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 ) .
Branched-chain aminoacids and retraining of patients with chronic obstructive lung disease.
BACKGROUND The aim of this work was to improve the efficacy of rehabilitation by retraining , by oral supply in branched-chain aminoacids ( BCAA ) .  Patients with chronic respiratory insufficiency mainly suffer from obstructive bronchitis due to tobacco or asthma .  Nutritional assessment is one of the components of respiratory rehabilitation , with retraining . Intense physical training for several days negativates the nitrogen balance , the beginning of a training programme for sedentary patients increases their need in proteins . An additional supply in branched-chain aminoacids increases proteic anabolism , by synthesis increase and catabolism slackening of proteins . Moreover it is known that exposure to high altitude reduces lean mass by inducing a muscular atrophy , which can be avoided by the BCAA provided . This leads to wonder if extra supply of BCAA could play similar role in muscular mass loss induced by pathological chronic hypoxia . METHODS The prospect i ve and comparative survey carried out in Toki-Eder ( private hospital in Cambo ) consisted in supplying ( during five weeks or more ) 30 retrained patients suffering from chronic obstructive bronchitis , and in matching them with 30 witnesses ( obstructive patients retrained without additional supply in BCAA ) . Their  mean hypoxemia  amounted to 7 torr for age . RESULTS Each of them improved their reached maximal power , and their VO2 SL , very highly significantly . Each of them developed a moderate metabolic acidosis ( whose possible mechanisms are discussed ) and slightly increased their ventilation at rest . On the other h and only the supplied patients improved their PaO2 at rest highly significantly , a result which poses the question of the responsible mechanism , most likely a decrease of pulmonary shunt effect . The hypotheses concerning the acid load due to BCAA ingestion are discussed . Only the supplied patients developed hypocapnia expressing a gaseous alkalosis which might be due to a direct effect of BCAA on the respiratory centers . CONCLUSIONS This observation could have practical outcomes in the management of rehabilitation of chronic respiratory insufficiency : it should be useful to systematic ally supplement the patients with BCAA during their retraining in order to obtain a more effective improvement of their respiratory function
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 ) .