD . Although data based on short term effects can not be directly applied to long term therapy , theophylline added to an inhaled anticholinergic agent may have beneficial effects on exercise capacity in patients with COPD BACKGROUND The aim of this study was to investigate the clinical characteristics , exercise training response , β-blocker selectivity , and outcomes in patients with heart failure ( HF ) and chronic obstructive pulmonary disease ( COPD ) . METHODS We performed an analysis of HF-ACTION , which r and omized 2,331 patients with HF having an ejection fraction of ≤35 % to usual care with or without aerobic exercise training .  We examined clinical characteristics and outcomes ( mortality/hospitalization , mortality , cardiovascular [ CV ] mortality/CV hospitalization , and CV mortality/HF hospitalization ) by physician-reported COPD status using adjusted Cox models and explored an interaction with exercise training . The interaction between β-blocker cardioselectivity and outcomes was investigated . RESULTS Of patients with COPD status documented ( n = 2311 ) , 11 % ( n = 249 ) had COPD . Patients with COPD were older , had more comorbidities , and had lower use of β-blockers compared with those without COPD . At baseline , patients with COPD had lower peak oxygen consumption and higher V(E)/V(CO)(2 ) slope . During a median follow-up of 2.5 years , COPD was associated with increased mortality/hospitalization , mortality , and CV mortality/HF hospitalization . After multivariable adjustment , the risk of CV mortality/HF hospitalization remained increased ( hazard ratio [ HR ] 1.46 , 95 % CI 1.14 - 1.87 ) , whereas mortality/hospitalization ( HR 1.15 , 95 % CI 0.96 - 1.37 ) and mortality ( HR 1.33 , 95 % CI 0.99 - 1.76 ) were not significantly increased . There was no interaction between COPD and exercise training on outcomes or between COPD and β-blocker selectivity on mortality/hospitalization ( all P > .1 ) . CONCLUSIONS Chronic obstructive pulmonary disease in patients with HF was associated with older age , more comorbidities , reduced exercise capacity , and increased CV mortality/HF hospitalization , but not a differential response to exercise training . β-Blocker selectivity was not associated with differences in outcome for patients with vs without COPD 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 In most chronic obstructive pulmonary disease ( COPD ) patients , dyspnoea and functional exercise capacity may improve as a result of inspiratory muscle training ( IMT ) . However , the long-term benefits of IMT have been investigated to a much lesser extent . The present study investigated the short-term and long-term benefits of IMT on inspiratory muscle performance ( strength and endurance ) , exercise capacity and the perception of dyspnoea .  Thirty-eight patients with significant COPD had 3 months of basic IMT and were then r and omised into a group that received maintenance IMT for the next year , and a group that got training with very low load . Following the basic training there was a statistically significant increase in inspiratory muscle performance , 6-min walk test ( 6MWT ) , and a decrease in the dyspnoea . During the second stage of the study , the training group continued to maintain the improvement in all parameters , while there was already deterioration in the inspiratory muscle performance , exercise capacity and dyspnoea in the low intensity group during the 6–12 month period . The present study concludes that , in patients with significant chronic obstructive pulmonary disease , inspiratory muscle training results in improvement in performance , exercise capacity and in the sensation of dyspnoea . The benefits of 12‐weeks of inspiratory muscle training decline gradually over 1 yr of follow-up if maintenance training is not performed Background Pulmonary rehabilitation is widely advocated for people with chronic obstructive pulmonary disease ( COPD ) to improve exercise capacity , symptoms and quality of life , however only a minority of individuals with COPD are able to participate . Travel and transport are frequently cited as barriers to uptake of centre-based programs . Other models of pulmonary rehabilitation , including home-based programs , have been proposed in order to improve access to this important treatment . Previous studies of home-based pulmonary rehabilitation in COPD have demonstrated improvement in exercise capacity and quality of life , but not all elements of the program were conducted in the home environment . It is uncertain whether a pulmonary rehabilitation program delivered in its entirety at home is cost effective and equally capable of producing benefits in exercise capacity , symptoms and quality of life as a hospital-based program . The aim of this study is to compare the costs and benefits of home-based and hospital-based pulmonary rehabilitation