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Background: Despite the wide-ranging benefits of pulmonary rehabilitation, conflicting results remain regarding whether people with COPD can improve their peak oxygen uptake (V˙O 2peak) with aerobic training., Research Question: The goal of this study was to investigate the effect of aerobic training and exercise prescription on V˙O 2peak in COPD., Study Design and Methods: A systematic review was performed by using MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases for all studies measuring V˙O 2peak prior to and following supervised lower-limb aerobic training in COPD. A random effects meta-analysis limited to randomized controlled trials comparing aerobic training vs usual care was conducted. Other study designs were included in a secondary meta-analysis and meta-regression to investigate the influence of program and patient factors on outcome., Results: A total of 112 studies were included (participants, N = 3,484): 21 controlled trials (n = 489), of which 13 were randomized (n = 288) and 91 were uncontrolled (n = 2,995) studies. Meta-analysis found a moderate positive change in V˙O 2peak (standardized mean difference, 0.52; 95% CI, 0.34-0.69) with the intervention. The change in V˙O 2peak was positively associated with target duration of exercise session (P = .01) and, when studies > 1 year duration were excluded, greater total volume of exercise training (P = .01). Similarly, the change in V˙O 2peak was greater for programs > 12 weeks compared with those 6 to 12 weeks when adjusted for age and sex. However, reported prescribed exercise intensity (P = .77), training modality (P > .35), and mode (P = .29) did not affect V˙O 2peak . Cohorts with more severe airflow obstruction exhibited smaller improvements in V˙O 2peak (P < .001)., Interpretation: Overall, people with COPD achieved moderate improvements in V˙O 2peak through supervised aerobic training. There is sufficient evidence to show that programs with greater total exercise volume, including duration of exercise session and program duration, are more effective. Reduced effects in severe disease suggest alternative aerobic training methods may be needed in this population., Clinical Trial Registration: PROSPERO; No.: CRD42018099300; URL: https://www.crd.york.ac.uk/prospero/., (Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Background: Hyperinflated patients with COPD breathe against an increased elastic load during physical activity. Arm activities are especially demanding. Some pulmonary rehabilitation programs instruct patients to inhale while raising their arms, whereas others recommend the opposite. This study aimed to determine the effect of coordinating breathing with arm movements on the endurance of a lifting task., Methods: Participants with COPD and hyperinflation completed two (high intensity and severe intensity) rhythmic, constant load-lifting tasks to intolerance (tlimit) before and after attending four "teaching" sessions. Participants were randomly assigned to one of three groups: (1) taught to inhale during the lift, (2) taught to exhale during the lift, or (3) sham (unconstrained coordination)., Results: Thirty-six participants (FEV1 % predicted [SD], 34 [13]; FEV1/FVC [SD], 33% [10%]; thoracic gas volume % predicted [SD], 179 [44]) completed the study. There was an effect of group on the change in tlimit (P<.01) regardless of task intensity (P=.47). The change in tlimit in the exhalation group was greater than in both the sham (difference [95% CI]: 2.82 [0.21-5.44] min; P<.05) and inhalation (difference [95% CI]: 3.29 [0.65-5.92] min; P<.05) groups at the high intensity. There was no difference in the change in tlimit between the inhalation and sham groups., Conclusions: A specific breathing strategy, exhalation during the lift, improved task performance. Coordinating exhalation with lifting may be of value to hyperinflated patients with COPD who are engaged in arm and shoulder training exercises or daily activities that involve arm elevation., Trial Registry: ClinicalTrials.gov; No: NCT00836108; URL: www.clinicaltrials.gov.

