title: Interval versus continuous training in patients with severe COPD: a randomized clinical trial. Aerobic Exercise Training Improves Right- and Left Ventricular Systolic Function in Patients with COPD Interval versus Continuous High-Intensity Exercise in Chronic Obstructive Pulmonary Disease An evaluation of two approaches to exercise conditioning in pulmonary rehabilitation. Aerobic high-intensity intervals improve VO2max more than moderate training. Interval training as an alternative modality to continuous exercise in patients with COPD Effects of high-intensity exercise training in a pulmonary rehabilitation programme for patients with chronic obstructive pulmonary disease. Improvement of heart rate variability after exercise training and its predictors in COPD. Effects of interval and continuous exercise training on autonomic cardiac function in COPD patients Effects of 2 Exercise Training Programs on Physical Activity in Daily Life in Patients With COPD Interval Training Versus Continuous Training in Patients With Chronic Obstructive Pulmonary Disease Skeletal muscle adaptations to interval training in patients with advanced COPD. Interval training compared with continuous training in patients with COPD. [Effects of a high intensity training program on patients with chronic obstructive airways disease (COAD)]. High-intensity training and cardiopulmonary exercise testing in patients with chronic obstructive pulmonary disease and non-small-cell lung cancer undergoing lobectomy. A Simple Method for Home Exercise Training in Patients With Chronic Obstructive Pulmonary Disease: ONE-YEAR STUDY Effects of Isolated Cycle Ergometer Training on Patients with Moderate-to-Severe Chronic Obstructive Pulmonary Disease
abstract: Limited information is available regarding the physiological responses to different types of exercise training in patients with severe chronic obstructive pulmonary disease ( COPD ) . The aim of this study was two fold : firstly , to investigate the physiological response to training at 60 % of achieved peak load in patients with severe COPD ; and secondly to study the effects of interval ( I ) versus continuous ( C ) training in these patients . Twenty-one patients with COPD ( mean+/-SD forced expiratory volume in one second : 37+/-15 % of predicted , normoxaemic at rest ) were evaluated at baseline and after 8 weeks ' training . Patients were r and omly allocated to either I or C training . The training was performed on a cycle ergometer , 5 days a week , 30 min daily . The total work load was the same for both training programmes . C training result ed in a significant increase in oxygen consumption ( V'O2 ) ( 17 % , p<0.05 ) and a decrease in minute ventilation (V'E)/V'O2 ( p<0.01 ) and V'E/carbon dioxide production ( V'CO2 ) ( p<0.05 ) at peak exercise capacity , while no changes in these measures were observed after interval training . During submaximal exercise a significant decrease was observed in lactic acid production , being most pronounced in the C-trained group ( -31 % , p<0.01 versus -20 % , p<0.05 ) . Only in the I-trained group did a significant increase in peak work load ( 17 % , p<0.05 ) and a decrease in leg pain ( p<0.05 ) occur . Training did not result in a significant improvement in lung function , but maximal inspiratory mouth pressure increased in both groups by 10 % ( C : p<0.05 ) and 23 % ( I : p<0.01 ) . The present study shows a different physiological response pattern to interval or continuous training in chronic obstruction pulmonary disease , which might be a reflection of specific training effects in either oxidative or glycolytic muscle metabolic pathways . Further work is required to determine the role of the different exercise programmes and the particular category of patients for whom this might be beneficial Abstract Objective : The aim of this study was to investigate the effects of moderate continuous training ( MCT ) and high intensity aerobic interval training ( AIT ) on systolic ventricular function and aerobic capacity in COPD patients . Methods : Seventeen patients with COPD ( 64 ± 8 years , 12 men ) with FEV1 of 52.8 ± 11 % of predicted , were r and omly assigned to isocaloric programs of MCT at 70 % of max heart rate ( HR ) for 47 minutes ) or AIT ( ∼90 % of max HR for 4 × 4 minutes ) three times per week for 10 weeks . Baseline cardiac function was compared with 17 age- and sex-matched healthy individuals . Peak oxygen uptake ( VO2-peak ) and left ( LV ) and right ventricular ( RV ) function examined by echocardiography , were measured at baseline and after 10 weeks of training . Results : At baseline , the COPD patients had reduced systolic function compared to healthy controls ( p < 0.05 ) . After the training , AIT and MCT  increased VO2-peak by 8 % and 9 % and work economy by 7 % and 10 % , respectively ( all p < 0.05 ) . LV and RV systolic function both improved ( p < 0.05 ) , with no difference between the groups after the two modes of exercise training . Stroke volume increased by 17 % and 20 % , LV systolic tissue Doppler velocity ( S ’ ) by 18 % and 17 % and RV S ’ by 15 % after AIT and MCT , respectively ( p < 0.05 ) . Conclusion : Systolic cardiac function is reduced in COPD . Both AIT and MCT  improved systolic cardiac function . In contrast to other patient groups studied , higher exercise intensity does not seem to have additional effects on cardiac function or aerobic capacity in COPD patients Context Exercise training improves quality of life in patients with chronic obstructive pulmonary disease , but many of these patients can not tolerate continuous exercise . The effects of intermittent exercise are not known . Contribution The authors r and omly assigned 100 in patients with chronic obstructive pulmonary disease in a 3-week respiratory rehabilitation program to receive either high-intensity continuous exercise or high-intensity exercise alternating with low-intensity exercise ( interval exercise ) . After 5 weeks , the 2 groups had similar respiratory symptoms in daily activities and 6-minute walking distance , but the interval exercise group adhered better to the exercise protocol . Caution s The study focused on initiation of exercise and not on outpatient or home-based maintenance of exercise . Implication s For pulmonary rehabilitation , interval exercise is as effective as continuous high-intensity exercise and is better tolerated . The Editors Low exercise capacity is an important systemic manifestation of advanced chronic obstructive pulmonary disease ( COPD ) associated with poor health-related quality of life , exacerbations , and death ( 14 ) . Physical exercise , therefore , represents an important element of COPD management ( 5 , 6 ) . If performed under supervision during respiratory rehabilitation , exercise training improves health-related quality of life and may improve prognosis ( 79 ) . Dyspnea and leg fatigue limit the ability of patients with COPD to exercise , and patient response to exercise is highly variable ( 10 ) . It is challenging to find endurable exercise programs that are still effective . Current guidelines recommend endurance exercise at constant and high intensity ( 70 % of maximum exercise capacity ) ( 11 , 12 ) . For example , if a patient achieves 100 watts in an incremental exercise test , workload would be set at 70 watts for the entire exercise session of at least 20 minute 's duration . Strong evidence from r and omized trials shows that patients achieve clinical ly important improvements of health-related quality of life and exercise capacity with a continuous exercise protocol ( 1316 ) . However , patients with severe COPD are often unable to tolerate continuous exercise ( 17 ) , which can be frustrating for them and can limit their long-term adherence to exercise programs . Effective alternatives to continuous exercise are required to offer this important intervention to more patients with COPD . The American Thoracic Society and the European Respiratory Society state , on the basis of 2 r and omized trials ( 18 , 19 ) , that interval exercise may be an alternative . The benefits of interval exercise may be similar to those of continuous training , but this method is associated with less dyspnea ( 11 , 12 ) . Although studies indicated that interval exercise is well tolerated ( 1821 ) , evidence about its effectiveness relative to continuous exercise is inconclusive ; previous trials had method ological limitations and were small ( 22 ) . Because of perceived better tolerability of interval exercise , r and omized trials should be explicitly design ed to show that interval exercise is no less effective ( clinical noninferiority ) ( 22 ) . Thus , the aim of our trial was to assess whether interval exercise is no less effective than high-intensity continuous exercise in patients with severe COPD and whether patient tolerance of the interval exercise protocol is superior to that of continuous exercise . Methods Design Overview We conducted a r and omized , controlled noninferiority trial to compare the effects of interval exercise with those of high-intensity continuous exercise in patients with severe COPD . We previously described the detailed study protocol ( 23 ) and report this trial following the recommendations of the extended Consoli date d St and ards of Reporting Trials ( CONSORT ) statement for noninferiority and equivalence trials ( 24 ) . Setting The trial took place in a public rehabilitation clinic , Klinik Barmelweid , in Aargau , Switzerl and . The ethics committee of the Kantonsspital Aarau , Aargau , Switzerl and , approved the study protocol , and all study participants provided written informed consent . Participants We screened