title: The effect of single set resistance training on strength and functional fitness in pulmonary rehabilitation patients. The Effect of Strength Training on Functional Fitness in Older Patients with Chronic Lung Disease Enrolled in Pulmonary Rehabilitation [Functional effects of different training in patients with COPD]. Aerobic and strength training in patients with chronic obstructive pulmonary disease. The effects of resistance training on functional outcomes in patients with chronic obstructive pulmonary disease Upper extremity exercise training in chronic obstructive pulmonary disease. Strength training increases maximum working capacity in patients with COPD--randomized clinical trial comparing three training modalities. Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial Effects of aerobic training and recreational activities in patients with chronic obstructive pulmonary disease
abstract: PURPOSE The primary goal of pulmonary rehabilitation ( PR ) is for patients to achieve and maintain their maximum level of independence and functioning in the community . Traditional PR uses a predominantly aerobic/endurance approach to rehabilitation with little or no inclusion of exercises to increase strength . Few studies have investigated the impact of resistance training on PR despite growing evidence supporting its efficacy to improve physical function ( functional fitness ) in both healthy individuals and those with chronic disease . The purpose of this study was to investigate the effect of single-set resistance training on strength and functional fitness outcomes in PR patients . METHODS Twenty PR patients , 60 to 81 years old , were r and omly assigned to an 8-week endurance-based PR program ( ET ) or an ET plus resistance training program ( RT ) . RESULTS Strength increased in RT ( P < .05 ) and decreased in  ET for both upper and lower body . Functional fitness improved ( P < .05 ) in 5 of 7 tests for RT compared with 2 tests for ET . CONCLUSIONS Single set RT can elicit significant improvements in both strength and functional fitness , which is not obtained by traditional PR alone . Our results are comparable to other studies with similar outcomes using multiple-set RT protocol s. These findings may have important implication s for program design , application , and adherence in PR & NA ; The purpose of this study was to compare the effects of a strength training‐enhanced program and a traditional pulmonary rehabilitation ( PR ) program on functional fitness ( FF ) in older patients with chronic obstructive pulmonary disease ( COPD ) , using the Senior Fitness Test . Twenty patients were recruited from an outpatient PR program . After completing baseline measures , including muscular strength and the Senior Fitness Test , patients were r and omly assigned to the strength training program ( TR+ST , n = 10 ) or traditional PR program ( TR , n = 10 ) . Patients completed 16 exercise sessions that were conducted twice a week for 8–10 weeks , after which patients repeated outcome measurements . Independent t tests were conducted to determine whether groups differed between measures . Both the TR+ST and TR groups improved on all FF measures . Moderate effect sizes were found for two of the FF measures when the groups were compared . The addition of strength training to PR may have a favorable impact on FF in older patients with COPD Disability and exertional dyspnea associated with chronic obstructive pulmonary disease has led to the development of rehabilitation programmes that aim to increase exercise tolerance and relief of dyspnea . To evaluate whether aerobic training ( training groups P1 and P4 ) , strength training ( P2 and P5 ) or a combination of both ( P4 and P6 ) is useful , 69 patients ( 44 m/25 f ) with moderate to severe COPD were r and omised to a three week inpatient training program . The training consisted of three weekly twenty minute exercise sessions without ( P1 - P3 ) or with supplemental oxygen ( P4 - P6 ) on a calibrated ergocycle ( 70 % W(max ) ) or three weekly sessions of 20 - 25 repetitions of 2 - 4 training series ( 40 % W(max ) ) or a combination of both . In general , the programme failed to demonstrate significant changes in lung function and arterial blood gases . Evaluation of exercise capacity via the six-minute-walking test ( 6MT ) yielded a significant increase of the walking distance in all groups except P2 ( 60 - 83 m ) , The time to finish a test-set of daily activities ( TAF ) was reduced in all groups ( 5 - 58 sec ) and reached significance in P1 , P3 , P5 and P6 . After the 6MT , exertional dyspnea improved in all groups except P4 and was significant in P1 and P3 ; after the TAF , dyspnea again was reduced in all groups with a significant change in P2 and P5 . These data support the hypotheses that a short term inpatient training programme is suitable to improve exercise-capacity and dyspnea .  