Resistance versus endurance training in patients with COPD and peripheral muscle weakness Effects of Combined Resistance and Endurance Training Versus Resistance Training Alone on Strength, Exercise Capacity, and Quality of Life in Patients With COPD Four weeks’ intensive rehabilitation generates significant health effects in COPD patients Two different training programmes for patients with COPD: a randomised study with 1-year follow-up. Resistance training as a preconditioning strategy for enhancing aerobic exercise training outcomes in COPD. Strength training increases maximum working capacity in patients with COPD--randomized clinical trial comparing three training modalities. Effect of respiratory muscle endurance training in patients with COPD undergoing pulmonary rehabilitation. How should we train the upper limbs? Randomized trial of non-invasive ventilation combined with exercise training in patients with chronic hypercapnic failure due to chronic obstructive pulmonary disease. [Exercise training in chronic obstructive pulmonary disease. Comparative study of aerobic training of lower limbs vs. combination with upper limbs]. Effects of Combined Aerobic-Strength Training vs Fitness Education Program in COPD Patients. Comparison of the effects of neuromuscular electrical stimulation and endurance training in patients with severe chronic obstructive pulmonary disease. Home based neuromuscular electrical stimulation as a new rehabilitative strategy for severely disabled patients with chronic obstructive pulmonary disease (COPD) 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) Does unsupported upper limb exercise training improve symptoms and quality of life for patients with chronic obstructive pulmonary disease? Effects of combined inspiratory muscle and cycle ergometer training on exercise performance in patients with COPD. Oxygen compared to air during exercise training in COPD with exercise-induced desaturation Systematic Review: Inspiratory Muscle Training in Patients with Chronic Obstructive Pulmonary Disease: The State of the Evidence Impact of resistance training in chronic obstructive pulmonary disease patients during periods of acute exacerbation. Comparison of effectiveness of pressure threshold and targeted resistance devices for inspiratory muscle training in patients with chronic obstructive pulmonary disease. Aerobic and strength training in patients with chronic obstructive pulmonary disease. Home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized clinical trial Ground walk training improves functional exercise capacity more than cycle training in people with chronic obstructive pulmonary disease (COPD): a randomised trial.
The effects of endurance training on exercise capacity and health-related quality of life ( HRQL ) in chronic obstructive pulmonary disease ( COPD ) patients have been studied thoroughly , while resistance training has been rarely evaluated . This study investigated the effects of resistance training in comparison with endurance training in patients with moderate to severe COPD and peripheral muscle weakness ( isometric knee extension peak torque < 75 % predicted ) . Forty-eight patients ( age 64±8 yrs , forced expiratory volume in one second 38±17 % pred ) were r and omly assigned to resistance training ( RT , n=24 ) or endurance training ( ET , n=24 ) . The former consisted of dynamic strengthening exercises . The latter consisted of walking , cycling and arm cranking .  Respiratory and peripheral muscle force , exercise capacity , and HRQL were re-evaluated in all patients who completed the 12-week rehabilitation ( RT n=14 , ET n=16 ) . Statistically significant increases in knee extension peak torque ( RT 20±21 % , ET 42±21 % ) , maximal knee flexion force ( RT 31±39 % , ET 28±37 % ) , elbow flexion force ( RT 24±19 % , ET 33±25 % ) , 6-min walking distance ( 6MWD ) ( RT 79±74 m , ET 95±57 m ) , maximum workload ( RT 15±16 Watt , ET 14±13 Watt ) and HRQL ( RT 16±25 points , ET 16±15 points ) were observed . No significant differences in changes in HRQL and 6MWD were seen between the two treatments . Resistance training and endurance training have similar effects on peripheral muscle force , exercise capacity and health-related quality of life in chronic obstructive pulmonary disease patients with peripheral muscle weakness PURPOSE : To compare the effects of 12-week training periods ( 2 d·wk−1 ) involving resistance training only with the effects of 12-week training periods involving combined resistance ( once weekly ) and endurance ( once weekly ) training on strength , endurance performance , and quality of life . METHODS : Thirty-six patients with moderate-to-severe chronic obstructive pulmonary disease were r and omized to combined training ( REG ) , resistance training alone ( RG ) , or control ( CG ) groups . Patients were tested for maximal strength of the upper and lower extremities , power output of the lower extremities , maximal ( W max ) and submaximal exercise capacity , performance on a 6-minute walk