Background: The original method for determining endurance shuttle walk test (ESWT) speed involves components that are time consuming for clinicians. We sought to determine: (i) whether components described in the original method for determining ESWT speed held true and; (ii) the agreement between speeds derived using the original method and that equivalent to 85% of the peak speed achieved during the incremental shuttle walk test (ISWT)., Methods: Patients with chronic obstructive pulmonary disease (COPD) performed two ISWTs and one ESWT on separate days, wearing a calibrated portable gas analysis unit. A retrospective analysis of these data allowed us to determine whether: (i) the peak rate of oxygen uptake (V˙O₂peak) can be accurately estimated from the incremental shuttle walk distance (ISWD) and; (ii) ESWTs performed at a speed derived using the original method elicited 85% of V˙O₂peak. Agreement between walks speeds was determined using Bland-Altman analysis., Results: Twenty-two participants (FEV₁ 48 ± 13% predicted, age 66 ± 8 yr) completed the study. The V˙O₂peak estimated from the ISWD was less than that measured during the ISWT (mean difference -4.4; 95% confidence interval (CI), -6.0 to -2.9 ml· kg⁻¹·min⁻¹). The ESWT and ISWT elicited similar V˙O₂peak (mean difference -0.2; 95% CI, -1.5 to 1.2 ml·kg⁻¹·min⁻¹). The mean difference (±limits of agreement) between ESWT speeds was 0.15 (±0.34) km·h⁻¹., Conclusions: Components of the original method for determining the ESWT speed did not hold true in our sample. ESWT speed can be derived by calculating 85% of the peak speed achieved during the ISWT., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Study Objective: Estimating lung volume using inspiratory capacity (IC) maneuvers is a useful way of tracking dynamic hyperinflation. An understanding of the repeatability of the IC in a clinical setting is important when evaluating an individual's response to a therapeutic intervention that might influence lung volume. This is the first study to determine the repeatability of serial IC measurements of patients with severe COPD undergoing incremental exercise testing in a clinical setting., Subjects and Methods: Ten patients with severe COPD, inexperienced in exercise testing, cycled with power increased until they reached symptom limitation. Flow was measured at the mouth using a pneumotachograph. IC maneuvers were performed at 1-min to 3-min intervals. Subjects repeated the exercise test 2 days later. Three methods of calculating IC from flow have been described previously. To determine which method provided the best repeatability, we calculated the following: (1) IC calculated by the integration of inspired flow from the start to the end of the IC maneuver (ICINSP); (2) IC calculated from the difference between the drift-corrected peak inspiratory volume (total lung capacity [TLC]) and the drift-corrected end-expiratory lung volume (EELV) of the six breaths that preceded the IC prompt (ICREG); and (3) IC calculated, after correction of the expiratory part of the signal, as the difference between the mean EELV of the six breaths that preceded the IC prompt and the peak inspiratory volume (ICRATIO). Each individual's IC response was expressed as a function of exercise time and of ventilation., Results: There was a significant (p < 0.05) decrease in the expired volume of the breath before the IC maneuver (0.11 +/- 0.26 L) [mean +/- SD]. ICINSP (1.78 +/- 0.88 L) was significantly less than the IC calculated using the other two methods (ICREG, 1.88 +/- 0.89 L; ICRATIO, 1.86 +/- 0.87 L). ICRATIO improved the repeatability of the serial IC measures by as much as 60% over ICINSP and ICREG., Conclusion: Calculating IC as the difference between EELV and TLC was unaffected by unsatisfactory technique, such as a change in breathing pattern immediately before the maneuver. Adjusting expiratory flow based on premaneuver inspiratory to expiratory volume ratio before estimating EELV improved the repeatability coefficient of the IC.