patients admitted to the respiratory medicine unit and included consecutive patients following inclusion criteria similar to those of previous respiratory rehabilitation trials ( 7 ) : COPD as defined by FEV1FVC ratio less than 70 % of predicted , FEV1 less than 50 % of predicted after bronchodilation corresponding to Global Initiative for Chronic Obstructive Lung Disease ( GOLD ) stage III to IV ( 5 ) , and German as first or daily language . Exclusion criteria included cardiovascular , musculoskeletal , or neurologic disorders that inhibited physical exercise or the performance of exercise tests ( 6 ) . We also excluded patients who had received a diagnosis of cancer ( excluding skin cancer ) within the past 2 years and were undergoing treatment . R and omization and Interventions A third party not involved in the execution of the trial ( DatInf GmbH , Tuebingen , Germany ) provided online central r and omization using a computerized minimization procedure , thereby ensuring concealment of r and omization ( 25 ) . Stratification variables were exercise capacity ( 6-minute walking distance < 300 or 300 meters ) , the presence of affective disorders ( Hospital Anxiety Depression Scale scores < or 8) , stability of pulmonary condition ( stable or exacerbation within the last 8 weeks ) , and the need for oxygen at rest ( Pao 2 < 55 mm Hg or 55 mm Hg ) . Patients followed an inpatient respiratory rehabilitation of approximately 3 week 's duration that included 12 to 15 exercise sessions . On weekdays , patients usually participated in 1 exercise session .  Twelve physical therapists worked with an approximately equal number of patients from both treatment groups . Apart from exercise , the rehabilitation program was identical for both groups and included breathing therapy , relaxation therapy , guided walking tours , and patient education ( 23 ) . At discharge , physiotherapists prescribed home-based exercise for each patient . Patients with cycle ergometers at home were instructed to exercise for at least 20 minutes per day . If no cycle ergometers were available , daily walking , swimming , or stair climbing was prescribed . High-Intensity Continuous Exercise Patients r and omly assigned to this intervention exercised on electromagnetically braked cycle ergometers ( Ergometrics 900S , Ergoline , Bitz , Germany ) with a target workload of 70 % or more of maximum exercise capacity ( Figure 1 ) . This exercise protocol has been used in earlier respiratory rehabilitation trials ( 7 ) . To determine maximum exercise capacity , patients pedaled unloaded for 3 minutes at 20 watts to warm up . Then , we used increments of 7.5 watts per minute until patients had to stop because of symptoms or cardiovascular stopping criteria . In each exercise session , patients completed a warm-up period of 2 minutes at 20 % of maximum exercise capacity , high-intensity exercise for 20 minutes , and a run-out phase of 2 minutes ( gradual decrease from 70 % to 0 % ) . If patients could not sustain the workload because of perceived dyspnea ( modified Borg [ 26 ] ratings > 5 on a scale from 0 to 10 ) or because heart rate exceeded safety limits , physical therapists let patients rest for 1 minute before continuing in the assigned phase . If patients had to rest more than twice per session , physical therapists lowered the workload by steps of 10 % of baseline maximum exercise capacity for the following exercise sessions . If workload was too low ( modified Borg ratings < 3 or patients or physical therapists considered the workload to be too low ) , physical therapists increased the workload by steps of 10 % of baseline maximum exercise capacity . Figure 1 . Exercise protocol s. Interval Exercise The target workload for this group was 50 % ( high-intensity intervals ) and 10 % ( low-intensity intervals ) of short-term maximum exercise capacity as determined by a steep ramp test ( 27 , 28 ) . The steep ramp test is an incremental cycle ergometer test in which patients pedal cycle ergometers unloaded for 2 minutes and then at increments of 25 watts every 10 seconds until they can not maintain a pedaling frequency above 50 pedals per minute or their heart rate exceeds the limit set by the normal incremental exercise test . We used the steep ramp test because workload for interval exercise can be underestimated if it is based on normal incremental exercise tests ( 28 ) . Fifty percent of short-term maximum exercise capacity corresponds , on average , to 90 % to 100 % of normal maximum exercise capacity ( 27 ) . We chose a workrecovery ratio of 1:2 that prevents high lactate accumulation and is well tolerated by patients ( 28 ) . In each session , patients had a warm-up period of 2 minutes at 10 % of the short-term maximum exercise capacity and then exercised for 20 minutes alternating between high-intensity intervals for 20 seconds