Effects of Combined Resistance and Endurance Training Versus Resistance Training Alone on Strength, Exercise Capacity, and Quality of Life in Patients With COPD

Functional capacity using sit-to-stand tests in people with chronic obstructive pulmonary disease and its relationship with disease severity-a cross-sectional study with matched controls

BACKGROUND

Functional capacity impairment is a crucial consequence of chronic obstructive pulmonary disease (COPD). Although it can be identified with simple tests, such as the sit-to-stand tests, its prevalence, relation with disease severity, and the characteristics of people presenting this impairment remain unknown.

OBJECTIVE

To explore the functional capacity of people with COPD.

METHODS

A cross-sectional study with people with COPD and age-/sex-matched healthy controls was conducted. Functional capacity was assessed with the 5-repetitions (5-STS) and the 1-minute (1-minSTS) sit-to-stand tests. People with COPD were grouped according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classifications. Comparisons between people with COPD and healthy controls, and among GOLD groups were established. Associations between symptoms, muscle strength, quality of life, and measures of functional capacity were explored.

RESULTS

302 people with COPD [79% male; mean (SD) 68 (10) years old] and 304 healthy controls [75% male; 66 (9) years old] were included. 23% of people with COPD presented impairment in the 5-STS and 33% in the 1-minSTS. People with COPD from all GOLD classifications presented significantly lower functional capacity than healthy controls (5-STS: COPD median [1st quartile; 3rd quartile] 8.4 [6.7; 10.6] versus healthy 7.4 [6.2; 9.3] s; 1-minSTS: COPD 27 [21; 35] vs healthy 35 [29; 43] reps). Correlations with symptoms, muscle strength, and quality of life were mostly weak (5-STS: rs [-0.34; 0.33]; 1-minSTS: rs [-0.47; 0.40]).

CONCLUSION

People with COPD have decreased functional capacity independently of their GOLD classifications. The prevalence of functional impairment is 23-33%. Because impaired functional capacity is a treatable trait not accurately reflected by other outcomes, comprehensive assessment and management is needed.

Effects and long-term outcomes of endurance versus resistance training as an adjunct to standard medication in patients with stable COPD: a multicenter randomized trial

BACKGROUND

Comparisons between endurance training (ET) and resistance training (RT) have produced equivocal findings in chronic obstructive pulmonary disease (COPD) patients. The purpose of our study is to investigate the effectiveness and long-term outcomes of adding ET and RT to conventional medical treatment in patients with COPD. A secondary objective is to investigate the clinical improvements resulting from exercise training in patients with different disease severities.

METHODS

The study was a multicenter, prospective trial in people with stable COPD. The cohort was randomized to three groups: individualized medical treatment group (MT), MT + endurance training group (MT + ET) and MT + resistance training group (MT + RT). Exercise was performed 3 times weekly over a 12-week period. The endpoints of exercise capacity, health-related quality of life, COPD symptoms, lung function, and anxiety and depression questionnaires were re-evaluated at baseline, at the completion of the intervention and at 6 and 12-month follow-up. According to the COPD assessment tool offered by GOLD guidelines, patients were stratified into GOLD A and B groups and GOLD C and D groups for further subgroup analysis.

RESULTS

The intention-to-treat (ITT) population included 366 patients, 328 of them completed the study protocol over 12 months (the PP-population). There were no significant differences in the primary outcome, quality of life, between patients who underwent medical treatment (MT) alone, MT + endurance training (MT + ET), or MT + resistance training (MT + RT) at the completion of the intervention, 6-, or 12-month follow-up. Additionally, no significant differences were observed between MT, MT + RT, or MT + ET groups concerning the primary outcome, exercise capacity (3MWD), after initial 3 months of intervention. However, a small statistically significant difference was noted in favor of MT + ET compared to MT + RT at 12 months (ITT: Δ3MWD in ET vs RT = 5.53 m, 95% confidence interval: 0.87 to 13.84 m, P = 0.03) (PP: Δ3MWD in ET vs RT = 7.67 m, 95% confidence interval: 0.93 to 16.27 m, P = 0.04). For patients in the GOLD C and D groups, improvement in quality of life following ET or RT was significantly superior to medical intervention alone. Furthermore, upon completion of the exercise regimen, RT exhibited a greater improvement in anxiety compared to ET in these patients (ITT: ΔHAD-A at 3-month: RT = -1.63 ± 0.31 vs ET = -0.61 ± 0.33, p < 0.01) (PP: ΔHAD-A at 3-month: RT = -1.80 ± 0.36 vs ET = -0.75 ± 0.37, p < 0.01).

CONCLUSIONS

Our study presents evidence of the beneficial effects of ET and RT in combination with standard medical treatment, as well as the long-term effects over time after the intervention. While the statistically significant effect favoring ET over RT in terms of exercise capacity was observed, it should be interpreted cautiously. Patients in severe stages of COPD may derive greater benefits from either ET or RT and should be encouraged accordingly. These findings have implications for exercise prescription in patients with COPD.

TRIAL REGISTRATION

ChiCTR-INR-16009892 (17, Nov, 2016).

Efficacy of aerobic training and resistance training combined with external diaphragm pacing in patients with chronic obstructive pulmonary disease: A randomized controlled study

OBJECTIVE

To evaluate the efficacy of aerobic training, resistance training combined with external diaphragm pacing in patients with chronic obstructive pulmonary disease.

DESIGN

Randomized controlled trial.

SETTING

The Fourth Rehabilitation Hospital of Shanghai, China.

PARTICIPANTS

82 (67.0  ±  6.5 years, 59.8% male) patients with stable chronic obstructive pulmonary disease were randomized to intervention group 1 (n  =  27), intervention group 2 (n  =  28), and control group (n  =  27).

INTERVENTION

Intervention group 1 received aerobic and resistance training, while intervention group 2 received additional external diaphragm pacing. Control group received aerobic training only.

MAIN MEASURES

1-year follow-up of physical activity, body composition, respiratory function and diaphragm function.

RESULTS

Intervention groups 1 and 2 showed statistically improvements in the difference value compared with control group in terms of 6-min walk distance (-95.28  ±  20.09 and -101.92  ±  34.91 vs -63.58  ±  23.38), forced expiratory volume in 1 s (-0.042  ±  0.027 and -0.130  ±  0.050 vs -0.005  ±  0.068), fat-free mass (-2.11  ±  3.74 and -3.82  ±  3.74vs 0.28  ±  1.49) and chronic obstructive pulmonary disease assessment test value (2.16  ±  0.85 and 2.38  ±  1.02 vs 1.50  ±  0.93). Intervention group 2 showed significant difference in arterial oxygen pressure (-4.46  ±  3.22 vs -1.92  ±  3.45), diaphragm excursion during deep breaths (-0.82  ±  0.74 vs -0.38  ±  0.29), and diaphragm thickness fraction (-8.77  ±  3.22 vs -4.88  ±  2.69) compared with control group.