Patients with advanced disease ( P4 - P6 ) show greater benefits with strength training ( alone or in combination with aerobic training ) while for patients with moderate disease ( P1 - P3 ) aerobic training is favourable . These changes may translate into improved performance of daily activities and general well-being 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 Aerobic exercise training is used for rehabilitation in patients with chronic obstructive pulmonary disease ( COPD ) , although it has little effect on muscle weakness and atrophy . Resistance training may be a useful addition to aerobic programs for these patients . The purpose of the present study was to investigate the effects of resistance training in addition to aerobic training on functional outcomes in patients with COPD . Seventeen COPD patients enrolled in an aerobic-based program that met twice a week were assigned to a 12-week control/aerobic [ CON : n=8 ; 63 ( 8) years ; mean ( SD ) ] or a resistance/aerobic group [ RES : n=9 ; 61 ( 7 ) years ] . RES trained an additional twice a week on 12 resistance machines , performing three sets of 8–12 repetitions at 32–64 % of their one-repetition maximum ( 1-RM ) lifts . RES ( P<0.05 ) increased upper ( 36 % ) and lower ( 36 % ) body strength , as well as lean body mass ( 5 % ) , while CON showed little to no change . The 12-min walk distance increased ( P<0.05 ) in only the RES [ 676 ( 219 ) to 875 ( 172 ) m ] . Measurements of three of the eight tasks of activities of daily living improved in RES ( P<0.05 ) compared to CON . This study demonstrated that progressive resistance training was well tolerated and improved functional outcomes in COPD patients that were currently involved in an aerobic training program Many patients with chronic obstructive pulmonary disease ( COPD ) report greater limitation for activities involving the upper extremities than the lower extremities . Exercise training has generally emphasized lower-extremity exercise . We design ed and evaluated two simple , practical , and widely applicable upper-extremity training programs in 45 patients with COPD participating concurrently in a comprehensive , multidisciplinary pulmonary rehabilitation program . Patients were r and omly assigned to one of the following three groups : ( 1 ) gravity-resistance ( GR ) upper-extremity training ; ( 2 ) modified proprioceptive neuromuscular facilitation ( PNF ) upper-extremity training ; or ( 3 ) no upper-extremity training ( control ) . Patients were evaluated before and after at least six weeks of uninterrupted training . Twenty-eight patients completed the study . Compared to controls , both GR and PNF patients demonstrated improved performance on tests specific to the training performed ( upper-extremity performance test , maximal level and endurance on isokinetic arm cycle ) . There were no significant changes on isotonic arm cycle , ventilatory muscle endurance , or simulated activities of daily-living tests . Ratings of perceived breathlessness and fatigue decreased significantly in all groups for several tests . We conclude that specific upper-extremity training may be beneficial in the rehabilitation of patients with COPD and warrants further investigation 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 Pulmonary rehabilitation seems to be an effective intervention in patients with chronic obstructive pulmonary disease . We undertook a r and omised controlled trial to assess the effect of outpatient pulmonary rehabilitation on use of health care and patients ' wellbeing over 1 year . METHODS 200 patients with disabling chronic lung disease ( the majority with chronic obstructive pulmonary disease ) were r and omly assigned a 6-week multidisciplinary rehabilitation programme ( 18 visits ) or st and ard medical management . Use of health services was assessed from hospital and general- practice records . Analysis was by intention to treat . FINDINGS There was no difference between the rehabilitation ( n=99 ) and control ( n=101 ) groups in the number of patients admitted to hospital ( 40 vs 41 ) but the number of days these patients spent in hospital differed significantly ( mean 10.4 [ SD 9.7 ] vs 21.0 [ 20.7 ] , p=0.022 ) . The rehabilitation group had more primary -care consultations at the general-practitioner 's premises than did the control group ( 8.6 [ 6.8 ] vs 7.3 [ 8.3 ] , p=0.033 ) but fewer primary -care home visits ( 1.5 [ 2.8 ] vs 2.8 [ 4.6 ] , p=0.037 ) . Compared with control , the rehabilitation group also showed greater improvements in walking ability and in general and disease-specific health status . INTERPRETATION For patients chronically disabled by obstructive pulmonary disease , an intensive , multidisciplinary , outpatient programme of rehabilitation is an effective intervention , in the short term and the long term , that decreases use of health services The purpose of this study was to evaluate whether strength or recreational activities are a useful addition to