and low-intensity intervals for 40 seconds ( Figure 1 ) . Patients also had a slowdown period of 2 minutes before completing the training session . We adjusted the exercise load for each patient individually if workload was too high or too low as described earlier ; physiotherapists lowered or increased the workload by steps of 10 % of short-term maximum exercise capacity , but the length of intervals remained constant ( 23 ) . Outcomes and Measurements Our primary outcome for effectiveness was the difference from baseline in Chronic Respiratory Question naire ( CRQ ) scores 5 weeks after r and omization as measured by the self-administered German- language version ( 29 , 30 ) with st and ardized dyspnea questions ( 31 ) . The CRQ is a widely used instrument in respiratory rehabilitation and measures dyspnea , fatigue , emotional functioning , and ability to cope with COPD ( 7 , 32 ) . Domain and total ( average of domains ) scores are presented on a Likert-type scale from 1 ( most severe impairment ) to 7 ( no impairment ) . We selected assessment at 5 weeks after r and omization as the primary outcome STUDY OBJECTIVES To compare the effectiveness of two forms of exercise training in pulmonary rehabilitation . DESIGN A prospect i ve , r and omized , unblinded , 8-week trial . SETTING A hospital-based outpatient pulmonary rehabilitation program . PATIENTS Forty patients ( 20 patients in each group ) with COPD who were referred for pulmonary rehabilitation . INTERVENTIONS We compared the short-term effectiveness of a high-intensity , lower-extremity endurance program with a low-intensity , multicomponent calisthenics program for the rehabilitation of patients with COPD . The high-intensity group trained predominately on the stationary bicycle and treadmill , with a goal of exercising at > or = 80 % of maximal level determined from incremental testing for 30 min per session . The low-intensity group performed predominately classroom exercises for approximately 30 min per session . For both groups , twice-weekly sessions were held for 8 weeks . The primary outcome measure was health status , measured using the Chronic Respiratory Disease Question naire . Other outcomes included peak oxygen consumption on incremental treadmill exercise testing , exertional dyspnea , treadmill endurance time , the number of sit-to-st and repetitions and arm lifts in 1 min , overall dyspnea , and question naire-rated functional status . MEASUREMENTS AND RESULTS Both groups showed significant postrehabilitation improvement in exercise variables , exertional and overall dyspnea , functional performance , and health status . Patients in the high-intensity group showed greater increases in treadmill endurance and greater reductions in exertional dyspnea , whereas those in the low-intensity group showed greater increases in arm-endurance testing . Both groups had similar improvements in overall dyspnea , functional performance , and health status . CONCLUSIONS Despite differences in exercise performance , both high-intensity , lower-extremity endurance training and low-intensity calisthenics led to similar short-term improvements in question naire-rated dyspnea , functional performance , and health status PURPOSE The present study compared the effects of aerobic endurance training at different intensities and with different methods matched for total work and frequency . Responses in maximal oxygen uptake ( VO2max ) , stroke volume of the heart ( SV ) , blood volume , lactate threshold ( LT ) , and running economy ( CR ) were examined . METHODS Forty healthy , nonsmoking , moderately trained male subjects were r and omly assigned to one of four groups:1 ) long slow distance ( 70 % maximal heart rate ; HRmax ) ; 2)lactate threshold ( 85 % HRmax ) ; 3 ) 15/15 interval running ( 15 s of running at 90 - 95 % HRmax followed by 15 s of active resting at 70 % HRmax ) ; and 4 ) 4 x 4 min of interval running ( 4 min of running at 90 - 95 % HRmax followed by 3 min of active resting at 70%HRmax ) . All four training protocol s result ed in similar total oxygen consumption and were performed 3 d.wk for 8 wk . RESULTS High-intensity aerobic interval training result ed in significantly increased VO2max compared with long slow distance and lactate-threshold training intensities ( P<0.01 ) . The percentage increases for the 15/15 and 4 x 4 min groups were 5.5 and 7.2 % , respectively , reflecting increases in V O2max from 60.5 to 64.4 mL x kg(-1 ) x min(-1 ) and 55.5 to 60.4 mL x kg(-1 ) x min(-1 ) . SV increased significantly by approximately 10 % after interval training ( P<0.05 ) . CONCLUSIONS : High-aerobic intensity endurance interval training is significantly more effective than performing the same total work at either lactate threshold or at 70 % HRmax , in improving VO2max . The changes in VO2max correspond with changes in SV , indicating a close link between the two Underst and ing of what constitutes a training load adequate to induce training effects in patients with chronic obstructive pulmonary disease ( COPD ) is still evolving . The present study investigated whether interval training ( IT ) is effective in terms of inducing measurable improvements in physiological response and compared its effects on exercise tolerance ( ET ) and quality of life to those of continuous training ( CT ) . Thirty-six COPD patients , with a forced expiratory volume in one second of 45±4 % of the predicted value ( mean±sem ) , were r and omly assigned to CT ( exercise at 50 % of baseline peak work-rate ) or IT ( work for 30 s at 100 % of peak work-rate alternating with 30‐s rest intervals ) groups that cycled 40 min·day−1 and 2 days·week−1 for 12 weeks . After training , both groups showed significantly improved ET ( IT , 57±6 to 71±8 W ; CT , 57±5 to 70±6 W ) and total quality -of-life score of the Chronic Respiratory Disease Question naire ( IT , 77±3 to 88±2 ; CT , 78±3 to 93±2 ) . At identical levels of exercise , minute ventilation was significantly reduced ( IT , 35.8±2.5 to 31.7±2.5 L·min−1 ; CT , 36.4±2.7 to 32.5±2.7 L·min−1 ) . The magnitude of improvement in these variables was not significantly different among groups . The present data exp and on the principles of exercise prescription for chronic obstructive pulmonary disease patients by demonstrating that interval training elicits substantial training effects , which are similar in magnitude to those produced by continuous training at half the exercise intensity but double the exercise time BACKGROUND AND OBJECTIVES The benefits of pulmonary rehabilitation for patients with COPD depend on the intensity of training . Traditional pulmonary rehabilitation programmes ( PRPs ) do not consistently achieve high-intensity training and have variable training effects . This study examined the effects of high-intensity exercise training on cardiac and pulmonary function in COPD patients . METHODS Patients with COPD participated in a 6-week , cardiopulmonary exercise test-based PRP . Spirometry , 6-min walking distance and cardiopulmonary exercise test were used to evaluate cardiopulmonary function , respiratory muscle strength and endurance at rest , during exercise and before and after the programme . Patients were encouraged to complete high-intensity exercise with a targeted training intensity of at least 75 % maximum oxygen uptake ( VO(2 ) ) . RESULTS Thirty-four COPD patients were enrolled into the study ; 16 completed the high-intensity training , 18 did not . At the end of the 12-session PRP , submaximal exercise capacity ( 6-min walking distance , 461.8 + /- 77.2 - 502.7 + /- 66.9 m , P < 0.001 ) improved in both the patients who completed high-intensity training and those who did not . Only the patients who completed high-intensity training had significant improvements in FVC ( 2.47 + /- 0.70 - 2.70 + /- 0.62 L , P = 0.024 ) at rest , maximal exercise capacity ( peak VO(2 ) , 1001.6 + /- 286.4 - 1116.1 + /- 320.4 mL/min , P = 0.020 ) and work efficiency ( 7.3 + /- 1.4 - 8.4 + /- 1.8 mL/min/watt , P = 0.026 ) . There was no statistically significant difference between the two groups in the change in the physiological parameters before and after exercise . CONCLUSIONS Exercise training in a PRP improved submaximal exercise capacity . Only patients who completed high-intensity exercise training showed improvements in maximal exercise capacity , FVC and work efficiency BACKGROUND Current literature lacks solid evidence on the improvement of heart rate variability ( HRV ) after exercise training in patients with COPD . OBJECTIVES We aim ed to investigate changes in HRV after two exercise training programs in patients with COPD and to investigate the determinants of these eventual changes . METHODS Forty patients with COPD ( FEV(1 ) 39 ± 13%pred ) were r and omized into high ( n = 20 ) or low ( n = 20 ) intensity exercise training ( 3-month duration ) , and had their HRV assessed by the head-up tilt test before and after either protocol s. Baseline spirometry , level of daily physical activity , exercise capacity , body composition , functional status , health-related quality of life and muscle force were also assessed to investigate the determinants of improvement in HRV after the training program . RESULTS There was a significant improvement in HRV only after the high-intensity protocol ( pre versus post ; SDNN 29 ± 15 ms versus 36 ± 19 ms ; rMSSD 22 ± 14 ms versus 28 ± 22 ms ; p < 0.05 for both ) . Higher values of biceps brachialis strength , time spent walking in daily life and SDNN at baseline were determinants of improvement in HRV after the training program . CONCLUSIONS High-intensity exercise training  improves HRV at rest and during orthostatic stimulus in patients