CONCLUSION

The combination of aerobic training, resistance training, and external diaphragm pacing obtained significant improvements in physical activity, respiratory function, body composition, arterial oxygen pressure, and diaphragm function in patients with chronic obstructive pulmonary disease.

TRIAL REGISTRATION

ChiCTR1800020257, www.chictr.org.cn/index.aspx.

Exercise Rehabilitation and Chronic Respiratory Diseases: Effects, Mechanisms, and Therapeutic Benefits

Chronic respiratory diseases (CRD), is a group of disorders, primarily chronic obstructive pulmonary disease and asthma, which are characterized by high prevalence and disability, recurrent acute exacerbations, and multiple comorbidities, resulting in exercise limitations and reduced health-related quality of life. Exercise training, an important tool in pulmonary rehabilitation, reduces adverse symptoms in patients by relieving respiratory limitations, increasing gas exchange, increasing central and peripheral hemodynamic forces, and enhancing skeletal muscle function. Aerobic, resistance, and high-intensity intermittent exercises, and other emerging forms such as aquatic exercise and Tai Chi effectively improve exercise capacity, physical fitness, and pulmonary function in patients with CRD. The underlying mechanisms include enhancement of the body's immune response, better control of the inflammatory response, and acceleration of the interaction between the vagus and sympathetic nerves to improve gas exchange. Here, we reviewed the new evidence of benefits and mechanisms of exercise intervention in the pulmonary rehabilitation of patients with chronic obstructive pulmonary disease, bronchial asthma, bronchiectasis, interstitial lung disease, and lung cancer.

Pilot testing the impact of an aerobic exercise plus rehabilitation training on respiratory function in older adults with COPD

Chronic obstructive pulmonary disease (COPD) is a chronic intractable lung disease. To investigate the therapeutic effect, older adult patients were subjected to aerobic exercise and respiratory rehabilitation (diaphragmatic breathing) for six months. At the end of six-month intervention, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), 6-minute walking distance (6 MWD), and patient activation measure scores increased; St. George's respiratory questionnaire scores and disease impact score decreased; and PaCO₂ and PaO₂ were significantly improved in both groups, particularly in the experimental group. In addition, FEV1, FEV1/FVC, 6 MWD, blood gas levels, quality of life, and self-care ability in the experimental group were significantly improved compared with those in the control group, and the improvements were significantly greater in male, younger, and less diseased patients. Our study demonstrated that aerobic exercise combined with diaphragmatic breathing significantly improves respiratory function and quality of life in older adult patients.

Muscle Power in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis

This study aimed to review the impact of training on muscle power in patients with chronic obstructive pulmonary disease (COPD). Randomized controlled trials evaluating the effects of exercise-based interventions on limbs muscle power and rate of force development in COPD patients were investigated. Five international databases were searched until October 2022. Meta-analyses were performed calculating the mean difference or standardized mean difference. Risk of bias in studies was assessed using Cochrane Risk of Bias tool 2.0. A total of nine studies were included in the analysis. There were concerns about risk of bias in seven out of nine studies. Comparison of exercising and non-exercising groups showed a significant effect of exercise in improving muscle power (P=0.0004) and rate of force development (P<0.001), in five and three trials, respectively. Four studies comparing different trainings showed no significant results on muscle power (P=0.45). Eight to 16 weeks of exercise-based intervention versus no intervention might be beneficial to enhance upper and lower limbs muscle power and rate of force development in people with COPD. In contrast, muscle power did not improve when different training modalities were compared. Future studies performing power training in COPD patients are encouraged.

Effect of Endurance Training in COPD Patients Undergoing Pulmonary Rehabilitation: A Meta-Analysis

Background

The efficacy of endurance training (ET) on patients with chronic obstructive pulmonary disease (COPD) has been controversial. This study was aimed at meta-analyzing the effect of ET in COPD patients undergoing pulmonary rehabilitation.

Methods

The literature retrieval was performed in databases to screen relevant literature. Inclusion criteria were as follows: (1) subjects—COPD patients; (2) inclusion of interventional and control groups; (3) intervention measures—the interventional group received whole-body ET and other lung rehabilitation training, while the control group did not receive intervention or other lung rehabilitation training; (4) outcome indicators which included at least one of the following—6MWD, modified Medical Research Council questionnaire (mMRC), and COPD Assessment Test (CAT); and (5) study type—randomized controlled trials (RCTs). The Cochrane risk-of-bias tool was used to assess the risk of bias. The chi-square test was used to evaluate the magnitude of heterogeneity. Subgroup analysis was used to explore the source of heterogeneity. A funnel plot and Egger's test were used to evaluate publication bias.

Results

The 6MWD in the ET group was significantly higher than that in the control group (MD = 47.20, 95% CI [28.60, 65.79], P < 0.00001). Significant heterogeneity (P < 0.00001, I² = 76%) without publication bias (P > 0.05) was noted. Subgroup analysis showed that the 6MWD of the ET group was significantly larger than that of the control group without heterogeneity (P = 0.63, I² = 0%; P = 0.59, I² = 0%) in both the no training subgroup (MD = 79.26, 95% CI [72.69, 85.82], P < 0.00001) and other rehabilitation training group (MD = 23.64, 95% CI [6.70, 40.57], P = 0.006). The mMRC score (MD = −0.72, 95% CI [-1.09, -0.34], P = 0.002) and CAT (MD = −6.07, 95% CI [-7.28, -4.87], P < 0.00001) of the ET group were significantly lower than those of the control group. There was no heterogeneity (P = 0.32, I² = 15%; P = 0.16, I² = 41%).

Conclusion

ET can improve patients' motor function and reduce dyspnea. ET might be incorporated as an important part of lung rehabilitation training.