for people with COPD . Methods / Design This r and omised , controlled , equivalence trial conducted at two centres will recruit 166 individuals with spirometrically confirmed COPD . Participants will be r and omly allocated to hospital-based or home-based pulmonary rehabilitation . Hospital programs will follow the traditional outpatient model consisting of twice weekly supervised exercise training and education for eight weeks . Home-based programs will involve one home visit followed by seven weekly telephone calls , using a motivational interviewing approach to enhance exercise participation and facilitate self management . The primary outcome is change in 6-minute walk distance immediately following intervention . Measurements of exercise capacity , physical activity , symptoms and quality of life will be taken at baseline , immediately following the intervention and at 12 months , by a blinded assessor . Completion rates will be compared between programs . Direct healthcare costs and indirect ( patient-related ) costs will be measured to compare the cost-effectiveness of each program . Discussion This trial will identify whether home-based pulmonary rehabilitation can deliver equivalent benefits to centre-based pulmonary rehabilitation in a cost effective manner . The results of this study will contribute new knowledge regarding alternative models of pulmonary rehabilitation and will inform pulmonary rehabilitation guidelines for COPD .Trial registration Clinical Trials.gov : NCT01423227 Introduction Although pulmonary rehabilitation ( PR ) is associated with significant clinical benefits in chronic obstructive pulmonary disease ( COPD ) and has been recommended by guidelines , PR with conventional exercise training has not been widely applied in the clinic because of its inherent limitations . Alternative exercise such as Tai Chi has been investigated and the results are promising . However , the strengths and weaknesses of the exercise modality of Tai Chi , conventional PR and a combination of Tai Chi and conventional PR and the possible mechanisms underlying Tai Chi exercise remain unclear . This study aims to address the above research gaps in a well- design ed clinical trial . Methods and analysis This study is a single-blind , r and omised controlled trial . Participants with stable COPD will be recruited and r and omly assigned to one of four groups receiving Tai Chi exercise , conventional PR using a total body recumbent stepper ( TBRS ) , combined Tai Chi and TBRS , or usual care ( control ) in a 1:1:1:1 ratio . Participants will perform 30 min of supervised exercise three times a week for 8 weeks ; they will receive sequential follow-ups until 12 months after recruitment . The primary outcome will be health-related quality of life as measured by the St George 's Respiratory Question naire . Secondary outcomes will include 6 min walking distance , pulmonary function , the modified Medical Research Council Dyspnoea Scale , the COPD Assessment Test , the Hospital Anxiety and Depression Scale , the Berg Balance Scale , exacerbation frequency during the study period , and systemic inflammatory and immune markers . Ethics and dissemination Ethics approval has been granted by the Clinical Trial and Biomedical Ethics Committee of West China Hospital of Sichuan University ( No TCM-2015 - 82 ) . Written informed consent will be obtained from each participant before any procedures are performed . The study findings will be published in peer- review ed journals and presented at national and international conferences . Trial registration number ChiCTR-IOR-15006874 ; Pre- results PURPOSE The effects of a long-term treatment of autogenic drainage ( AD ) and the active cycle of breathing techniques ( ACBT ) were evaluated in patients with chronic obstructive pulmonary disease ( COPD ) . METHODS Thirty clinical ly stable male COPD patients were r and omly assigned to AD or the ACBT treatment for a 20-day treatment period . Patients were assessed through pulmonary function tests , arterial blood gases , a 6-minute walking test , and a modified Borg Scale before , and immediately after the walking test . RESULTS Autogenic drainage improved forced vital capacity , forced expiratory volume in 1 second , peak expiratory flow rate , forced expiratory volume from 25 to 75 % , chronic hypercapnia , arterial oxygenation , exercise performance , and dyspnea perception during exercise . The ACBT increased forced vital capacity , peak expiratory flow rate , arterial oxygenation and exercise performance . Peak expiratory flow rate increased in AD more than in ACBT . In AD treatment , the increase in oxygen saturation was significantly higher than in ACBT treatment . Chronic hypercapnia improved significantly in AD treatment than in ACBT . No differences were found in other lung function parameters . CONCLUSIONS Autogenic drainage