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 ) .
Proportional assist ventilation as an aid to exercise training in severe chronic obstructive pulmonary disease
Background : The effects of providing ventilatory assistance to patients with severe chronic obstructive pulmonary disease ( COPD ) during a high intensity outpatient cycle exercise programme were examined . Methods : Nineteen patients ( 17 men ) with severe COPD ( mean ( SD ) forced expiratory volume in 1 second ( FEV1 ) 27 (7)% predicted ) underwent a 6 week supervised outpatient cycle exercise programme . Ten patients were r and omised to exercise with ventilatory assistance using proportional assist ventilation ( PAV ) and nine ( two women ) to exercise unaided . Before and after training patients performed a maximal symptom limited incremental cycle test to determine peak work rate ( Wpeak ) followed by a constant work rate ( CWR ) test at 70 % of Wpeak achieved in the baseline incremental test . Minute ventilation ( Ve ) , heart rate , and arterialised venous plasma lactate concentration [ La+ ] were measured before and after each test . Results : Mean training intensity ( Wt/Wpeak ) at 6 weeks was 15.2 % ( 95 % CI 3.2 to 27.1 ) higher in the group that used ventilatory assistance ( p=0.016 ) . Peak work rate after training was 18.4 % ( 95 % CI 6.4 to 30.5 ) higher ( p=0.005 ) in the assisted group ( p=0.09 ) . [ La+ ] at an identical workload after training was reduced by 30 % ( 95 % CI 16 to 44 ) in the assisted group ( p=0.002 compared with baseline ) and by 11 % ( 95 % CI –7 to 31 ) ( p=0.08 compared with baseline ) in the unassisted group ( mean difference 18.4 % ( 95 % CI 3.3 to 40 ) , p=0.09 ) . A significant inverse relationship was found between reduction in plasma lactate concentration ( ΔL ) at an equivalent workload after training during the CWR test and Wt/Wpeak achieved during the last week of training ( r=–0.7 , p=0.0006 ) . Conclusions : PAV enables a higher intensity of training in patients with severe COPD , leading to greater improvements in maximum exercise capacity with evidence of true physiological adaptation
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 ) .