test ( 6MWT ) , and quality of life . RESULTS : REG and RG induced similar maximal strength gains . Muscle power increased 19 % ( P ⩽ .01 ) and W max improved 13 % ( P < .05 ) in REG . Reductions ( P < .05 ) in the heart rate and blood lactate at a given submaximal workload were observed in REG . Improvements in 6MWT and quality of life were similar in both training groups . CONCLUSIONS : Compared with a twice-weekly resistance training program , the combination of once-weekly resistance and once-weekly endurance training not only produced similar gains in maximal strength , 6MWT performance , and quality of life but also produced improvements in muscle power and endurance performance . These findings may have implication s for the prescription of resistance and endurance exercise for patients with chronic obstructive pulmonary disease Changes in health according to World Health Organization ’s International Classification of Functioning , Disability and Health ( ICF ) after four weeks of pulmonary rehabilitation ( PR ) were investigated . Gender differences in the response to PR , and the correlation between improvements in the two components of ICF ( Body functions and Activities and Participation ) were examined . Twenty-two men and 18 women with chronic obstructive pulmonary disease in Global Initiative for Chronic Obstructive Lung Disease ( GOLD ) stage II-IV attended in-patient , multidisciplinary PR consisting of endurance training four to five times/week at 70 % of peak work rate ( WRpeak ) , resistance training three to four times/week at 72 % of 15 repetitions maximum , educational sessions and individual counselling . The results were compared to those of 20 Chronic Obstructive Pulmonary Disease ( COPD ) patients included after the same criteria and investigated while waiting for admission to PR . In the rehabilitation group , we found significant improvements in health related quality of life ( HRQoL ) ( -7 units , St. George ’s Respiratory Question naire ) , arm ( 6 % ) and leg ( 15 % ) maximal voluntary contraction , peak oxygen uptake ( 6 % ) , WRpeak ( 60 % ) and treadmill endurance time ( 93 % ) . At iso-WR , ventilation and dyspnoea were significantly lower , but inspiratory capacity remained unchanged . Improvements in HRQoL correlated with increases in peak ventilation , but not in muscle strength or exercise capacity . Men improved their six-minute walking distance significantly in contrast to women . Clinical ly important improvements in HRQoL were found in two out of three of the men , and one out of three of the women . Four weeks of intensive PR generated significant health effects comparable to longer lasting programmes . Changes in exercise capacity and muscle strength were not related to improvements in HRQoL. The gender differences in the response to PR deserve attention in future studies PURPOSE To compare the effects on exercise capacity and health related quality of life ( HRQoL ) of two exercise programmes ; one programme including endurance training and one including only resistance training and callisthenics . A second purpose was to find out whether the severity of chronic obstructive pulmonary disease ( COPD ) affected the training response and whether the interventions had a long-term effect . METHODS Sixty-three patients were stratified according to severity of COPD and r and omised to two training groups . Group A had a mixed programme including endurance training . Group B had resistance training and callisthenics . All trained twice weekly for 8 weeks . A symptom-limited ergometer test , 12-min walking test , dynamic spirometry , blood gas analysis at rest and HRQoL were measured before and after the training period . Follow-up tests were conducted at 6 and 12 months after training . RESULTS Forty-two patients fulfilled the trial . In group A ( n=20 ) peak exercise capacity increased by 7W ( P<0.001 ) and 12-min walking distance ( 12MWD ) by 50 m ( P<0.01 ) , whereas group B ( n=22 ) did not change in any of these variables . HRQoL did not change significantly in either group . Training response was similar in patients with moderate and severe disease . One year post-training 12MWD had returned to pre-training level in group A , and below pre-training level in group B ( P<0.05 ) . CONCLUSIONS Exercise capacity in patients with severe and moderate COPD improved by intensive endurance training , two sessions a week for 8 weeks . The improvement was however small and HRQoL did not improve . Severity of illness did not affect response to training . The results indicated that the effects of a short endurance training intervention slowed down decline in baseline functional exercise capacity for 1 year PURPOSE Aerobic exercise training is a recognized approach for improving functional capacity in COPD . People with greater disease severity often have difficulty achieving higher aerobic exercise training intensity . The effects of resistance training prior to aerobic training were examined to determine if this sequential approach was