with COPD . Better baseline total HRV , muscle force and daily physical activity level are predictors of HRV improvements after the training program 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 : The effects of different exercise training programs on the level of physical activity in daily life in patients with COPD remain to be investigated . OBJECTIVE : In patients with COPD we compared the effects of 2 exercise/training regimens ( a high-intensity whole-body endurance- and -strength program , and a low-intensity calisthenics- and -breathing-exercises program ) on physical activity in daily life , exercise capacity , muscle force , health-related quality of life , and functional status . METHODS : We r and omized 40 patients with COPD to perform either endurance- and -strength training ( no. = 20 , mean ± SD FEV1 40 ± 13 % of predicted ) at 60–75 % of maximum capacity ,  or calisthenics- and -breathing-exercises training  ( no. = 20 , mean ± SD FEV1 39 ± 14 % of predicted ) . Both groups underwent 3 sessions per week for 12 weeks . Before and after the training programs the patients underwent activity monitoring with motion sensors , incremental cycle-ergometry , 6-min walk test , and peripheral-muscle-force test , and responded to question naires on health-related quality of life and functional status ( activities of daily living , pulmonary functional status , and dyspnea ) . RESULTS : Time spent active and energy expenditure in daily life were not significantly altered in either group . Exercise capacity and muscle force significantly improved only in the endurance- and -strength group . Health-related quality of life and functional status improved significantly in both groups . CONCLUSIONS : Neither training program significantly improved time spent active or energy expenditure in daily life . The training regimens similarly improved quality of life and functional status . Exercise capacity and muscle force significantly improved only in the high-intensity endurance- and -strength group PURPOSE The purpose of this study was to compare the effects of interval training ( IT ) and continuous steady-pace training ( CT ) in patients with COPD . METHODS Patients ( n = 21 ) ( mean forced expiratory volume in 1 second ( [ FEV1 ] = 44.6 % ± 13.9 % ) were r and omized to IT , and 20 patients ( mean FEV1 = 41.7 % ± 12.6 % ) to CT . Outcome measures included 6-minute walk distance , maximal work capacity , endurance exercise time during constant workload exercise at 60 % to 70 % of maximal work capacity , and quality of life including fatigue and dyspnea . Participants exercised 3 times per week for 8 weeks , and total work was the same for both training regimens . RESULTS Significant improvement in mean score was observed in each variable within each of the 2 groups : 6-minute walk distance ( IT = 158 ± 178 ft , CT = 106 ± 165 ft ) ; maximal work capacity ( IT = 10.0 ± 13.0 W , CT = 11.5 ± 13.1 W ) ; endurance exercise time ( IT = 15.0 ± 12.5 minutes , CT = 18.7 ± 10.6 minutes ) ; and quality of life domains , fatigue ( IT = 3.1 ± 3.0 , CT = 2.8 ± 4.7 ) , and dyspnea ( IT = 4.4 ± 5.3 , CT = 5.4 ± 5.1 ) . There was no significant difference in the extent of improvement between the 2 training regimens for any of the outcome variables . CONCLUSION Compared with CT , IT was well tolerated and produced similar improvements in exercise performance and quality of life STUDY OBJECTIVES To investigate the response to interval exercise ( IE ) training by looking at changes in morphologic and biochemical characteristics of the vastus lateralis muscle , and to compare these changes to those incurred after constant-load exercise ( CLE ) training . DESIGN R and omized , controlled , parallel , two-group study ( IE vs CLE training ) . SETTING Multidisciplinary , outpatient , hospital-based , pulmonary rehabilitation program . PATIENTS Nineteen patients with stable advanced COPD ( mean + /- SEM FEV1 , 40 + /- 4 % predicted ) . INTERVENTIONS Patients ( n = 10 ) assigned to IE training exercised at a mean intensity of 124 + /- 15 % of baseline peak exercise capacity ( peak work rate [ Wpeak ] ) with 30-s work periods interspersed with 30-s rest periods for 45 min/d . Patients ( n = 9 ) allocated to CLE training exercised at a mean intensity of 75 + /- 5 % Wpeak for 30 min/d . Patients exercised 3 d/wk for 10 weeks . MEASUREMENTS AND RESULTS Needle biopsies of the right vastus lateralis muscle were performed before and after rehabilitation . After IE training , the cross-sectional areas of type I and IIa fibers were significantly increased ( type I before , 3,972 + /- 455 microm2 ; after , 4,934 + /- 467 microm2 [ p = 0.004 ] ; type IIa before , 3,695 + /- 372 microm2 ; after , 4,486 + /- 346 microm2 [ p = 0.008 ] ) , whereas the capillary-to-fiber ratio was significantly enlarged ( from 1.13 + /- 0.08 to 