is as effective as the ACBT in cleaning secretions and improving lung functions . These techniques can be used in stable COPD patients according to the patients ' and the physiotherapists ' preferences Oxidative capacity and uncoupling protein-3 ( UCP3 ) content are reduced in limb muscles of patients with chronic obstructive pulmonary disease ( COPD ) . It has been hypothesized that the physiological role of UCP3 is to protect mitochondria against lipotoxicity in cases where fatty acid influx exceeds the capacity to oxidize them . Exercise training improves oxidative capacity and reduces UCP3 protein content in healthy subjects , but the response of UCP3 to training in COPD is unknown . We studied the effect of exercise training on UCP3 content in limb muscles of COPD patients . For this , seven healthy age-matched subjects and thirteen patients with COPD were studied . All patients were admitted to an 8-wk exercise training intervention .  Exercise capacity was assessed by means of an incremental cycle ergometry test . Biopsies were taken from the vastus lateralis in which UCP3 and lipid peroxidation levels were determined by Western blotting . Citrate synthase and 3-hydroxyacyl-CoA dehydrogenase ( HAD ; an enzyme involved in fatty acid oxidation ) were measured as indexes of muscle oxidative capacity . UCP3 in COPD was approximately 50 % lower compared with healthy age-matched controls . In COPD , training induced upregulation of UCP3 [ from 67.7 ( SD 41.8 ) to 113.8 ( SD 104.2 ) arbitrary units ( AU ) , P = 0.062 ] , especially in the patients who showed no increase in HAD activity [ from 80.9 ( SD 52.6 ) to 167.9 ( SD 109.1 ) AU , P = 0.028 ] , whereas lipid peroxidation levels remained unaltered . We conclude that exercise-training can restore muscle UCP3 protein level in COPD , and the nature of this response complies with the hypothesis that UCP3 may protect against lipotoxicity BACKGROUND AND OBJECTIVE Non-anaemic iron deficiency ( NAID ) might alter the oxygen pathway in health and disease . The current study aims at assessing the impact of NAID on aerobic capacity in patients with chronic obstructive pulmonary disease ( COPD ) . METHODS A prospect i ve sample of 70 non-anaemic COPD patients c and i date to participate in an 8-week pulmonary rehabilitation ( PR ) programme  was studied . Incremental cycling exercise to peak oxygen uptake ( V'O2peak ) and constant work-rate exercise at 80 % V'O2peak to exhaustion were assessed pre- and post-PR . Training-induced increase of endurance time ( ET ) ≥33 % , which represented the minimal clinical ly important difference , classified patients as responders to exercise training . RESULTS The prevalence of NAID was 48 % ( n = 34 ) showing no relationship with the Global Initiative for Chronic Obstructive Lung Disease stages ( P = 0.209 ) . Patients with NAID showed lower pre-training ET ( P = 0.033 ) and V'O2peak ( P = 0.007 ) than normal iron status ( NIS ) patients after adjustment for potential covariates . Significant training-induced physiological changes were seen in the NIS group ( ΔV'O2peak 68(132 ) mL/min ; P = 0.009 ) , but not in the NAID group ( ΔV'O2peak 26 ( 126 ) mL/min ; P = 0.269 ) . The NAID group showed lower percentage of responders to training ( 56 % ) than the NIS group ( 78 % ) ( P = 0.041 ) . CONCLUSIONS COPD patients with NAID showed lower pre-training aerobic capacity and reduced training-induced response than NIS patients after adjusting for potential confounding variables BACKGROUND Non-invasive ventilation and exercise training might prove beneficial in the management of COPD patients . OBJETIVE to compare the combined use of exercise training and non-invasive ventilation with the two interventions separately in chronic respiratory failure due to chronic obstructive pulmonary disease . As primary objective exercise capacity and secondary objectives gas exchange , peripheral muscle strength , BODE index , quality of life and systemic inflammatory response . METHODS Forty-five patients with severe chronic obstructive pulmonary disease were r and omized into three groups for an intervention of 12 weeks : exercise training alone , ventilation alone and combined treatment . We assessed exercise capacity , pulmonary function , BODE index , perception of dyspnoea , quality of life and several biomarkers . RESULTS All exercise capacity parameters improved after training and the combined treatment . In addition , peripheral muscle strength and six-minute walk distance increased after ventilation . We found differences between the combined group and the ventilation group in submaximal effort and in oxygen consumption . Changes in respiratory function were observed in blood gases that improved after ventilation and the combined treatment , with differences between these groups . BODE index , perception of dyspnoea and quality of life improved in all