Impact of concurrent training versus aerobic or resistance training on cardiorespiratory fitness and muscular strength in middle-aged to older adults: A systematic review and meta-analysis

The effects of aerobic training (AT) on cardiorespiratory fitness (CRF), and resistance training (RT) on muscular strength, are well known in older adults. However, less is known about the potential additive benefits of concurrent training (CT) versus AT or RT alone in this population. We conducted a systematic review and meta-analysis to investigate the effects of CT, versus AT or RT, on CRF and muscular strength in middle-aged to older adults. PubMed and Web of Science were searched through October 2021 to identify randomized trials evaluating CT versus AT and/or RT in middle-aged and older adults (>50 yrs). Studies were included that measured CRF, using maximal or peak oxygen uptake (VO_2max/peak); and/or lower- and upper-body muscular strength measured using 1-repetition maximum (1RM) to 10RM tests during isoinertial contractions, or peak torque during isometric dynamometry or isokinetic dynamometry at 30 to 60°/s. Standardized mean differences (SMD) and 95% confidence intervals (95% CIs) were determined using random or fixed effects models. Forty-nine studies involving 2,587 middle-aged to older participants with mean ages ranging from 55 to 88 years, were included in the meta-analysis. Results indicated that CT effectively increased VO_2max/peak (SMD: 0.77, p = 0.005, 12 intervention arms) when compared to RT. In addition, CT effectively increased lower- (SMD: 0.60, p = 0.001, 43 intervention arms) and upper-body (SMD: 0.57, p = 0.001, 28 intervention arms) muscular strength when compared to AT. However, there were no differences in VO_2max/peak (SMD: 0.09, p = 0.09, 33 intervention arms) between CT and AT, or in lower-body (SMD: 0.07, p = 0.48, 21 intervention arms) and upper-body (SMD: -0.07, p = 0.38, 17 intervention arms) muscular strength between CT and RT. Overall, CT was shown to be effective for increasing CRF and muscular strength in middle-aged to older adults and there was no negative effect on the magnitude of changes in these outcomes compared to either AT or RT alone. These results suggested that CT should be considered a viable strategy to improvement of CRF and muscular strength with aging.

Metabolic Flexibility and Mechanical Efficiency in Women Over-60

Purpose: Aging deteriorates metabolic flexibility (MF). Moreover, recent studies show that glycolysis is barely increased despite impoverished lipid metabolism, in addition to increased relevance of muscle power in older adults. This study aims to analyze MF, i.e., fat and carbohydrates oxidation rates (FATox and CHOox), and the point of maximal fat oxidation (MFO), in a group of active women over-60. It also aims to delve into the role of power production and mechanical efficiency regarding MF. This will help to decipher their metabolic behavior in response to increasing intensity. Methods: Twenty-nine women (66.13 ± 5.62 years) performed a submaximal graded cycling test, increasing 10 W each 3-min15-s, from 30 W to the second ventilatory threshold (VT2). Muscle power was adjusted with a Saris-H3 roller, together with a continuous gas analysis by indirect calorimetry (Cosmed K4b2). Pre and post-test blood lactate (BLa) samples were included. Frayn's equations, MFO and CHOoxpeak (mg/min/kg FFM) were considered for MF analysis (accounting for average VO2 and VCO2 in each last 60-s), whilst delta and gross efficiencies (DE%, GE%), and exercise economy (EC), were added for Mechanical Efficiency. Mean comparisons regarding intensities 60, 80 and 100% at VT2, completed the study together with correlation analysis among the main variables. Results: MFO and CHOoxpeak were small (6.35 ± 3.59 and 72.79 ± 34.76 g/min/kgFFM respectively) for a reduced muscle power (78.21 ± 15.84 W). Notwithstanding, GE% and EC increased significantly (p < 0.01) with exercise intensity. Importantly, coefficients of variation were very large confirming heterogeneity. Whilst muscle power outcomes correlated significantly (p < 0.01) with MFO (r = 0.66) and age (r = -0.62), these latter failed to be associated. Only GE% correlated to CHOoxpeak (r = -0.61, p < 0.01) regarding mechanical efficiency. Conclusions: Despite being active, women over-60 confirmed impaired substrates switching in response to exercise, from both FAT and CHO pathways. This limits their power production affecting exercise capacity. Our data suggest that decreased power with age has a key role above age per se in this metabolic inflexibility. Vice versa, increasing power seems to protect from mitochondrial dysfunction with aging. New studies will confirm if this higher efficiency when coming close to VT2, where GE is the more informative variable, might be a protective compensatory mechanism.

Effects of Exercise Intervention on Peripheral Skeletal Muscle in Stable Patients With COPD: A Systematic Review and Meta-Analysis

Objectives: Peripheral skeletal muscle dysfunction is an important extrapulmonary manifestation of chronic obstructive pulmonary disease (COPD) that can be counteracted by exercise training. This study aimed to review the effect of three major exercise training modalities, which are used in pulmonary rehabilitation to improve on skeletal muscle mass, function, and exercise capacity in COPD.

Methods: PubMed, Embase, EBSCO, Web of Science, and the PEDro database were searched on April 25, 2020. Only randomized controlled studies published in English evaluating the effects of exercise interventions on peripheral skeletal muscle mass, strength, and exercise capacity in stable COPD patients were included. The quality of included studies was evaluated using the PEDro scale. The mean difference (MD) or the standardized mean difference (SMD) with 95% CI was calculated to summarize the results. Subgroup meta-analysis was used to investigate the effects of different exercise training modalities and different outcome measures. The Grading of Recommendations Assessment, Development, and Evaluation guidelines were used to rate evidence quality.

Results: A total of 30 randomized controlled trials involving 1,317 participants were included. Data from trials investigating endurance exercise (EE), resistance exercise (RE), and combined aerobic and resistance exercise (CE) were pooled into a meta-analysis, and the differences compared with the non-exercising COPD control were improvement in the muscle strength and exercise capacity in stable COPD patients. Subgroup meta-analysis for different exercise training modalities showed that RE significantly improved muscle strength (SMD = 0.6, 95% CI 0.35–0.84, I² = 61%), EE and CE significantly increased VO_2peak (EE: MD = 3.5, 95% CI 1.1–5.91, I² = 92%; CE: MD = 1.66, 95% CI 0.22–3.1, I² = 1%). Subgroup meta-analysis for different outcome measures showed that only isotonic strength was improved after exercise interventions (SMD = 0.89, 95% CI 0.51–1.26, I² = 71%).

Conclusion: Moderate evidence supports that exercise training in stable COPD patients has meaningful and beneficial effects on peripheral skeletal muscle strength and exercise capacity. Peripheral skeletal muscle shows a higher response to RE, and the isotonic test is relatively sensitive in reflecting muscle strength changes. The proportion of aerobic and resistance exercise components in a combined exercise program still needs exploration.

Systematic Review Registration: The review was registered with the PROSPERO: (The website is https://www.crd.york.ac.uk/PROSPERO/, and the ID is CRD42020164868).