aerobic training in patients with chronic obstructive pulmonary disease ( COPD ) . Thirty-three patients with moderate to severe COPD were r and omly assigned to 12 weeks of aerobic combined with strength training ( AERO+ST ) or combined with recreational activities ( AERO+RA ) . The AERO regimen consisted of three weekly 20-min walking exercise sessions ; the ST regimen included three series of 10 repetitions of four exercises ; and the RA regimen consisted of training using exercise balls to perform smoothly for instrumental activity of daily living . Baseline and after-training measurements of peripheral muscular strength and endurance , cardio respiratory fitness , and 6-min walking distance were obtained , whereas quality of life was assessed with the Short Form 36 question naire . Change in grip strength showed a significant difference between the AERO+ST group ( 8.3±6.7 % ) and the control group ( −1.3±10.5 % ) , and AERO+RA group ( −4.7±5.6 % ) ( P<0.05 ) . A significant increase was found in percentage change in peak & OV0312;o2 between the AERO+ST group ( 5.1±11.8 % ) and the control group ( −9.2±8.6 % ) ( P<0.05 ) . In the health-related quality of life scores , there was a significant difference in mean percentage change in physical functioning between the AERO+ST group ( 7.9±24.4 % ) and the control group ( −14.8±19.1 % ) ( P<0.05 ) . A significant difference was found in mean percentage change in social functioning between the AERO+RA group ( 9.4±20.0 % ) and the control group ( −14.9±23.2 % ) ( P<0.05 ) . A significant difference in mean percentage change in mental health was also found between the AERO+RA group ( 12.2±12.4 % ) and the control group ( −5.0±7.8 % ) ( P<0.05 ) . It is preferable to introduce various forms of exercise that use different muscles involving the whole body , such as recreational activities , as they are an appropriate approach to stimulating physical activity and to improving functional fitness gradually while improving health-related quality of life , though it is necessary to practice exercises for maintenance and improvement in patients with COPD . Die vorliegende Studie soll ermitteln , ob Krafttraining oder Freizeitaktivitäten das Aerobictraining von Patienten mit chronisch-obstruktiver Lungenerkrankung ( COPD ) sinnvoll ergänzen . Insgesamt wurden 33 Patienten mit moderater bis schlimmer COPD einem 12-wöchigen Aerobictraining mit Krafttraining ( AERO+ST ) oder einem 12-wöchigen Aerobictraining mit Freizeitaktivitäten ( AERO+RA ) r and omisiert zugeordnet . Das AERO-Programm umfasste drei 20-minütige Gehübungen pro Woche , das ST-Programm dreimal je 10 Wiederholungen mit vier Übungen und das RA-Programm ein Training mit Gymnastikbällen , die wichtige Aktivitäten i m Alltagsleben erleichtern sollten . Messungen wie periphere Muskelkraft und Ausdauer , kardiorespiratorische Fitness und 6-minütiges Gehen gegenüber Baseline und nach dem Training wurden erhalten , und die Lebensqualität wurde mittels Fragebogen SF-36 beurteilt . Veränderungen bei der Griffstärke wiesen einen signifikanten Unterschied zwischen der AERO+ST Gruppe ( 8,3±6,7 % ) und der Kontrollgruppe ( −1,3±10,5 % ) und der AERO+RA Gruppe ( −4,7±5,6 % ) auf ( P<0,05 ) . Ebenfalls beobachtet wurde ein signifikanter Anstieg bei der prozentualen Veränderung von & OV0312;o2 maximal zwischen der AERO+ST Gruppe ( 5,1±11,8 % ) und der Kontrollgruppe ( −9,2±8,6 % ) ( P<0,05 ) . Bei den gesundheitsbezogenen Lebensqualitäts-Scores best and ein signifikanter Unterschied in der durchschnittlichen prozentualen Veränderung bei der körperlichen Funktion zwischen der AERO+ST Gruppe ( 7,9±24,4 % ) und der Kontrollgruppe ( −14,8±19,1 % ) ( P<0,05 ) . Ein signifikanter Unterschied wurde bei der durchschnittlichen prozentualen Veränderung bei der gesellschaftlichen Funktionsfähigkeit zwischen der AERO+RA Gruppe ( 9,4±20,0 % ) und der Kontrollgruppe ( −14,9±23,2 % ) beobachtet ( P<0,05 ) . Außerdem beobachtet wurde ein signifikanter Unterschied in der durchschnittlichen prozentualen Veränderung in der seelischen Gesundheit zwischen der AERO+RA Gruppe ( 12,2±12,4 % ) und der Kontrollgruppe ( −5,0±7,8 % ) ( P<0,05 ) . Verschiedene Übungsformen wie Freizeitaktivitäten , die verschiedene Körpermuskeln trainieren , sind als angemessener Stimulus der körperlichen Betätigung und zur allmählichen Verbesserung der funktionellen Fitness vorzuziehen , während sie gleichzeitig die gesundheitsrelevante Lebensqualität verbessern , obwohl Übungen zur Erhaltung und Verbesserung von Patienten mit COPD notwendig sind . El objetivo de este estudio fue evaluar si los ejercicios de desarrollo de fuerza o las actividades recreativas result an de utilidad , además de los ejercicios aeróbicos , en pacientes afectos de enfermedad pulmonar obstructiva crónica ( EPOC ) . Se distribuyeron de manera aleatoria a 33 pacientes afectos de EPOC de moderada a grave para participar en un programa de 12 semanas de ejercicios aeróbicos