Resistance versus endurance training in patients with COPD and peripheral muscle weakness Effects of Combined Resistance and Endurance Training Versus Resistance Training Alone on Strength, Exercise Capacity, and Quality of Life in Patients With COPD Four weeks’ intensive rehabilitation generates significant health effects in COPD patients Two different training programmes for patients with COPD: a randomised study with 1-year follow-up. Resistance training as a preconditioning strategy for enhancing aerobic exercise training outcomes in COPD. Strength training increases maximum working capacity in patients with COPD--randomized clinical trial comparing three training modalities. Effect of respiratory muscle endurance training in patients with COPD undergoing pulmonary rehabilitation. How should we train the upper limbs? Randomized trial of non-invasive ventilation combined with exercise training in patients with chronic hypercapnic failure due to chronic obstructive pulmonary disease.
The effects of endurance training on exercise capacity and health-related quality of life ( HRQL ) in chronic obstructive pulmonary disease ( COPD ) patients have been studied thoroughly , while resistance training has been rarely evaluated . This study investigated the effects of resistance training in comparison with endurance training in patients with moderate to severe COPD and peripheral muscle weakness ( isometric knee extension peak torque < 75 % predicted ) . Forty-eight patients ( age 64±8 yrs , forced expiratory volume in one second 38±17 % pred ) were r and omly assigned to resistance training ( RT , n=24 ) or endurance training ( ET , n=24 ) . The former consisted of dynamic strengthening exercises . The latter consisted of walking , cycling and arm cranking .  Respiratory and peripheral muscle force , exercise capacity , and HRQL were re-evaluated in all patients who completed the 12-week rehabilitation ( RT n=14 , ET n=16 ) . Statistically significant increases in knee extension peak torque ( RT 20±21 % , ET 42±21 % ) , maximal knee flexion force ( RT 31±39 % , ET 28±37 % ) , elbow flexion force ( RT 24±19 % , ET 33±25 % ) , 6-min walking distance ( 6MWD ) ( RT 79±74 m , ET 95±57 m ) , maximum workload ( RT 15±16 Watt , ET 14±13 Watt ) and HRQL ( RT 16±25 points , ET 16±15 points ) were observed . No significant differences in changes in HRQL and 6MWD were seen between the two treatments . Resistance training and endurance training have similar effects on peripheral muscle force , exercise capacity and health-related quality of life in chronic obstructive pulmonary disease patients with peripheral muscle weakness PURPOSE : To compare the effects of 12-week training periods ( 2 d·wk−1 ) involving resistance training only with the effects of 12-week training periods involving combined resistance ( once weekly ) and endurance ( once weekly ) training on strength , endurance performance , and quality of life . METHODS : Thirty-six patients with moderate-to-severe chronic obstructive pulmonary disease were r and omized to combined training ( REG ) , resistance training alone ( RG ) , or control ( CG ) groups . Patients were tested for maximal strength of the upper and lower extremities , power output of the lower extremities , maximal ( W max ) and submaximal exercise capacity , performance on a 6-minute walk test ( 6MWT ) , and quality of life . RESULTS : REG and RG induced similar maximal strength gains . Muscle power increased 19 % ( P ⩽ .01 ) and W max improved 13 % ( P < .05 ) in REG . Reductions ( P < .05 ) in the heart rate and blood lactate at a given submaximal workload were observed in REG . Improvements in 6MWT and quality of life were similar in both training groups . CONCLUSIONS : Compared with a twice-weekly resistance training program , the combination of once-weekly resistance and once-weekly endurance training not only produced similar gains in maximal strength , 6MWT performance , and quality of life but also produced improvements in muscle power and endurance performance . These findings may have implication s for the prescription of resistance and endurance exercise for patients with chronic obstructive pulmonary disease Changes in health according to World Health Organization ’s International Classification of Functioning , Disability and Health ( ICF ) after four weeks of pulmonary rehabilitation ( PR ) were investigated . Gender differences in the response to PR , and the correlation between improvements in the two components of ICF ( Body functions and Activities and Participation ) were examined . Twenty-two men and 18 women with chronic obstructive pulmonary disease in Global Initiative for Chronic Obstructive Lung Disease ( GOLD ) stage II-IV attended in-patient , multidisciplinary PR consisting of endurance training four to five times/week at 70 % of peak work rate ( WRpeak ) , resistance training three to four times/week at 72 % of 15 repetitions maximum , educational sessions and individual counselling . The results were compared to those of 20 Chronic Obstructive Pulmonary Disease ( COPD ) patients included after the same criteria and investigated while waiting for admission to PR . In the rehabilitation group , we found significant improvements in health related quality of life ( HRQoL ) ( -7 units , St. George ’s Respiratory Question naire ) , arm ( 6 % ) and leg ( 15 % ) maximal voluntary contraction , peak oxygen uptake ( 6 % ) , WRpeak ( 60 % ) and treadmill endurance time ( 93 % ) . At iso-WR , ventilation and dyspnoea were significantly lower , but inspiratory capacity remained unchanged . Improvements in HRQoL correlated with increases in peak ventilation , but not in muscle strength or exercise capacity . Men improved their six-minute walking distance significantly in contrast to women . Clinical ly important improvements in HRQoL were found in two out of three of the men , and one out of three of the women . Four weeks of intensive PR