Impact of resistance training on the 6-minute walk test in individuals with chronic obstructive pulmonary disease: A systematic review and meta-analysis

OBJECTIVE

The aim of this systematic review was to assess functional improvement, measured by the 6-minute walk test (6MWT) after the application of a resistance training (RT) protocol in people with chronic obstructive pulmonary disease (COPD).

MATERIALS AND METHODS

The search involved the databases ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, EMBASE, PubMed and Scopus from the beginning of inception to September 1, 2019. Randomized controlled trials evaluating the functional impact of RT were included. The quality of the trials was assessed with the Physiotherapy Evidence Database (PEDro) scale. Calculations were performed according to mean difference (MD) for differences between pre- and post-intervention in 6MWT distance and according to the standardized mean difference (SMD) for post-treatment results of the 6MWT and quadriceps muscle strength (QMS) improvement.

RESULTS

In total, 23 studies (690 patients) met the inclusion criteria. Meta-analysis was used to compute the best improvement on the 6MWT with an analysis of improvement pre- versus post-treatment (MD 37.3, 95% confidence interval [CI] 9.8; 64.8, I² = 86%, p = 0.008) versus post-treatment alone, intervention versus control group (MD 15.5, 95% CI -7.7; 38.6, I^2 = 71%, p = 0.19). QMS was significantly improved (SMD 2.9, 95% CI 1.1; 4.7, I^2 = 91%, p = 0.002).

CONCLUSION

The results of the meta-analysis show a significant improvement in walking ability and performance measured by the 6MWT and an improvement in QMS for people with COPD responding to the therapy. The main limitation of this review is the significant heterogeneity across the study results. Furthermore, the statistical significance does not totally coincide with the clinical significance. RT is recommended to reduce muscle dysfunction and seems useful when combined with endurance training.

Effect of Strength Versus Strength and Endurance Upper Limb Exercise Training in Patients With Chronic Obstructive Pulmonary Disease: A RANDOMIZED CLINICAL TRIAL

PURPOSE

Pulmonary rehabilitation (PR) including exercise training improves muscle strength, exercise capacity, and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). However, the evidence of the effect of upper limb exercise training (ULET) on activities of daily living (ADL) is sparse. This study investigated the effect of two different types of ULET on ADL in addition to standard PR.

METHODS

Patients were randomly assigned to a strength or a combined ULET group. Both groups exercised 2 d/wk for 12 wk. Outcome measures were handgrip strength and muscle strength of biceps and triceps muscles. Moreover, health-related quality of life was assessed through the COPD assessment test (CAT) and Saint George Respiratory Questionnaire. Ability to perform ADL was evaluated through an ADL simulation test. Dyspnea was evaluated by a modified Medical Research Council scale, whereas dyspnea and fatigue perception during strength and ADL tests were measured through a modified Borg scale.

RESULTS

Thirty-six patients with COPD (67.4 ± 5.3 yr) participated in the study. Significant improvements in upper limb strength and CAT were found within both groups. At the end of the study period, patients in the combined group improved time of the ADL test (P = .02) with reduced perception of fatigue (P = .03) compared with patients in the strength group.

CONCLUSIONS

In addition to standard PR of patients with COPD, the combined endurance and resistance ULET program improved ADL and muscle strength, whereas resistance training only increased strength.

Isolated Resistance Training Programs to Improve Peripheral Muscle Function in Outpatients with Chronic Obstructive Pulmonary Diseases: A Systematic Review

This systematic review aims to establish which isolated resistance training (RT) programs have been used in outpatients with chronic obstructive pulmonary disease (COPD) and their impact on all aspects of peripheral skeletal muscle function. Electronic databases were systematically searched up to June 2021. The eligibility criteria were: (1) randomized controlled trials investigating the effects of supervised and isolated RT programs in outpatients with COPD and (2) RT programs lasting 8-12 weeks, (3) including at least one outcome measure related to trainable muscle characteristics. Initially, 6576 studies were identified, whereas 15 trials met the inclusion criteria. All the included trials reported that isolated RT improved both upper and lower limbs' maximal strength. Muscle endurance and power also increased after RT but received less attention in the analysis. Furthermore, few studies assessed the effect of RT on muscle mass and cross-sectional area, reporting only limited improvement. Isolated RT programs carried out 2-3 days a week for 8-12 weeks improved skeletal muscle function in individuals with COPD. The RT program should be specifically focused to the trainable muscle characteristic to be improved. For this reason, we further encourage the introduction of a detailed assessment of muscle function and structure during the pulmonary rehabilitation practice.

Effects of resistance training on exercise ability in chronic obstructive pulmonary disease subjects: A systematic review and meta-analysis

INTRODUCTION

The resistance exercise effect on the exercise ability in chronic obstructive pulmonary disease (COPD) subjects has drawn considerable attention. However, the relationship between resistance exercise and the exercise ability of COPD subjects is conflicting. This meta-analysis was performed to evaluate this relationship.

METHODS

A systematic-literature search up to July 2020 was performed in OVID, Embase, Cochrane Library, PubMed, Google scholar for randomised control trials reported relationships between resistance exercise and the exercise ability of COPD subjects, and 13 studies were detected with 1286 subjects at the baseline. Mean differences (MD) with 95% confidence intervals (CIs) were calculated comparing the resistance exercise and the exercise ability of COPD subjects using the continuous method with a random or fixed-effect model.

RESULTS

A significantly higher 6-minutes walk test was observed in subjects performing resistance training (MD, 60.41; 95% CI, 39.97-80.85, P < .001) compared with non-resistance training subjects. However, no significant difference was observed between COPD subjects performing resistance exercise compared with non-resistance training COPD subjects in constant work rate cycle endurance test (MD, 1.59; 95% CI, 0.03-3.15, P = .05), unsupported upper extremity exercise test (MD, 48.77; 95% CI, -1.20 to 98.75, P < .06) and quality of life questionnaires (MD, -0.62; 95% CI, -2.49 to 1.245, P < .51).

CONCLUSIONS

The resistance exercise significantly increases the 6-minutes walk test in COPD subjects. However, resistance exercise did not significantly affect the constant work rate cycle endurance test, unsupported upper extremity exercise test and quality of life questionnaires. This relationship forces us to recommend the resistance exercise to improve the 6-minutes walk test as a simple and easy evaluation of functional exercise ability in COPD subjects.

Exercise Training and Neuromuscular Parameters in Patients With Type 1 Diabetes: Systematic Review and Meta-Analysis

BACKGROUND

The present study aimed to systematically review the literature on the effects of physical training on neuromuscular parameters in patients with type 1 diabetes mellitus (T1DM).