three groups without differences between groups . Levels of interleukin 8 and tumour necrosis factor α decreased after ventilation , and interleukin 8 , C-reactive protein and surfactant protein D decreased after training , while all four of these markers fell after the combined treatment . No differences between groups were found . CONCLUSIONS The combination of ventilation and exercise training had greater benefits than the separate treatments : improvements were observed in both blood gases and the levels of more biomarkers decreased . In addition , submaximal exercise capacity increased in all groups . The improvements seen in BODE index , perception of dyspnoea and quality of life were similar in all groups Almost half the patients referred to pulmonary rehabilitation with chronic obstructive pulmonary disease ( COPD ) desaturate during exercise . Although oxygen supplementation may ameliorate oxygen desaturation , the effects on outcomes of exercise training have not been rigorously evaluated . This study aim ed to determine whether supplemental oxygen during exercise training was more effective than medical air in improving exercise capacity and health-related quality of life ( HRQoL ) in people with COPD . People with COPD who demonstrated oxygen desaturation < 90 % during the 6-min walk test were recruited to this multicentre trial with r and omisation ( independent , concealed allocation ) to either an Oxygen group or Air group , blinding ( participants , exercise trainers and European Respiratory Journal assessors ) and intention-to-treat analysis . Both groups received the respective gas from concentrators via nasal prongs at 5 L·min−1 during exercise training consisting of treadmill and cycle exercise , three times per week for 8 weeks . Primary outcomes were the endurance shuttle walk test ( ESWT ) time and Chronic Respiratory Disease Question naire (CRQ)-Total score . 111 participants ( 60 males ) , mean±sd age 69±7 years , with moderate to severe COPD were recruited and 97 completed ( Oxygen  group n=52 ; Air group n=45 ) . At the end of the 8-week training programme there were no between-group differences in change in ESWT ( mean difference 15 s ( 95 % CI −106–136 s ) or change in CRQ-Total ( 0.0 points ( 95 % CI −0.3–0.3 points ) ) . Within-group changes at end-training were significant for ESWT and CRQ-Total ( all p<0.01 ) . Exercise capacity and HRQoL improved in both groups , with no greater benefit from training with supplemental oxygen than medical air . Exercise training improved exercise capacity and quality of life in normoxaemic COPD patients who demonstrated oxygen desaturation during exercise , with no greater improvement with supplemental oxygen during exercise training compared to air Background Breathing programs have been reported to have positive effects in alleviating symptoms and optimizing pulmonary function in patients with chronic obstructive pulmonary disease ( COPD ) . However , patients with stable disease may drop out of such programs if they are not modified to the individual ’s exercise tolerance level , or if they are not easy to perform in the home . Little is known about the effectiveness of web-based home breathing programs for dyspnea . The purpose of this study was to evaluate the effectiveness of an online breathing program which included an animated diagram and video-guided instruction on pulmonary function , exercise capacity , and health-related quality of life in patients with COPD . Methods Sixty patients with stable COPD were r and omized 1:1 to an experimental group ( n = 30 ) or a control group ( n = 30 ) . Subjects in the experimental group trained for four months using an online program which included an animated diagram and video-guided instruction while the control group received conventional patient education on discharge from hospital .  Forced expiratory volume , forced expiratory volume in one second (FEV1)/forced vital capacity ( % ) , peak expiratory volume , six-minute walking distance test , and responses to the St George ’s Respiratory Question naire were assessed before and after the intervention . Results Patients in the two groups were well matched for demographic and clinical characteristics at baseline . All outcome measures showed significant improvement in the experimental group but not in the control group . Conclusion The online training program result ed in improved pulmonary function , exercise capacity , and health status . Therefore , it is strongly recommended that patients with stable COPD be trained with such programs PURPOSE Many patients with chronic obstructive pulmonary disease ( COPD ) report dyspnea and fatigue when performing upper limb activities . Unsupported upper limb training has been shown to improve upper limb endurance , but its effects on symptoms and quality of life have not been examined . The aim of this study was to