1.24 + /- 0.07 [ p = 0.013 ] ) . Citrate synthase activity increased ( from 14.3 + /- 1.4 to 20.5 + /- 4.2 micromol/min/g ) , albeit not significantly ( p = 0.097 ) . There was also a significant improvement in Wpeak ( by 19 + /- 5 % ; p = 0.04 ) and in lactate threshold ( by 17 + /- 5 % ; p = 0.02 ) . The magnitude of changes in all the above variables was not significantly different compared to that incurred after CLE training . During training sessions , however , ratings of dyspnea and leg discomfort , expressed as fraction of values achieved at baseline Wpeak , were significantly lower ( p < 0.05 ) for IE training ( 73 + /- 9 % and 60 + /- 8 % , respectively ) compared to CLE training ( 83 + /- 10 % and 87 + /- 13 % , respectively ) . CONCLUSIONS High-intensity IE training is equally effective to moderately intense CLE training in inducing peripheral muscle adaptations ; however , IE is associated with fewer training symptoms The aim of this study was to compare the effects of interval training ( 3-min intervals ) with continuous training on peak exercise capacity ( W peak ) , physiological response , functional capacity , dyspnoea , mental health and health-related quality of life ( HRQoL ) in patients with moderate or severe COPD . Sixty patients exercised twice weekly for 16 weeks after r and omisation to interval- or continuous training . Target intensity was 80 % of baseline W peak in the interval group ( I-group ) and 65 % in the continuous group ( C-group ) . Patients were tested by spirometry , ergometer cycle test , cardiopulmonary test and a 12 min walk test . Dyspnoea was measured by the dyspnoea scale from Chronic Obstructive Disease Question naire ( CRDQ ) , mental health by Hospital Anxiety and Depression scale ( HAD ) and HRQoL by the Medical Outcomes Survey Short Form 36 ( SF-36 ) . After training , W peak , peak oxygen uptake ( VO(2 ) peak ) and exhaled carbon dioxide ( VCO(2 ) peak ) increased significantly in both groups , no significant differences between the groups . Minute ventilation ( V(E ) peak ) increased only in the C-group . At identical work rates ( isotime ) VO(2 ) , VCO(2 ) and V(E ) were significantly more decreased in the I-group than in the C-group ( p<0.05 ) . Functional capacity , dyspnoea , mental health , and HRQoL improved significantly in both groups , no difference between the groups . Interval training and continuous training were equally potent in improving peak exercise capacity , functional exercise capacity , dyspnoea , mental health and HRQoL in patients with moderate or severe COPD . At isotime , the physiological response to training differed between the groups , in favour of the interval training UNLABELLED In a controlled/ prospect i ve clinical trial we examined 125 patients with moderate COAD , 84 of which performed a high-intensity training program on cycle ergometers . METHODS All participants ( controls n = 39 , training-group n = 84 , age 48.7 versus 48.1 years , FEV1 62.3 % vs. 63.1 % of predicted ) were examined spiroergometrically ( ramp protocol , increment 10 W/min ) , the anaerobic threshold ( AT ) determined and a training intensity calculated ( AT + 40 % of the difference to peak exercise ) . Training was carried out on cycle ergometers with 5 training units weekly at 40 minutes each . We aim ed at a minimum of 22 training units during 4 weeks . RESULTS Both groups improved in the lung function at rest ( FEV1 + 11 % versus + 12 % in the controls ) . Only for the training group we found a statistically significant improvement in maximum exercise capacity ( O2 uptake + 286.4 ml vs. + 72.4 ml , maximum workrate + 20.0 watts vs. + 5.7 W ) , of the anaerobic threshold ( AT improved by 8.4 watts vs. 5.1 W ) as well as in the metabolic load ( lactate decreased by 1.3 mmol vs. 0.2 mmol , ventilation decreased by 3.8 l/min vs. 2.3 l/min ) . In most subscales of the SF-36 question naire quality of living improved more clearly in the training group , whereas the LAQ question naire showed no group-specific differences and no improvement after training . CONCLUSION We conclude from the result that a high intensity training program can be recommended as a useful and low-risk component in pulmonary rehabilitation programs OBJECTIVES Peak VO2 , as measure of physical performance is central to a correct preoperative evaluation in patients with both non-small-cell lung cancer ( NSCLC ) and chronic obstructive pulmonary disease ( COPD ) because it is closely related both to operability criteria and the rate of postoperative complications . Strategies to improve peak VO2 , as a preoperative pulmonary rehabilitation programme ( PRP ) , should be considered favourably in these patients . In order to clarify the role of pulmonary rehabilitation , we have evaluated the effects of 3-week preoperative high-intensity training on physical performance