METHODS

The PubMed, Scopus, EMBASE, and COCHRANE databases were accessed in September 2020. Clinical trials that evaluated the effects of physical training on neuromuscular parameters (maximum strength, resistance strength, muscle power, muscle quality, and muscle thickness) of patients with T1DM compared with a control group were considered eligible. The results were presented as the standardized mean difference with 95% confidence intervals. Effect size (ES) calculations were performed using the fixed effect method, with α = .05.

RESULTS

Combined training increased the maximum strength levels in individuals with T1DM to a lesser extent than in healthy individuals (ES: 0.363; P = .038). Strength training increased the maximum strength (ES: 1.067; P < .001), as well as combined training (ES: 0.943; P < .001); both compared with aerobic training in patients with T1DM. Strength training increased the maximum strength in a similar magnitude to combined training in patients with T1DM (ES: -0.114; P = .624).

CONCLUSION

Both combined training and strength training represent effective strategies for improving the maximum strength in individuals with T1DM.

Effects of resistance training on exercise capacity in elderly patients with chronic obstructive pulmonary disease: a meta-analysis and systematic review

OBJECTIVE

The objective of this study was to summarize and determine the effectiveness of resistance training on exercise capacity in patients with chronic obstructive pulmonary disease (COPD).

METHODS

We searched PubMed, EMBASE, Cochrane Library, and two Chinese databases (China National Knowledge Infrastructure and Wanfang Data) to identify articles written in English or Chinese and published from January 2000 to January 2019. Randomized controlled trials were included if they evaluated the effects of resistance training on exercise capacity in COPD patients. We assessed the quality of the trials using the Physiotherapy Evidence Database Scale. Data from these studies were pooled to calculate weighted mean difference (WMD) or standardized mean difference (SMD) with 95% confidence intervals (CI).

RESULTS

Eleven studies with a total of 405 participants met the inclusion criteria. Compared with the non-exercise control group, resistance training significantly improved 6-min walking distance (WMD, 54.52; 95% CI 25.47-83.56; I2 = 43%; P = 0.14), transfer numbers for the 6-min pegboard and ring test (WMD, 25.17; 95% CI 10.17-40.16; I2 = 0%; P = 0.55), and tolerance time for the unsupported upper-limb exercise test (SMD, 0.41; 95% CI 0.03-0.79; I2 = 0%; P = 0.83). There were no significant differences in constant work rate endurance test results or in peak oxygen uptake between the two groups.

CONCLUSIONS

Resistance training was an effective approach to improve functional exercise capacity, endurance exercise capacity, and peak exercise capacity in COPD patients.

Change in V˙O2peak in Response to Aerobic Exercise Training and the Relationship With Exercise Prescription in People With COPD: A Systematic Review and Meta-analysis

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/.

Exercise Training in Patients with Chronic Respiratory Diseases: Are Cardiovascular Comorbidities and Outcomes Taken into Account?-A Systematic Review

Patients with chronic obstructive pulmonary disease (COPD), asthma and interstitial lung diseases (ILD) frequently suffer from cardiovascular comorbidities (CVC). Exercise training is a cornerstone intervention for the management of these conditions, however recommendations on tailoring programmes to patients suffering from respiratory diseases and CVC are scarce. This systematic review aimed to identify the eligibility criteria used to select patients with COPD, asthma or ILD and CVC to exercise programmes; assess the impact of exercise on cardiovascular outcomes; and identify how exercise programmes were tailored to CVC. PubMed, Scopus, Web of Science and Cochrane were searched. Three reviewers extracted the data and two reviewers independently assessed the quality of studies with the Quality Assessment Tool for Quantitative Studies. MetaXL 5.3 was used to calculate the individual and pooled effect sizes (ES). Most studies (58.9%) excluded patients with both stable and unstable CVC. In total, 26/42 studies reported cardiovascular outcomes. Resting heart rate was the most reported outcome measure (n = 13) and a small statistically significant effect (ES = -0.23) of exercise training on resting heart rate of patients with COPD was found. No specific adjustments to exercise prescription were described. Few studies have included patients with CVC. There was a lack of tailoring of exercise programmes and limited effects were found. Future studies should explore the effect of tailored exercise programmes on relevant outcome measures in respiratory patients with CVC.

Effects of concurrent exercise training on muscle dysfunction and systemic oxidative stress in older people with COPD

Oxidative stress is associated with disease severity and limb muscle dysfunction in COPD. Our main goal was to assess the effects of exercise training on systemic oxidative stress and limb muscle dysfunction in older people with COPD. Twenty-nine outpatients with COPD (66-90 years) were randomly assigned to a 12-week exercise training (ET; high-intensity interval training (HIIT) plus power training) or a control (CT; usual care) group. We evaluated mid-thigh muscle cross-sectional area (CSA; computed tomography); vastus lateralis (VL) muscle thickness, pennation angle, and fascicle length (ultrasonography); peak VO₂ uptake (VO_2peak ) and work rate (W_peak ) (incremental cardiopulmonary exercise test); rate of force development (RFD); maximal muscle power (P_max ; force-velocity testing); systemic oxidative stress (plasma protein carbonylation); and physical performance and quality of life. ET subjects experienced changes in mid-thigh muscle CSA (+4%), VL muscle thickness (+11%) and pennation angle (+19%), VO_2peak (+14%), W_peak (+37%), RFD (+32% to 65%), P_max (+38% to 51%), sit-to-stand time (-24%), and self-reported health status (+20%) (all P < 0.05). No changes were noted in the CT group (P > 0.05). Protein carbonylation decreased among ET subjects (-27%; P < 0.05), but not in the CT group (P > 0.05). Changes in protein carbonylation were associated with changes in muscle size and pennation angle (r = -0.44 to -0.57), exercise capacity (r = -0.46), muscle strength (r = -0.45), and sit-to-stand performance (r = 0.60) (all P < 0.05). The combination of HIIT and power training improved systemic oxidative stress and limb muscle dysfunction in older people with COPD. Changes in oxidative stress were associated with exercise-induced structural and functional adaptations.

Trajectories of functional exercise capacity in patients undergoing pulmonary rehabilitation

Background: Pulmonary rehabilitation (PR) is now considered fundamental when managing patients with chronic respiratory disease. The individual variation in functional exercise capacity (FEC) response to PR within the cohort is unknown. The purpose of this study was to identify FEC patterns in response to PR in patients with chronic respiratory disease using the trajectory modeling method.