Background: Despite the wide-ranging benefits of pulmonary rehabilitation, conflicting results remain regarding whether people with COPD can improve their peak oxygen uptake (V˙O2peak) with aerobic training.Research Question: The goal of this study was to investigate the effect of aerobic training and exercise prescription on V˙O2peak in COPD.Study Design and Methods: A systematic review was performed by using MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases for all studies measuring V˙O2peak prior to and following supervised lower-limb aerobic training in COPD. A random effects meta-analysis limited to randomized controlled trials comparing aerobic training vs usual care was conducted. Other study designs were included in a secondary meta-analysis and meta-regression to investigate the influence of program and patient factors on outcome.Results: A total of 112 studies were included (participants, N = 3,484): 21 controlled trials (n = 489), of which 13 were randomized (n = 288) and 91 were uncontrolled (n = 2,995) studies. Meta-analysis found a moderate positive change in V˙O2peak (standardized mean difference, 0.52; 95% CI, 0.34-0.69) with the intervention. The change in V˙O2peak was positively associated with target duration of exercise session (P = .01) and, when studies > 1 year duration were excluded, greater total volume of exercise training (P = .01). Similarly, the change in V˙O2peak was greater for programs > 12 weeks compared with those 6 to 12 weeks when adjusted for age and sex. However, reported prescribed exercise intensity (P = .77), training modality (P > .35), and mode (P = .29) did not affect V˙O2peak. Cohorts with more severe airflow obstruction exhibited smaller improvements in V˙O2peak (P < .001).Interpretation: Overall, people with COPD achieved moderate improvements in V˙O2peak through supervised aerobic training. There is sufficient evidence to show that programs with greater total exercise volume, including duration of exercise session and program duration, are more effective. Reduced effects in severe disease suggest alternative aerobic training methods may be needed in this population.Clinical Trial Registration: PROSPERO; No.: CRD42018099300; URL: https://www.crd.york.ac.uk/prospero/. [ABSTRACT FROM AUTHOR]

To inform recommendations for the exercise component of a healthy lifestyle intervention for adults with obesity and treated obstructive sleep apnoea (OSA), we investigated the total energy expenditure (EE) and cardiorespiratory response to weight-supported (cycling) and unsupported (walking) exercise. Individuals with treated OSA and a body mass index (BMI) > 30 kg/m² performed an incremental cardiopulmonary exercise test on a cycle ergometer and a treadmill to determine the peak oxygen uptake (...O2pk). Participants subsequently completed two endurance tests on each modality, matched at 80% and 60% of the highest ...O2pk determined by the incremental tests, to intolerance. The cardiorespiratory response was measured and total EE was estimated from the ...O2. Sixteen participants completed all six tests: mean [SD] age 57 [13] years and median [IQ range] BMI 33.3 [30.8-35.3] kg/m². Total EE during treadmill walking was greater than cycling at both high (158 [101] vs. 29 [15] kcal; p < 0.001) and moderate (178 [100] vs. 85 [59] kcal; p = 0.002) intensities, respectively, with similar cardiorespiratory responses and pattern of EE during rest, exercise and recovery. Contrary to current guidelines, walking might be the preferred training modality to achieve the combination of weight loss and increased cardiorespiratory fitness in adults with obesity and treated OSA. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and objective: Field and laboratory-based tests are used to measure exercise capacity in people with COPD. A comparison of the cardiorespiratory responses to field tests, referenced to a laboratory test, is needed to appreciate the relative physiological demands. We sought to compare peak and submaximal cardiorespiratory responses to the 6-min walk test, incremental shuttle walk test and endurance shuttle walk test with a ramp cycle ergometer test (CET) in patients with COPD. Methods: Twenty-four participants (FEV1 50 ± 14%; 66.5 ± 7.7 years; 15 men) completed four sessions, separated by ≥24 h. During an individual session, participants completed either two 6-min walk tests, incremental shuttle walk tests, endurance shuttle walk tests using standardized protocols, or a single CET, wearing a portable gas analysis unit (Cosmed K4b2) which included measures of heart rate and arterial oxygen saturation (SpO2). Results: Between tests, no difference was observed in the peak rate of oxygen uptake ( F3,69 = 1.2; P = 0.31), end-test heart rate ( F2,50 = 0.6; P = 0.58) or tidal volume ( F3,69 = 1.5; P = 0.21). Compared with all walking tests, the CET elicited a higher peak rate of carbon dioxide output (1173 ± 350 mL/min; F3,62 = 4.8; P = 0.006), minute ventilation (48 ± 17 L/min; F3,69 = 10.2; P < 0.001) and a higher end-test SpO2 (95 ± 4%; F3,63 = 24.9; P < 0.001). Conclusions: In patients with moderate COPD, field walking tests elicited a similar peak rate of oxygen uptake and heart rate as a CET, demonstrating that both self- and externally paced walking tests progress to high intensities. [ABSTRACT FROM AUTHOR]

The article focuses on a study, to define the limitations of exercising with a smaller muscle mass, and to determine the endurance time in patients with COPD. Generally, exercise intensity in patients with COPD is limited by the ventilatory system. The study demonstrated that with the help of a smaller muscle mass, ventilatory-limited patients would perform more high-intensity, muscle-specific work. The study observations revealed the effectiveness of using one-legged exercise at the same muscle-specific intensity in extending the duration of exercise among patients with COPD.