associated with greater gains in functional status than aerobic training alone or concurrent aerobic and resistance training . METHODS Patients were r and omized to : 1 ) sequential resistance then aerobic training ( RT-then-AT ) ( 8 weeks resistance training followed by 8 weeks aerobic exercise training ) , 2 ) control group ( CE-then-AT + RT ) ( 8 weeks of ' sham ' training followed by 8 weeks concurrent aerobic and resistance training ) , 3 ) control group ( CE-then-AT ) ( 8 weeks ' sham ' training followed by 8 weeks aerobic training ) . Outcomes were assessed at study entry , after week 8 , and after week 16 : aerobic exercise performance ; muscle strength and endurance . RESULTS 75 patients completed training :  FEV1 % pred 40 ± 10 , V˙O(2peak ) % predicted , 71 ± 22 , fat-free mass index 19.5 ± 3.1 . RT-then-AT had greater acquisition of peripheral muscle endurance than CE-then-AT + RT and CE-then-AT , but improvements in aerobic exercise performance were similar . Improvements in muscle strength were similar between RT-then-AT and CE-then-AT + RT . Sarcopenia was associated with poorer attendance , and lower aerobic and resistance training volumes . CONCLUSION Although the sequential approach to resistance and aerobic training yielded a greater increase in muscle endurance and higher resistance training volume compared to concurrent resistance and aerobic training , other training outcomes were similar between the two groups , thus the sequential approach is not clearly superior to the concurrent approach in severe COPD . Clinical Trials.gov Identifier : NCT01058213 BACKGROUND AND OBJECTIVE Skeletal muscle dysfunction contributes to exercise limitation in patients with chronic obstructive pulmonary disease ( COPD ) .  Strength training increases muscle strength and muscle mass , but there is an ongoing debate on the additional effect concerning the exercise capacity . The purpose of this study was to compare the effects of three different exercise modalities in patients with COPD including endurance training ( ET ) , progressive strength training ( ST ) and the combination of strength training and endurance training ( CT ) . DESIGN A prospect i ve r and omized trial . METHODS Thirty-six patients with COPD were r and omly allocated either to ET , ST , or CT .  Muscle strength , cardiopulmonary exercise testing , lung function testing and quality of life were assessed before and after a 12-week training period . RESULTS Exercise capacity ( Wmax ) increased significantly in all three training groups with increase of peak oxygen uptake ( VO2peak ) in all three groups , reaching statistical significance in the ET group and the CT group . Muscle strength ( leg press , bench press , bench pull ) improved in all three training groups , with a higher improvement in the ST ( + 39.3 % , + 20.9 % , + 20.3 % ) and the CT group ( + 43.3 % , + 18.1 % , + 21.6 % ) compared to the ET group ( + 20.4 % , + 6.4 % , + 12.1 % ) . CONCLUSIONS Progressive strength training alone increases not only muscle strength and quality of life , but also exercise capacity in patients with COPD , which may have implication s in prescription of training modality . CLINICAL TRIALS.GOV IDENTIFIER : NCT01091623 BACKGROUND Respiratory muscle endurance training ( hyperpnea training ) has been shown to have beneficial effects in patients with COPD . STUDY OBJECTIVES The purpose of this study was to determine whether hyperpnea training , when added to an endurance exercise training program , would lead to additional benefits compared with endurance training alone in patients with COPD . SETTING AND PARTICIPANTS Patients with COPD entering an 8-week outpatient pulmonary rehabilitation program . Fifteen patients ( mean [ + /- SE ] FEV1 , 45 + /- 6 % predicted ) were r and omized to combined therapy , and 14 patients ( mean FEV1 , 44 + /- 4 % predicted ) were r and omized to endurance training .  METHODS  Peak exercise capacity , exercise endurance time during constant workload cycle exercise , 6-min walk distance , quality of life as measured by the chronic respiratory question naire , respiratory muscle strength and endurance , and quadriceps fatigability were measured before and after endurance or combined training . RESULTS After rehabilitation , peak exercise capacity , exercise endurance time , 6-min walk distance , and quality of life all increased in both groups , but there was no significant difference in the extent of improvement between groups . Mean respiratory muscle endurance increased to a significantly greater extent in the combined therapy group ( 17.5 + /- 2.7 vs 8.5 + /- 2.5 min , respectively ; p = 0.02 ) . Respiratory muscle strength was significantly increased , and quadriceps fatigability was significantly reduced after rehabilitation in the combined therapy group but not in the endurance training group , but the difference between groups did not reach statistical significance . CONCLUSION The endurance of the respiratory muscles can be improved by specific training beyond that achieved by endurance training alone in patients with COPD . However , this improvement did not translate into additional improvement in quality of life or exercise performance 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 . 