Methods: The data of 67 patients with the chronic respiratory disease were retrospectively reviewed and analyzed in this study. All patients received once-weekly supervised training for 8 weeks. Six-minute walk distance (6MWD) was used to measure FEC. Muscle strength and 6MWD were assessed at baseline, Week 4, Week 8 and monthly for two months after PR completion. Group-based trajectory modeling (GBTM) was used to identify patterns in 6MWD in response to PR. The generalized estimating equation method was then used to detect the differences within and between the trajectories of identified groups across time.

Results: Patients were grouped into low- (n=13), moderate- (n=34) and high- (n=20) FEC group based on GBTM analysis. All groups demonstrated significant improvements in 6MWD and leg muscle strength after 8-week PR. Compared to the high-FEC group, a greater proportion of the patients in the low-FEC group required oxygen supplementation during training and had worse baseline leg muscle strength.

Conclusions: Patients showed distinct patterns of 6MWD changes in response to 8-week PR. Distinct characteristics for the low-FEC group included poor lower extremity strength and a greater proportion of required oxygen use at home and during training.

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The six-minute stepper test is related to muscle strength but cannot substitute for the one repetition maximum to prescribe strength training in patients with COPD

Purpose

There are many barriers to pulmonary rehabilitation, including a limited access to evaluation centers. To cope with these difficulties, field tests are often used to prescribe endurance training. As field tests are related to muscle strength, they could also be used to prescribe strength training and increase the access to pulmonary rehabilitation in rural area. However, their validity for this purpose has never been studied.

Patients and methods

The relationship between the 6-minute stepper test (6MST), 6-minute walk test, maximal workload achieved during cardiopulmonary exercise testing (Wpeak), and one repetition maximum (1RM) was assessed in 35 patients with COPD through a retrospective chart review to derive predictive equation of the 1RM from these tests. The effectiveness of these equations to prescribe strength training at 70% of the 1RM was assessed in an independent cross-validation group of 34 patients with COPD.

Results

There was a moderate relationship between the 6MST, Wpeak and the 1RM (r=0.44 and r=0.41, respectively, both P≤0.01). Whatever the test, the prescription of strength training using the estimated 1RM compared with the measured 1RM resulted in a mean absolute difference and a mean bias of about 30 kg.

Conclusion

The use of the 6MST and Wpeak for the prescription of strength training would result in a clinically not acceptable error. Therefore, they should not be used as a substitute for the 1RM to prescribe strength training.

Effects of home-based prescribed pulmonary exercise by patients with chronic obstructive pulmonary disease: study protocol for a randomized controlled trial

BACKGROUND

Chronic obstructive pulmonary disease (COPD) not only affects pulmonary function but also leads to skeletal muscle dysfunction. The various characteristics of different forms of traditional Chinese exercise lead to inconsistent clinical effects in COPD patients. Hence, the present study carefully combined and rearranged liuzijue, wuqinxi, baduanjin, and yijinjing into a pulmonary exercise program targeting COPD patients.

METHODS/DESIGN

This study is a single-blind, randomized controlled trial. A random number table will be generated by an independent person. Each number will be placed in a sealed opaque envelop to blind assignment. All outcome assessors will be blinded to group assignment. COPD patients between 40 and 80 years of age, with stable medical treatment and no regular participation in regular exercise in the last 6 months will be included. All participants will be recruited from the Respiratory Medicine Department of Yue-Yang Integrative Medicine Hospital Affiliated to Shanghai University of Traditional Chinese Medicine. All participants will continue to follow their medical treatment. They will be randomly assigned to one of four groups in a 1:1:1:1 ratio: (1) usual care (control group, CG), (2) pulmonary exercise group (PG), (3) resistance exercise group (RG), or (4) combined pulmonary exercise and resistance exercise group (PRG). CG participants will receive medical treatment only. PG participants will perform 60 min of exercise twice a day 7 days a week for 3 months, with 1 day's exercise per week at hospital under guidance and supervision. RG participants will perform 60 min of resistance exercise once a day, three times a week for 3 months, with 1 day's exercise per week at hospital under guidance and supervision. PRG participants will perform 60 min of prescribed pulmonary exercise combined with resistance exercise for 3 months. The outcomes include the isokinetic strength of peripheral skeletal muscle, surface electromyography, 6-min walking distance, 30-s arm curl test, pulmonary function, respiratory muscle strength, dyspnea, body composition, physical activity, quality of life, and Chronic Disease Self-Efficacy Scale.

DISCUSSION

The results of this study will compensate for the current inadequate understanding of prescribed pulmonary exercise and may provide a new, simple, convenient, and effective home-based exercise intervention for COPD patients.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR-1800017405 . Registered on 28 July 2018.

Comparing the impact of different exercise interventions on fatigue in individuals with COPD: A systematic review and meta-analysis

To systematically review randomized controlled trials that compared the effectiveness of different types of exercise on the symptom of fatigue in individuals with chronic obstructive pulmonary disease (COPD). MEDLINE, EMBASE, EMcare, PsychINFO, and Cochrane library were searched from inception to October 2018. Studies were included if individuals with COPD were randomized into two or more physical exercise interventions that reported fatigue. Of the 395 full-texts reviewed, 17 studies were included. Fifteen studies reported the impact of exercise on health-related quality of life with fatigue as a subdomain. Reduction in fatigue was observed following endurance, resistance, or a combination of both exercises. There was no significant difference between continuous and interval training (n = 3 studies, pooled standardized mean difference (SMD) = -0.17, 95% CI = -0.47, 0.12, p = 0.25) or between endurance and resistance training (n = 3 studies, SMD = -0.35, 95% CI = -0.72, 0.01, p = 0.07) on fatigue in people with COPD. Fatigue reduction is not usually a primary outcome of exercise interventions, but it is frequently a secondary domain. The type of exercise did not influence the impact of exercise on fatigue, which was reduced in endurance, resistance, or a combination of both exercises, enabling clinicians to personalize training to match targeted outcomes.

Physical activity and sedentary time are related to clinically relevant health outcomes among adults with obstructive lung disease

Background

The purpose of the current study was to determine the association between sedentary time and physical activity with clinically relevant health outcomes among adults with impaired spirometry and those with or without self-reported obstructive lung disease (asthma or COPD).

Methods

Data from participants of the Canadian Longitudinal Study on Aging were used for analysis (n = 4156). Lung function was assessed using spirometry. Adults were said to have impaired spirometry if their Forced Expiratory Volume in 1 s was <5th percentile lower limit of normal (LLN). A modified version of the Physical Activity Scale for the Elderly was used to assess sitting time and physical activity levels. Healthcare use and quality of life outcomes were assessed using self report.

