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Pulmonary rehabilitation programmes including aerobic training improve cardiorespiratory fitness in patients with COPD, but the optimal programme design is unclear. We used random effects additive component network meta-analysis to investigate the relative effectiveness of different programme components on fitness measured by V̇O 2peak in COPD. The included 59 studies involving 2191 participants demonstrated that V̇O 2peak increased after aerobic training of at least moderate intensity with the greatest improvement seen following high intensity training. Lower limb aerobic training (SMD 0.56 95% CI 0.32;0.81, intervention arms=86) and the addition of non-invasive ventilation (SMD 0.55 95% CI 0.04;1.06, intervention arms=4) appeared to offer additional benefit but there was limited evidence for effectiveness of other exercise and non-exercise components., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Background : For assessing the effects of interventions on exercise tolerance, the tolerable duration (t limit ) of a high-intensity constant-speed endurance test is recommended. The test intensity is determined by the test speed ( s test ) which should be individualized to target a t limit of 3 to 15 minutes. We determined the accuracy of setting the s test to achieve a targeted t limit of 3 to 15 minutes using the participant's easily measured and non-fatiguing usual ( s usual ) and fast ( s fast ) walk speeds. Methods : Participants with COPD were asked to walk at their usual and fast walk speeds to establish their s usual and s fast . This required that they walk for less than 1 minute. The individualized s test was calculated from a previously developed equation (0.57 x [ s fast - s usual ]) + s usual . Participants then completed a constant-speed endurance test, walking at this calculated s test to intolerance, to determine if the resultant t limit occurred within 3 to 15 minutes. Results : Twenty-nine participants (forced expiratory volume in 1 second [FEV 1 ] standard deviation [SD ]=43 [25] %predicted; FEV 1 to forced vital capacity [FVC]ratio= 41 [13]%; s usual = 57.3 [10.4] meters per minute (m·min -1 ); s fast = 71.7 [10.7] m·min -1 ) completed the study. During testing, 24 (83%) participants used supplemental oxygen and 16 (55%) used a walking aid. The derived s test was 65.6 [10.3] m·min -1 with the observed t limit of 6.0 [5.0] minute. Twenty-four of 29 (83 %) endurance tests were within 3 to 15 minutes. Conclusion : Using the usual and fast walk speeds provides a simple, quick, inexpensive method for clinicians to set an acceptable endurance walk speed.