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 A prospect i ve , r and omized and controlled study has been performed in 28 patients with severe COPD . A group of 14 has been trained with their lower limbs ( LL ) , while another similar group of 14 patients was also trained with their upper limbs ( UL ) . Results showed improvement in both groups in the endurance test for LL , dyspnea scale , efficiency and muscular working capacity . A considerable improvement was observed in the oxygen uptake at the anerobic threshold ( VO2AT ) which suggests a training effect , expressed through an improvement in exercise tolerance . Only the group who trained UL showed a remarkable improvement in the dyspnea scale , endurance test and maximal static mouth pressure , showing a better intrinsic working capacity and participation of the UL muscles producing those manoeuvres . At the end of training , quality of life was significantly increased and the hospitalization rate was lower in both groups . According to these findings , it is suggested that patients with severe COPD included in training programmes add UL exercises to the LL usually carried out We compared the effects of a new physical activity education program approach ( EDU ) , based on a periodically supervised protocol of different exercise modalities vs traditionally supervised combined strength-endurance training ( CT ) on health-related factors in patients with stable chronic obstructive pulmonary disease ( COPD ) . Twenty-eight COPD patients without comorbidities were r and omly assigned to receive either EDU or CT . CT was continuously supervised to combine strength-endurance training ; EDU was taught to progressively increase the rate of autonomous physical activity , through different training modalities such as Nordic walking , group classes and circuit training .  Body composition , walking capacity , muscle strength , flexibility and balance , total daily energy expenditure and quality of life were evaluated at baseline , after 28 weeks training period ( 3d/week ) and after a 14-week follow-up . No adverse events occurred during the interventions . After training , CT and EDU similarly improved walking capacity , body composition and quality of life . However , after 14 weeks of follow-up , such improvements were not maintained . Only in CT , muscle strength and flexibility improved after training but returned to baseline after follow-up . EDU , similar to CT , can effectively and safely improve health-related parameters in COPD patients . EDU could be an attractive alternative to traditional supervised training for improving quality of life in COPD patients INTRODUCTION In severely disabled patients who are not capable of following formal pulmonary rehabilitation ( PR ) and /or tolerating higher training intensities , neuromuscular electrical stimulation ( NMES ) has been successfully utilized as a localized training method . MATERIAL S AND METHODS In this non-r and omized controlled observational study 50 patients with severe chronic obstructive pulmonary disease ( COPD ) , who were allocated into two groups . Endurance training group ( ET ) ( n= 27 ) and NMES group ( n= 23 ) . To compare the effects of NMES and ET on health-related quality of life ( HRQOL ) , exercise capacity , muscle strength , dyspnea , psychological status , and body composition in patients with severe COPD . Before and after PR program , the study parameters were assessed using the Medical Research Council ( MRC ) scale , incremental and endurance shuttle walking tests ( ISWT , ESWT ) , manual muscle testing ( MMT ) , the St. George 's Respiratory Question naire ( SGRQ ) , bioelectrical impedance analysis , and the Hospital Anxiety and Depression Scale ( HADS ) . RESULTS After the PR program , walking distance and endurance time significantly increased in both groups ( p < 0.001 for each ) , whereas the MRC scores of both groups significantly decreased ( p < 0.001 for each ) . In the ET group , significant decreases were noted in all domains of SGRQ and HADS . In the NMES group , significant improvements were observed in the HADS scores and in all SGRQ domain except symptom domain . No significant differences were observed between the NMES and ET groups regarding the changes from baseline to after PR program in walking distance ( p= 0.140 ) , endurance time ( p= 0.376 ) , the MRC ( p= 0.540 ) , HRQOL ( p > 0.05 ) and HADS ( p > 0.05 ) scores , body-mass index ( BMI ) ( p= 0.49 ) , fat-free mass ( FFM ) ( p= 0.50 ) and fat-free mass index ( FFMI ) ( p= 0.94 ) . CONCLUSION NMES can be used as an effective treatment strategy in PR programs for peripheral muscle training in patients with severe COPD Background : Passive training of specific locomotor muscle groups by means of neuromuscular electrical stimulation ( NMES ) might be better tolerated than whole body exercise in patients with severe chronic obstructive pulmonary disease ( COPD ) . It was hypothesised that this novel strategy would be particularly effective in improving functional impairment and the consequent disability which characterises patients with end stage COPD . Methods : Fifteen patients with advanced COPD ( nine men ) were r and omly assigned to either a home based 6 week quadriceps femoris NMES training programme ( group 1 , n=9 , FEV1=38.0 (9.6)% of predicted ) or a 6 week control period before receiving NMES ( group 2 , n=6 , FEV1=39.5 (13.3)% of predicted ) . Knee extensor strength and endurance , whole body exercise capacity , and health related quality of life ( Chronic Respiratory Disease Question naire , CRDQ ) were assessed . Results : All patients were able to complete the NMES training programme successfully , even in the presence of exacerbations ( n=4 ) . Training was associated with significant improvements in muscle function , maximal and endurance exercise tolerance , and the dyspnoea domain of the CRDQ ( p<0.05 ) . Improvements in muscle performance and exercise capacity after NMES correlated well with a reduction in perception of leg effort corrected for exercise intensity ( p<0.01 ) . Conclusions : For severely disabled COPD patients with incapacitating dyspnoea , short term electrical stimulation of selected lower limb muscles involved in ambulation can improve muscle strength and endurance , whole body exercise tolerance , and breathlessness during activities of daily living 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 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 Cycle ergometer training plays an important role in the rehabilitation of patients with chronic obstructive pulmonary disease ( COPD ) , but the usefulness of specific inspiratory muscle training as part of pulmonary rehabilitation remains uncertain . To determine whether inspiratory muscle training could intensify the known beneficial effects of cycle ergometer training on exercise performance in these patients , we compared the effect of an 8 week inspiratory muscle training combined with cycle ergometer training with that of an 8 week cycle ergometer training alone on inspiratory muscle performance and general exercise capacity . Patients were r and omly assigned to the two training groups ; 21 patients received additional inspiratory muscle training ( Group 1 ) and 21 did not ( Group 2 ) .  Maximal sniff assessed oesophageal and transdiaphragmatic pressures served as parameters for global inspiratory muscle strength and diaphragmatic strength , respectively . The duration for which the patient could breathe against a constant inspiratory pressure load was used as an index of inspiratory muscle endurance . Exercise capacity was determined by an incremental symptom-limited cycle ergometer test . After the training period , inspiratory muscle performance improved significantly in the patients with inspiratory muscle training , but not in those without . Both training regimens increased maximal power output and oxygen uptake , but this improvement was significantly greater in the patients with inspiratory muscle training than in those without . ( ABSTRACT TRUNCATED AT 250 WORDS 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 Purpose : The purpose of the present review was to assess the quality of evidence in the literature regarding the specific benefits of inspiratory muscle training ( IMT ) with an emphasis on training intensity and the relationships between changes in inspiratory muscle function and other clinical outcome measures . Methods : Articles were found by search ing CINAHL , PubMed , Medline via First Search , and ProQuest data bases . Articles used in the review were r and omized trials of IMT vs. sham IMT or no intervention  , published in English in a peer‐ review ed journal , included patients with chronic obstructive pulmonary disease ( COPD ) , and specified the intensity of training . The quality of the studies was evaluated by 2 independent review ers using the method ological rigor scale described by Medlicott and Harris as well as Sackett 's levels of evidence . Fifteen articles met the inclusion criteria and were used in this review . Results : Consistent improvements in maximal inspiratory pressures ( ranging from ‐11 to ‐30 cm H2O ) and inspiratory muscle endurance were found . Improvements in dyspnea and health‐related quality of life were also observed . Inspiratory muscle training may result in improved exercise tolerance as measured using walking tests . High‐intensity IMT result ed in improved training efficiency with respect to inspiratory muscle strength , but evidence of the effect of high‐intensity IMT on other clinical outcomes is lacking . Conclusion : Despite research spanning decades , there are numerous limitations in the literature regarding IMT . IMT appears to improve dyspnea , waking test distance , and health‐related quality of life in individuals with COPD , but