Results

Among those with asthma, participating in strengthening activities was associated with lower odds of reporting poor perceived health (OR = 0.65, CI: 0.53, 0.79), poor perceived mental-health (OR = 0.73, CI: 0.60, 0.88), unhealthy aging (OR = 0.68, CI: 0.56, 0.83), and reporting an emergency department visit in the past 12 months (OR = 0.76, CI: 0.60, 0.95). Among those with COPD, those who reported highest weekly sedentary time had higher odds of reporting poor perceived health (OR = 2.70, CI: 1.72, 4.24), poor perceived mental-health (OR = 1.99, CI: 1.29, 3.06), and unhealthy aging (OR = 3.04, CI: 1.96, 4.72). Among those below the LLN, sitting time (OR = 2.57, CI: 1.40, 4.72) and moderate intensity physical activity (OR = 0.23, CI: 0.09, 0.63) were associated with overnight hospital stays.

Conclusions

Higher physical activity levels and lower sedentary time may be associated with lower healthcare use and better quality of life. This research may have implications related to the use of physical activity for improving health outcomes and quality of life among adults with obstructive lung disease or impaired spirometry.

Electronic supplementary material

The online version of this article (10.1186/s12890-018-0659-8) contains supplementary material, which is available to authorized users.

Elastic Tubing Resistance Training and Autonomic Modulation in Subjects with Chronic Obstructive Pulmonary Disease

This study addresses evidence concerning elastic tubing resistance training (ET) on autonomic modulation in patients with chronic obstructive pulmonary disease (COPD). Autonomic dysfunction is common in COPD and contributes to the development of arrhythmias and sudden death. Along with autonomic dysfunction, muscle dysfunction is related to functional limitations and prognosis of the disease. This study investigated the effects of ET on autonomic modulation, muscle strength, and walking distance in COPD. Subjects were divided into two groups, ET (n = 20; 66,5 ± 8,9 y; 25,5 ± 3,5 kg/m2; FEV1/FVC: 50,3 ± 11,0) and conventional training (n = 19; 66,0 ± 6,9; 27,1 ± 4,3; FEV1/FVC: 55,05 ± 9,56). Both groups undertook 24 sessions for 60 minutes, 3 times in a week. The significance level was p ≤ 0,05. Autonomic modulation was evaluated using heart rate variability in the time (rMSSD, ms) and frequency domain (HF, ms). Strength for upper and lower limbs was measured using dynamometry and walking distance was measured using a 6-minute walking test. There were no significant differences in the outcomes between groups. There was an increment to rMSSD [(16,7 ± 11,0 versus 20,8 ± 14,9) versus (14,2 ± 10,0 versus 17,4 ± 12,1)], HF [(141,9 ± 191,3 versus 234,9 ± 335,7) versus (94,1 ± 123,5 versus 177,6 ± 275,5)], shoulder abduction [(50,1 ± 19,6 versus 56,9 ± 20,4) versus (50,5 ± 19,0 versus 56,9 ± 19,3)], knee flexion [(101,9 ± 34,0 versus 116,8 ± 43,3) versus (98,6 ± 21,5 versus 115,1 ± 30,8)], and walking test [(433,0 ± 84,8 versus 468,9 ± 90,8) versus (397,4 ± 99,8 versus 426,3 ± 101,6)] after training for ET and conventional training, respectively. In conclusion, ET improves autonomic modulation in COPD with additional benefits for strength and cardiorespiratory capacity similar to conventional training.

Immune-regulating effects of exercise on cigarette smoke-induced inflammation

Long-term cigarette smoking (LTCS) represents an important risk factor for cardiac infarction and stroke and the central risk factor for the development of a bronchial carcinoma, smoking-associated interstitial lung fibrosis, and chronic obstructive pulmonary disease. The pathophysiologic development of these diseases is suggested to be promoted by chronic and progressive inflammation. Cigarette smoking induces repetitive inflammatory insults followed by a chronic and progressive activation of the immune system. In the pulmonary system of cigarette smokers, oxidative stress, cellular damage, and a chronic activation of pattern recognition receptors are described which are followed by the translocation of the NF-kB, the release of pro-inflammatory cytokines, chemokines, matrix metalloproteases, and damage-associated molecular patterns. In parallel, smoke pollutants cross directly through the alveolus-capillary interface and spread through the systemic bloodstream targeting different organs. Consequently, LTCS induces a systemic low-grade inflammation and increased oxidative stress in the vascular system. In blood, these processes promote an increased coagulation and endothelial dysfunction. In muscle tissue, inflammatory processes activate catabolic signaling pathways followed by muscle wasting and sarcopenia. In brain, several characteristics of neuroinflammation were described. Regular exercise training has been shown to be an effective nonpharmacological treatment strategy in smoke-induced pulmonary diseases. It is well established that exercise training exerts immune-regulating effects by activating anti-inflammatory signaling pathways. In this regard, the release of myokines from contracting skeletal muscle, the elevations of cortisol and adrenalin, the reduced expression of Toll-like receptors, and the increased mobilization of immune-regulating leukocyte subtypes might be of vital importance. Exercise training also increases the local and systemic antioxidative capacity and several compensatory mechanisms in tissues such as an increased anabolic signaling in muscle or an increased compliance of the vascular system. Accordingly, regular exercise training seems to protect long-term smokers against some important negative local and systemic consequences of smoking. Data suggest that it seems to be important to start exercise training as early as possible.

Comparison of Effects of Endurance and Strength Training Programs in Patients with COPD

Comparisons between endurance and strength training in chronic obstructive pulmonary disease (COPD) patients have produced equivocal findings when examining physical function and health-related quality of life (HRQL). One reason for these differences may be due to individual patient responses to the different training modalities.

PURPOSE

To compare changes in physical function and HRQL in a group of COPD patients completing both an endurance and a strength training program.

METHODS

Eleven mildly diseased patients completed a three month endurance training program and, approximately 5 years later, completed a three month strength training program. Changes in 6 minute walk distance (6 MW), time to rise from a chair five times (CRT), and the total score and subscores from the SF-36 and Chronic Respiratory Disease Questionnaire (CRQ) were examined.

RESULTS

The forced expiratory volume as a percent of predicted remained relatively constant over the 5 years (61.1 ± 5.9 vs. 60.0 ± 10.3). Endurance and strength training increased 6 MW by 48.2 ± 11.2 (p = 0.008) and 39.8 ± 9.8 (p = 0.001) meters, respectively. Endurance and strength training decreased CRT by 4.8 ± 0.7 (p = 0.001) and 1.3 ± 1.2 (p = 0.056) seconds, respectively. Endurance training resulted in greater improvements in HRQL as compared to strength training.