combinados ya fuese con ejercicios de desarrollo de fuerza ( AERO+EF ) o con actividades recreativas ( AERO+AR ) . El régimen de ejercicios aeróbicos ( AERO ) consistió en 3 sesiones semanales de caminatas de 20 minutos de duración cada una ; el régimen EF consistió en 3 series de 10 repeticiones de 4 tipos de ejercicios ; y el régimen AR consistió en un programa con pelotas para ejercicios , para realizar actividades instrumentales de la vida cotidiana . Al inicio del estudio y una vez terminado el régimen de ejercicios se obtuvieron datos sobre la fuerza muscular periférica , la resistencia , la aptitud cardiorrespiratoria , y tras una caminata de 6 minutos . Para evaluar la calidad de vida se utilizó el cuestionario reducido de 36 preguntas ( Short Form 36 ) . Los cambios en la fuerza de agarre mostraron una diferencia significativa entre el grupo que recibió AERO+EF ( 8,3±6,7 % ) y el grupo de referencia ( −1,3±10,5 % ) , y el grupo que recibió AERO+AR ( −4,7±5,6 % ) ( P<0,05 ) . Se apreció un aumento importante en los cambios en los valores porcentuales máximos del & OV0312;o2 entre el grupo que realizó AERO+EF ( 5,1±11,8 % ) y el grupo de referencia ( −9,2±8,6 % ) ( P<0,05 ) . En cuanto a las puntuaciones sobre la calidad de vida relacionada al estado de salud , se apreció una diferencia importante en cuanto a la media de los cambios de los porcentajes del funcionamiento social entre el grupo que realizó AERO+AR ( 9,4±20,0 % ) y el grupo de referencia ( −14,9±23,2 % ) ( P<0,05 ) . Además se observó una diferencia significativa en la media de los cambios de los porcentajes relacionados con la salud mental entre el grupo que realizó AERO+AR ( 12,2±12,4 % ) y el grupo de referencia ( −5,0±7,8 % ) ( P<0,05 ) . Result a preferible la introducción de varios tipos de ejercicio físico , en los que haya que utilizar diferentes músculos de todo el cuerpo , tales como actividades recreativas , como una manera apropiada de promover la actividad física y mejorar la aptitud funcional de manera gradual a la vez que se mejora la calidad de vida relacionada con el estado de salud , aunque en los pacientes con EPOC la práctica de ejercicios es vital para mejorar y mantener la salud . Cette étude avait pour objet d'évaluer dans quelle mesure les activités fortifiantes ou de loisir constituent une addition utile aux exercices aérobic chez les patients souffrant de maladie pulmonaire obstructive chronique ( MPCO ) . Trente-trois patients souffrant de MPCO modérée à sévère ont été affectées de manière aléatoire à un programme de 12 semaines d'exercices d'aérobic combinés avec des activités fortifiantes ( AERO+ST ) ou des activités de loisirs ( AERO+RA ) . Le programme AERO comportait trois séances hebdomadaires de 20 minutes d'exercices de marche , le programme ST consistait en trois séries de 10 répétitions de quatre exercices , et le programme RA se composait d'exercice de formation utilisant des ballons , destinés à faciliter les activités d'utilisation d'instruments au quotidien . Des mesures de référence et après exercice de la force musculaire périphérique et de l'endurance et des capacités cardio-respiratoires après un exercice de marche de 6 minutes ont été effectuées , t and is que la qualité de vie a été évaluée grâce à un rapide question naire en 36 points . L'évolution de la force de préhension témoigne d'une différence significative entre le groupe AERO+ST ( 8,3±6,7 % ) et le groupe de contrôle ( −1,3±10,5 % ) , et le groupe AERO+RA ( −4,7±5,6 % ) ( P<0,05 ) . Une augmentation significative a été observée dans le changement du pourcentage de pic de & OV0312;o2 entre le groupe AERO+ST ( 5,1±11,8 % ) et le groupe de contrôle ( −9,2±8,6 % ) ( P<0,05 ) . En ce qui concerne les scores de qualité de vie associés à la santé , une différence significative a été constatée dans l'évolution du pourcentage moyen de fonctionnalité physique entre le groupe AERO+ST ( 7,9±24,4 % ) et le groupe de contrôle ( −14,8±19,1 % ) ( P<0,05 ) . Une différence significative a été observée dans l'évolution du pourcentage moyen de fonctionnalité sociale entre le groupe AERO+RA ( 9,4±20,0 % ) et le groupe de contrôle ( −14,9±23,2 % ) ( P<0,05 ) . En outre , une différence significative a été constatée dans l'évolution du pourcentage moyen de santé mentale entre le groupe AERO+RA ( 12,2±12,4 % ) et le groupe de contrôle ( −5,0±7,8 % ) ( P<0,05 ) . Il est préférable d'introduire diverses formes d'exercice faisant entrer en jeu différents muscles de l'ensemble du corps , en utilisant des activités de loisir comme méthode appropriée pour stimuler l'activité physique et accroître graduellement la forme fonctionnelle tout en améliorant la qualité de vie associée à la santé , bien qu'il soit également nécessaire de pratiquer des exercices d'entretien et d'amélioration chez les patients souffrant de MPCO
target: 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 .
background: 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 .