compare the effects of upper limb and lower limb training with lower limb training alone on exercise capacity , symptoms , and quality of life with COPD . METHODS For this study , 38 patients with moderate to severe COPD were r and omly allocated to unsupported upper limb endurance training or to a control group that completed a sham training task . All the patients underwent lower limb endurance training . The 6-minute walk test , the Incremental Unsupported Upper Limb Exercise Test , and the Chronic Respiratory Disease Question naire ( CRQ ) were completed before training and then 6 weeks afterward . Both patients and assessors were blinded to group allocation . RESULTS All the patients reported symptoms associated with upper limb activities on the initial CRQ . Both groups showed significant improvements in all domains of the CRQ and in the 6-minute walk test after training . Only the upper limb training group showed improvement in upper limb endurance time ( 57 + /- 75 vs 2 + /- 58 seconds ; P = .02 ) . There were no significant differences between the groups for 6-minute walk test or any domain of the CRQ . CONCLUSIONS Unsupported upper limb training for patients COPD improves upper limb exercise capacity , but has no additional effect on symptoms or quality of life , as compared with leg training alone . This type of upper limb training may not adequately address the complex interaction between respiratory mechanics and upper limb function The article by McKeough and colleagues in this issue of Chronic Respiratory Disease is the first study to compare different modes of upper extremity training in individuals with chronic obstructive pulmonary disease ( COPD ) . Limitations during exercise and daily activity in individuals with COPD are not limited to lower extremity activities such as walking or stair climbing ; most of the patients experience difficulty during activities that involve their arms due to the sensation of dyspnea and /or arm fatigue . Upper extremity training for patients with COPD is an important component of pulmonary rehabilitation ( PR ) , result ing in improvements in arm exercise capacity , arm function and muscle strength . However , there is limited evidence on what type of training should be performed . The study by McKeough and colleagues adds to the growing body of evidence in the area of upper extremity training in COPD and provides support for the inclusion of arm endurance and strength training as a part of PR . The study is a r and omized controlled trial ( RCT ) that aim ed to compare the effects of arm endurance training ; arm strength training , a combination of arm endurance and strength training ; and no arm training ( control group ) on endurance arm exercise capacity , functional arm exercise capacity and health-related quality of life ( HRQL ) in individuals with mild-tovery severe COPD . The authors found a significant improvement in arm endurance time ( arm endurance capacity ) between the endurance group and control group . There were nonsignificant trends in arm endurance time favoring the strength training and combined groups compared with the control group . In terms of symptoms , the authors demonstrated that the combined group had a significantly greater reduction in dyspnea and rate of perceived exertion at the end of the functional arm exercise test compared with the control and with each of the intervention groups . When the combined group was compared with the other two intervention groups , the improvement in HRQL ( measured using the St George ’s Respiratory Question naire ) exceeded the minimum clinical ly important difference of 4 units , although it did not reach statistical significance . Until the beginning of the century , several RCTs had been conducted to examine the effects of upper extremity training in individuals with COPD . However , there were considerable variations in the exercise protocol s rendering it impossible to determine the optimal training regimen for these patients . Moreover , the impact of upper extremity training on other clinical outcomes besides arm exercise capacity was unclear as shown consistently by four systematic review s. More recently , four RCTs examining the effects of arm exercise training in individuals with COPD have been published . Holl and and colleagues compared the effects of unsupported upper limb endurance training with lower extremity training alone . The authors found that unsupported upper limb endurance training improved upper limb exercise capacity but had no additional effects on the symptoms or HRQL compared with lower extremity training alone . Costi and colleagues examined the effects of upper extremity resistance training in patients with COPD compared with st and ard PR . The authors demonstrated improvement in arm functional exercise capacity ( measured using the 6-minute pegboard and ring test ) and