it is not clear whether this improvement is mediated through improved inspiratory muscle strength and endurance . This review discussed several considerations critical to the design of future trials OBJECTIVE To evaluate the effects of whole-body resistance training on exercise capacity , health-related quality of life ( HRQOL ) , and muscle strength in patients hospitalized for exacerbation of chronic obstructive pulmonary disease . DESIGN R and omized controlled trial . SETTING University hospital . PARTICIPANTS Patients ( N=46 ) were r and omized to either a control group ( CG ) or training group ( TG ) , and 29 patients completed the study . INTERVENTION Training consisted of weight-lifting exercises for 6 muscle groups in the upper and lower limbs ( 2 sets of 8 repetitions each ) , and the initial load was set at 80 % of the 1-repetition maximum load . MAIN OUTCOME MEASURES Patients were evaluated on the second day of hospitalization , at hospital discharge , and 30 days postdischarge . Patients were evaluated on the basis of the 6-minute walking distance ( 6MWD ) , HRQOL , muscle strength , systemic inflammatory markers , and level of physical activity in daily life ( PADL ) . RESULTS The CG showed a reduction in the strength of lower-limb muscles ( P<.05 ) but not in the 6MWD ( P>.05 ) . In contrast , patients from the TG improved strength in the lower-limb muscles and 6MWD during and 30 days after hospitalization ( P<.05 ) . The TG also improved the impact domain in HRQOL after hospitalization . No improvement in PADL was observed in the TG . Finally , a reduction in the blood levels of inflammatory markers was observed only in the TG after hospitalization . CONCLUSIONS Our results suggest that resistance training during hospitalization improves the 6MWD , HRQOL , and lower-limb muscle strength , without altering the levels of systemic inflammation . However , future research should explore this intervention in larger r and omized trials BACKGROUND AND PURPOSE Previous studies have provided little information about the comparative efficacy of treatment with pressure threshold and targeted resistive inspiratory muscle training devices . This study compared the efficacy of these two types of inspiratory muscle training ( IMT ) devices on inspiratory muscle function , exercise capacity , and quality of life in patients with chronic obstructive pulmonary disease ( COPD ) . METHODS Forty two patients with moderate to severe COPD were r and omly assigned to either a control group , a group receiving pressure threshold inspiratory muscle training , or a group receiving targeted resistive inspiratory muscle training . The training intensity was 50 % of patients ' maximal inspiratory pressure ( MIP ) . Home-based training comprised two 15-minute sessions a day , 5 days a week for 8 weeks . Inspiratory muscle function measurement included MIP and inspiratory muscle endurance . RESULTS Thirty patients completed the program , 10 from each group . Twelve patients were excluded because of changes in pharmacological regimen or admission to the hospital ( n = 5 ) , study withdrawal ( n = 4 ) , or poor compliance with the training program ( n = 3 ) . After training , a significant increase in endurance time was found for the threshold group and targeted resistive group ( 4.4 + /- 3.2 min and 3.0 + /- 2.9 min , respectively , both p < 0.05 vs control ) , with no significant difference between the 2 training groups . The 6-minute walking distance also increased significantly in both training groups ( p < 0.05 ) . CONCLUSIONS Targeted resistive IMT with a controlled training load has a similar efficacy to the more popularly used pressure threshold IMT and can be incorporated in the treatment of COPD patients . The targeted resistance device offers a less expensive and easily used treatment choice The purpose of this study was to evaluate whether strength training is a useful addition to aerobic training in patients with chronic obstructive pulmonary disease ( COPD ) . Forty-five patients with moderate to severe COPD were r and omized to 12 wk of aerobic training alone ( AERO ) or combined with strength training ( AERO + ST ) . The AERO regimen consisted of three weekly 30-min exercise sessions on a calibrated ergocycle , and the ST regimen included three series of eight to 10 repetitions of four weight lifting exercises .  