and respiratory function in a group of patients with both NSCLC and COPD who underwent lobectomy . METHODS We studied 40 patients with both NSCLC and COPD , age < 75 years , TNM stages I-II , who underwent lobectomy . Patients were r and omly divided into two groups ( R and S ) : Group R underwent an intensive preoperative PRP , while Group S underwent only lobectomy . We evaluated peak VO2 in all patients at Time 0 ( T0 ) , after PRP/before surgery in Group R/S ( T1 ) and 60 days after surgery , respectively , in both groups ( T2 ) . RESULTS There was no difference between groups in peak VO2 at T0 , while a significant difference was observed both at T1 and T2 . In Group R , peak VO2 improves significantly from T0 to T1 : 14.9 ± 2.3 - 17.8 ± 2.1 ml/kg/min ± st and ard deviation ( SD ) , P < 0.001 ( 64.5 ± 16.5 - 76.1 ± 14.9 % predicted ± SD , P < 0.05 ) and deteriorates from T1 to T2 : 17.8 ± 2.1 - 15.1 ± 2.4 , P < 0.001 ( 76.1 ± 14.9 - 64.6 ± 15.5 , P < 0.05 ) , reverting to a similar value to that at T0 , while in Group S peak VO2 did not change from T0 to T1 and significantly deteriorates from T1 to T2 : 14.5 ± 1.2 - 11.4 ± 1.2 ml/kg/min ± SD , P < 0.00001 ( 60.6 ± 8.4 - 47.4 ± 6.9 % predicted ± SD , P < 0.00001 ) . CONCLUSIONS PRP was a valid preoperative strategy to improve physical performance in patients with  both NSCLC and COPD and this advantage was also maintained after surgery PURPOSE : The success of long-term exercise training ( ExT ) programs resides in the integration between exercise prescription and patient compliance with home training . One of the crucial issues for the patients is the underst and ing of appropriate exercise intensity . We compared 2 methods of home ExT , based on walking . METHODS : Forty-seven patients with chronic obstructive pulmonary disease were recruited and underwent respiratory function , exercise capacity evaluation with a 6-minute walk test , and treadmill tests . Physical activity was monitored by a multisensor Armb and ( SenseWear , Body Media , Pittsburgh , PA ) . Patients were r and omly assigned to 2 different home training methods and assessed again after 6 and 12 months ; group A1 : speed walking paced by a metronome , and group A2 : walking a known distance in a fixed time . RESULTS : Thirty-six patients completed the study . All subjects showed a significant improvement in the 6-minute walk test after 1 year but the improvement was higher in A1 than in A2 ( P < .05 ) . Physical activity levels were significantly higher at T12 versus baseline only in group A1 ( P < .05 ) . CONCLUSIONS : The use of a metronome to maintain the rate of walking during home ExT seems to be beneficial , allowing patients to achieve and sustain the optimal exercise intensity , and result ing in greater improvement compared to simply using a fixed time interval exercise Background : Pulmonary rehabilitation ( PR ) programs are beneficial to patients with chronic obstructive pulmonary disease ( COPD ) , and lower-extremity training is considered a fundamental component of PR . Nevertheless , the isolated effects of each PR component are not well established . Objective : We aim ed to evaluate the effects of a cycle ergometry exercise protocol as the only intervention in a group of COPD patients , and to compare these results with a control group . Methods : 25 moderate-to-severe COPD patients were evaluated regarding pulmonary function , respiratory muscle strength , exercise capacity , quality of life and body composition . Patients were allocated to one of two groups : ( a ) the trained group ( TG ; n = 13 ; 6 men ) was su bmi tted to a protocol of 24 exercise sessions on a cycle ergometer , with training intensity initially set at a heart rate ( HR ) close to 80 % of maximal HR achieved in a maximal test , and load increase based on dyspnea scores , and ( b ) the control group ( CG ; n = 12 ; 6 men ) with no intervention during the protocol period . Results : TG showed within-group significant improvements in endurance cycling time , 6-min walking distance test , maximal inspiratory pressure and in the domain ‘ dyspnea ’ related to quality of life . Despite the within-group changes , no between-group significant differences were observed . Conclusion : In COPD patients , the results of isolated low-to-moderate intensity cycle ergometer training are not comparable to effects of multimodality and high-intensity training programs
target: The effects of HIIT appear to be comparable to those of continuous exercise in relation to functional and cardiovascular responses .
background: OBJECTIVE To evaluate the effects of high-intensity interval training ( HIIT ) , in comparison with those of continuous exercise , on functional capacity and cardiovascular variables in patients with COPD , through a systematic review and meta- analysis of r and omized controlled trials .