in performance during activities of daily living ( ADL ) measured by an ADL field test . In addition , the authors found a decrease in arm fatigue at the end of the ADL test in the intervention group . Objective : To investigate the effects of elastic tubing training compared with conventional resistance training on the improvement of functional exercise capacity , muscle strength , fat-free mass , and systemic inflammation in patients with chronic obstructive pulmonary disease . Design : A prospect i ve , r and omized , eight-week clinical trial . Setting : The study was conducted in a university-based , outpatient , physical therapy clinic . Subjects : A total of 49 patients with moderate chronic obstructive pulmonary disease . Interventions : Participants were r and omly assigned to perform elastic tubing training or conventional resistance training three times per week for eight weeks . Main measures : The primary outcome measure was functional exercise capacity . The secondary outcome measures were peripheral muscle strength , health-related quality of life assessed by the Chronic Respiratory Disease Question naire ( CRDQ ) , fat-free mass , and cytokine profile . Results : After eight weeks , the mean distance covered during six minutes increased by 73 meters ( ±69 ) in the elastic tubing group and by 42 meters ( ±59 ) in the conventional group ( p < 0.05 ) . The muscle strength and quality of life improved in both groups ( P < 0.05 ) , with no significant differences between the groups . There was a trend toward an improved fat-free mass in both groups ( P = 0.05 ) . After the first and last sessions , there was an increase in interleukin 1β ( IL-1β ) and interleukin 10 ( IL-10 ) in both groups , while tumour necrosis factor alpha ( TNF-α ) was stimulated only in the conventional training group . Conclusion : Elastic tubing training had a greater effect on functional exercise capacity than conventional resistance training . Both interventions were equally effective in improving muscle strength and quality of life The aim of this study was to determine if weekly , supervised , outpatient-based exercise plus unsupervised home exercise following an 8-week pulmonary rehabilitation programme would maintain functional exercise capacity and quality of life at 12 months better than st and ard care of unsupervised home exercise training . Chronic obstructive pulmonary disease ( COPD ) subjects completed an 8-week pulmonary rehabilitation programme  , were r and omised to an intervention group ( IG ) of weekly , supervised , exercise plus home exercise or to a control group ( CG ) of unsupervised home exercise and followed for 12 months . Outcome measurements at baseline ( after pulmonary rehabilitation ) , and 3 , 6 and 12 months included the 6-min walk test and St George 's Respiratory Question naire ( SGRQ ) .  59 subjects with moderate COPD ( Global Initiative for Chronic Obstructive Lung Disease stage II ) were recruited and 48 subjects completed the study . 12-month mean difference showed no significant change from baseline in 6-min walk distance ( IG -11 m , 95 % CI -21–10 m ; CG -6 m , 95 % CI -34–11 m ) or total SGRQ score ( IG 3 , 95 % CI -0.8–7 ; CG -3 , 95 % CI -7–3 ) . 12 months following pulmonary rehabilitation both weekly , supervised , outpatient-based exercise plus unsupervised home exercise and st and ard care of unsupervised home exercise successfully maintained 6-min walk distance and quality of life in subjects with moderate COPD 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 This study was design ed to determine the effect of ground-based walking training on health-related quality of life and exercise capacity in people with chronic obstructive pulmonary disease ( COPD ) . People with COPD were r and omised to either a walking group that received supervised , ground-based walking training two to three times a week for 8–10 weeks , or a control group that received usual medical care and did not participate in exercise training .  130 out of 143 participants ( mean±sd age 69±8 years , forced expiratory volume in 1 s 43±15 % predicted ) completed the study . Compared to the control group , the walking group demonstrated greater improvements in the St George ’s Respiratory Question naire total score ( mean difference -6 points ( 95 % CI -10– -2 ) , p<0.003 ) , Chronic Respiratory Disease Question naire total score ( mean difference 7 points ( 95 % CI 2–11 ) , p<0.01 ) and endurance shuttle walk test time ( mean difference 208 s ( 95 % CI 104–313 ) , p<0.001 ) . This study shows that ground-based walking training  is an effective training modality that improves quality of life and endurance exercise capacity in people with COPD  . Walking training  improves quality of life and endurance exercise capacity compared to usual medical care in COPD
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 ) .