generated significant health effects comparable to longer lasting programmes . Changes in exercise capacity and muscle strength were not related to improvements in HRQoL. The gender differences in the response to PR deserve attention in future studies PURPOSE To compare the effects on exercise capacity and health related quality of life ( HRQoL ) of two exercise programmes ; one programme including endurance training and one including only resistance training and callisthenics . A second purpose was to find out whether the severity of chronic obstructive pulmonary disease ( COPD ) affected the training response and whether the interventions had a long-term effect . METHODS Sixty-three patients were stratified according to severity of COPD and r and omised to two training groups . Group A had a mixed programme including endurance training . Group B had resistance training and callisthenics . All trained twice weekly for 8 weeks . A symptom-limited ergometer test , 12-min walking test , dynamic spirometry , blood gas analysis at rest and HRQoL were measured before and after the training period . Follow-up tests were conducted at 6 and 12 months after training . RESULTS Forty-two patients fulfilled the trial . In group A ( n=20 ) peak exercise capacity increased by 7W ( P<0.001 ) and 12-min walking distance ( 12MWD ) by 50 m ( P<0.01 ) , whereas group B ( n=22 ) did not change in any of these variables . HRQoL did not change significantly in either group . Training response was similar in patients with moderate and severe disease . One year post-training 12MWD had returned to pre-training level in group A , and below pre-training level in group B ( P<0.05 ) . CONCLUSIONS Exercise capacity in patients with severe and moderate COPD improved by intensive endurance training , two sessions a week for 8 weeks . The improvement was however small and HRQoL did not improve . Severity of illness did not affect response to training . The results indicated that the effects of a short endurance training intervention slowed down decline in baseline functional exercise capacity for 1 year PURPOSE Aerobic exercise training is a recognized approach for improving functional capacity in COPD . People with greater disease severity often have difficulty achieving higher aerobic exercise training intensity . The effects of resistance training prior to aerobic training were examined to determine if this sequential approach was associated with greater gains in functional status than aerobic training alone or concurrent aerobic and resistance training . METHODS Patients were r and omized to : 1 ) sequential resistance then aerobic training ( RT-then-AT ) ( 8 weeks resistance training followed by 8 weeks aerobic exercise training ) , 2 ) control group ( CE-then-AT + RT ) ( 8 weeks of ' sham ' training followed by 8 weeks concurrent aerobic and resistance training ) , 3 ) control group ( CE-then-AT ) ( 8 weeks ' sham ' training followed by 8 weeks aerobic training ) . Outcomes were assessed at study entry , after week 8 , and after week 16 : aerobic exercise performance ; muscle strength and endurance . RESULTS 75 patients completed training :  FEV1 % pred 40 ± 10 , V˙O(2peak ) % predicted , 71 ± 22 , fat-free mass index 19.5 ± 3.1 . RT-then-AT had greater acquisition of peripheral muscle endurance than CE-then-AT + RT and CE-then-AT , but improvements in aerobic exercise performance were similar . Improvements in muscle strength were similar between RT-then-AT and CE-then-AT + RT . Sarcopenia was associated with poorer attendance , and lower aerobic and resistance training volumes . CONCLUSION Although the sequential approach to resistance and aerobic training yielded a greater increase in muscle endurance and higher resistance training volume compared to concurrent resistance and aerobic training , other training outcomes were similar between the two groups , thus the sequential approach is not clearly superior to the concurrent approach in severe COPD . Clinical Trials.gov Identifier : NCT01058213 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 Respiratory muscle endurance training ( hyperpnea training ) has been shown to have beneficial effects in patients with COPD . STUDY OBJECTIVES The purpose of this study was to determine whether hyperpnea training , when added to an endurance exercise training program , would lead to additional benefits compared with endurance training alone in patients with COPD . SETTING AND PARTICIPANTS Patients with COPD entering an 8-week outpatient pulmonary rehabilitation program . Fifteen patients ( mean [ + /- SE ] FEV1 , 45 + /- 6 % predicted ) were r and omized to combined therapy , and 14 patients ( mean FEV1 , 44 + /- 4 % predicted ) were r and omized to endurance training .  METHODS  Peak exercise capacity , exercise endurance time during constant workload cycle exercise , 6-min walk distance , quality of life as measured by the chronic respiratory question naire , respiratory muscle strength and endurance , and quadriceps fatigability were measured before and after endurance or combined training . RESULTS After rehabilitation , peak exercise capacity , exercise endurance time , 6-min walk distance , and quality of life all increased in both groups , but there was no significant difference in the extent of improvement between groups . Mean respiratory muscle endurance increased to a significantly greater extent in the combined therapy group ( 17.5 + /- 2.7 vs 8.5 + /- 2.5 min , respectively ; p = 0.02 ) . Respiratory muscle strength was significantly increased , and quadriceps fatigability was significantly reduced after rehabilitation in the combined therapy group but not in the endurance training group , but the difference between groups did not reach statistical significance . CONCLUSION The endurance of the respiratory muscles can be improved by specific training beyond that achieved by endurance training alone in patients with COPD . However , this improvement did not translate into additional improvement in quality of life or exercise performance The article by McKeough and colleagues in this issue of Chronic Respiratory Disease is the first study to compare different modes of upper extremity training in individuals with chronic obstructive pulmonary disease ( COPD ) . Limitations during exercise and daily activity in individuals with COPD are not limited to lower extremity activities such as walking or stair climbing ; most of the patients experience difficulty during activities that involve their arms due to the sensation of dyspnea and /or arm fatigue . Upper extremity training for patients with COPD is an important component of pulmonary rehabilitation ( PR ) , result ing in improvements in arm exercise capacity , arm function and muscle strength . However , there is limited evidence on what type of training should be performed . The study by McKeough and colleagues adds to the growing body of evidence in the area of upper extremity training in COPD and provides support for the inclusion of arm endurance and strength training as a part of PR . The study is a r and omized controlled trial ( RCT ) that aim ed to compare the effects of arm endurance training ; arm strength training , a combination of arm endurance and strength training ; and no arm training ( control group ) on endurance arm exercise capacity , functional arm exercise capacity and health-related quality of life ( HRQL ) in individuals with mild-tovery severe COPD . The authors found a significant improvement in arm endurance time ( arm endurance capacity ) between the endurance group and control group . There were nonsignificant trends in arm endurance time favoring the strength training and combined groups compared with the control group . In terms of symptoms , the authors demonstrated that the combined group had a significantly greater reduction in dyspnea and rate of perceived exertion at the end of the functional arm exercise test compared with the control and with each of the intervention groups . When the combined group was compared with the other two intervention groups , the improvement in HRQL ( measured using the St George ’s Respiratory Question naire ) exceeded the minimum clinical ly important difference of 4 units , although it did not reach statistical significance . Until the beginning of the century , several RCTs had been conducted to examine the effects of upper extremity training in individuals with COPD . However , there were considerable variations in the exercise protocol s rendering it impossible to determine the optimal training regimen for these patients . Moreover , the impact of upper extremity training on other clinical outcomes besides arm exercise capacity was unclear as shown consistently by four systematic review s. More recently , four RCTs examining the effects of arm exercise training in individuals with COPD have been published . Holl and and colleagues compared the effects of unsupported upper limb endurance training with lower extremity training alone . The authors found that unsupported upper limb endurance training improved upper limb exercise capacity but had no additional effects on the symptoms or HRQL compared with lower extremity training alone . Costi and colleagues examined the effects of upper extremity resistance training in patients with COPD compared with st and ard PR . The authors demonstrated improvement in arm functional exercise capacity ( measured using the 6-minute pegboard and ring test ) and in performance during activities of daily living ( ADL ) measured by an ADL field test . In addition , the authors found a decrease in arm fatigue at the end of the ADL test in the intervention group . BACKGROUND Non-invasive ventilation and exercise training might prove beneficial in the management of COPD patients . OBJETIVE to compare the combined use of exercise training and non-invasive ventilation with the two interventions separately in chronic respiratory failure due to chronic obstructive pulmonary disease . As primary objective exercise capacity and secondary objectives gas exchange , peripheral muscle strength , BODE index , quality of life and systemic inflammatory response . METHODS Forty-five patients with severe chronic obstructive pulmonary disease were r and omized into three groups for an intervention of 12 weeks : exercise training alone , ventilation alone and combined treatment . We assessed exercise capacity , pulmonary function , BODE index , perception of dyspnoea , quality of life and several biomarkers . RESULTS All exercise capacity parameters improved after training and the combined treatment . In addition , peripheral muscle strength and six-minute walk distance increased after ventilation . We found differences between the combined group and the ventilation group in submaximal effort and in oxygen consumption . Changes in respiratory function were observed in blood gases that improved after ventilation and the combined treatment , with differences between these groups . BODE index , perception of dyspnoea and quality of life improved in all three groups without differences between groups . Levels of interleukin 8 and tumour necrosis factor α decreased after ventilation , and interleukin 8 , C-reactive protein and surfactant protein D decreased after training , while all four of these markers fell after the combined treatment . No differences between groups were found . CONCLUSIONS The combination of ventilation and exercise training had greater benefits than the separate treatments : improvements were observed in both blood gases and the levels of more biomarkers decreased . In addition , submaximal exercise capacity increased in all groups . The improvements seen in BODE index , perception of dyspnoea and quality of life were similar in all groups
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 .
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 .