Measurements of peripheral muscle strength , thigh muscle cross-sectional area ( MCSA ) by computed tomographic scanning , maximal exercise capacity , 6-min walking distance ( 6MWD ) , and quality of life with the chronic respiratory question naire were obtained at baseline and after training . Thirty-six patients completed the program and constituted the study group . The strength of the quadriceps femoris increased significantly in both groups ( p < 0.05 ) , but the improvement was greater in the AERO + ST group ( 20 + /- 12 % versus 8 + /- 10 % [ mean + /- SD ] in the AERO group , p < 0.005 ) . The thigh MCSA and strength of the pectoralis major muscle increased in the AERO + ST group by 8 + /- 13 % and 15 + /- 9 % , respectively ( p < 0.001 ) , but not in the AERO group ( 3 + /- 6 % and 2 + /- 10 % , respectively , p > 0.05 ) . These changes were significantly different in the two study groups ( p < 0.01 ) . The increase in strength of the latissimus dorsi muscle after training was modest and of similar magnitude for both groups . The changes in peak exercise work rate , 6MWD , and quality of life were comparable in the two groups . In conclusion , the addition of strength training to aerobic training in patients with COPD is associated with significantly greater increases in muscle strength and mass , but does not provide additional improvement in exercise capacity or quality of life Introduction Pulmonary rehabilitation ( PR ) is a multidisciplinary program of care for patients with chronic obstructive pulmonary disease ( COPD ) with the goal of improving the functional capacity and quality of life , as well as maintaining the clinical stability of COPD sufferers . However , not all patients are available for such a program despite discomfort with their condition . The aim of this study was to evaluate the effects of a home-based PR ( HBPR ) program on functional ability , quality of life , and respiratory muscle strength and endurance . Patients and methods Patients with COPD according to the Global Initiative of Chronic Obstructive Lung Disease were r and omized ( double-blind ) into two groups . One group performed a protocol at home with aerobic and muscle strength exercises and was called the intervention group ; the other group received only instructions to perform breathing and stretching exercises , characterizing it as the control group ( CG ) . We assessed the following variables at baseline and 2 months : exercise tolerance ( incremental shuttle walk test and upper limb test ) , respiratory muscle ( strength and endurance test ) , and health-related quality of life ( Airways Question naire 20 ) . Results There were no significant changes after the intervention in either of the two groups in exercise tolerance and quality of life . However , the intervention group had improved respiratory endurance compared with the CG , while the CG presented a decrease in the load sustained by the respiratory muscles after the HBPR . Conclusion A program of HBPR with biweekly supervision ( although not enough to provide significant improvements in physical capacity or quality of life ) played an important role in maintaining the stability of the clinical features of patients with COPD ; the patients had no worsening of symptoms during the intervention period according to the daily log QUESTIONS Does an eight-week program of walk training improve endurance walking capacity in people with COPD compared to cycle training ? Does walk training improve peak walking capacity , cycle capacity , and quality of life compared to cycle training ? Is the endurance shuttle walk test ( ESWT ) responsive to change in walking capacity elicited by exercise training ? DESIGN R and omised trial with concealed allocation , assessor blinding , and intention-to-treat analysis . PARTICIPANTS 36 people with stable COPD recruited with four dropouts . INTERVENTION Participants were r and omised into either a walk or cycle training group . Both groups trained indoors for 30 to 45 minutes per session , three times weekly over eight weeks at Concord Hospital . Training intensities were based on baseline peak exercise tests and progressed as able . OUTCOME MEASURES The primary outcome was endurance walking capacity measured by the ESWT . Secondary outcomes included peak walking capacity , peak and endurance cycle capacity , and health-related quality of life . Measures were taken at baseline ( Week 0 ) and following training ( Week 8) . RESULTS The walk training group increased their endurance walking time by 279 seconds ( 95 % CI 70 to 483 ) more than the cycle training group . No significant differences between the groups were found for any other outcome . CONCLUSION Ground walk training increased endurance walking capacity more than cycle training and was similar to cycle training in improving peak walking capacity , peak and endurance cycle capacity and quality of life . This study provides evidence for ground walking as a mode of exercise training in pulmonary rehabilitation programs
We included 11 r and omized controlled trials ( 331 participants ) and 2 previous systematic review s. The meta-analyses showed equal improvements in HRQoL , walking distance and exercise capacity .
In conclusion , we found significantly increased leg muscle strength favouring a combination of RT with ET compared with ET alone .
Resistance training ( RT ) is thought to be effective in preventing muscle depletion , whereas endurance training ( ET ) is known to improve exercise capacity and health-related quality of life ( HRQoL ) in chronic obstructive pulmonary disease ( COPD ) .
Our objectives were to assess the efficiency of combining RT with ET compared with ET alone .