CONCLUSION

These results show that walk distance improves as a result of participating in either an endurance or a strength training program. However, an endurance training program leads to greater improvements in both general and disease specific measures of HRQL.

Effects of simple long-term respiratory care strategies in older men with COPD

OBJECTIVE

To evaluate a 24-month supervised, community-based maintenance exercise program after 3 months of pulmonary rehabilitation (PR) in comparison with a 27-month physical activity counseling program, in terms of the effects on maximal muscle strength, muscle power output, and exercise capacity, in individuals with COPD.

METHODS

Sixty-three men with moderate-to-severe COPD were recruited from two previous studies. Of those 63 participants, 31 were offered 3 months of PR followed by a 24-month supervised maintenance exercise program (24MME group) and 32 were offered a 27-month physical activity counseling program (27MPAC group). Measurements at 3 months and at the end of the study period included maximal strength of the upper and lower limbs, power output of the lower limbs, six-minute walk distance (6MWD), and quality of life.

RESULTS

At 27 months, the improvements in maximal strength of the upper and lower limbs were greater in the 24MME group than in the 27MPAC group (37.6 ± 28.3% and 28.4 ± 13.3%, respectively, vs. 8.8 ± 16% and 13.6 ± 16.4%, respectively; p < 0.05), as was the improvement in power output of the lower limbs (24.6 ± 18.4% vs. -2.3 ± 28.5%; p < 0.01). The increase in the 6MWD after 3 months was also greater in the 24MME group than in the 27MPAC group (33.2 ± 36.6 m vs. 2.9 ± 34.7 m; p < 0.05), although there were no differences between the two groups in terms of the Δ6MWD at 27 months (vs. baseline).

CONCLUSIONS

A supervised, community-based maintenance program is a successful long-term strategy to preserve the benefits of PR on peripheral muscle function and exercise capacity in individuals with COPD. However, physical activity counseling can maintain maximal muscle strength and exercise capacity in such individuals.

Effects of telephone support on exercise capacity and quality of life in patients with chronic obstructive pulmonary disease: a meta-analysis

The aim of this meta-analysis was to evaluate the effects of disease education or pulmonary rehabilitation programs assisted with telephone support on physical capacity and quality of life (QOL) in chronic obstructive pulmonary disease (COPD) patients. A systematic search of PubMed, Embase, Web of Science and The Cochrane Library was conducted until May 2017. Randomized controlled trials (RCTs) examining the effects of telephone-assisted intervention versus a control group on exercise tolerance and QOL in patients with COPD were included. Two independent authors assessed the methodological quality of the trials using the Cochrane risk of bias tool. A meta-analysis was conducted with the Revman5.3 to quantify the effects of telephone-assisted interventions on walking capacity and QOL. In total, 10 studies involving 1037 participants were included. Due to the effect of telephone-assisted interventions, statistically significant results were found on Saint-George's Respiratory Questionnaire (SGRQ) symptom scores [standard mean difference (SMD) -.18, 95% confidence interval (CI) -.33, -.03, p-value .02)], SGRQ impact scores [SMD -.35, 95% CI -.60, -.10, p-value .006)], SGRQ activity scores [SMD -.30, 95% CI -.45, -.15, p-value < .0001)], SGRQ total score [SMD -.36, 95% CI -.51, -.21, p-value < .00001)]. The effects on 6-min walk test (6MWT) and all Chronic Respiratory Questionnaire (CRQ) subscales were not significant (p > .05) based on the insufficient evidence. In conclusion, the role of telephone-assisted interventions in the management of COPD remains equivocal. Some encouraging results were seen with regard to SGRQ symptom, SGRQ impact, SGRQ activity and SGRQ total score. We believe that more methodologically rigorous large-scale randomized controlled trials are necessary to answer this study question.

Reducing Anxiety to Increase Exercise in Individuals With Decreased Lung Capacity

The management of chronic disease is complex. For many diseases, the treatment for the disease may mimic disease symptoms. For example, exercise training is recommended as part of the treatment of chronic obstructive pulmonary disease (COPD). Individuals may confuse the physiological experiences related to exercise with COPD symptoms. This type of association between treatment and disease can cause anxiety. For health care practitioners to successfully motivate their patients to make the necessary behavior changes for disease treatment, anxiety must also be addressed.

Muscle strengthening activity associates with reduced all-cause mortality in COPD

Objective Emerging research suggests that aerobic-based physical activity may help to promote survival among chronic obstructive pulmonary disease patients. However, the extent to which engagement in resistance training on survival among chronic obstructive pulmonary disease patients is relatively unknown. Therefore, the purpose of this study was to examine the independent associations of muscle strengthening activities on all-cause mortality among a national sample of U.S. adults with chronic obstructive pulmonary disease. We hypothesize that muscle strengthening activities will be inversely associated with all-cause mortality. Methods Data from the 2003-2006 NHANES were employed, with follow-up through 2011. Aerobic-based physical activity was objectively measured via accelerometry, muscle strengthening activities engagement was assessed via self-report, and chronic obstructive pulmonary disease was assessed via physician-diagnosis. Results Analysis included 385 adults (20 + yrs) with chronic obstructive pulmonary disease, who represent 13.3 million chronic obstructive pulmonary disease patients in the USA. The median follow-up period was 78 months (IQR=64-90), with 82 chronic obstructive pulmonary disease patients dying during this period. For a two muscle strengthening activity sessions/week increase (consistent with national guidelines), chronic obstructive pulmonary disease patients had a 29% reduced risk of all-cause mortality (HR=0.71; 95% CI: 0.51-0.99; P = 0.04). Conclusion Participation in muscle strengthening activities, independent of aerobic-based physical activity and other potential confounders, is associated with greater survival among chronic obstructive pulmonary disease patients.

Sex Differences in Muscle Wasting

With aging and other muscle wasting diseases, men and women undergo similar pathological changes in skeletal muscle: increased inflammation, enhanced oxidative stress, mitochondrial dysfunction, satellite cell senescence, elevated apoptosis and proteasome activity, and suppressed protein synthesis and myocyte regeneration. Decreased food intake and physical activity also indirectly contribute to muscle wasting. Sex hormones also play important roles in maintaining skeletal muscle homeostasis. Testosterone is a potent anabolic factor promoting muscle protein synthesis and muscular regeneration. Estrogens have a protective effect on skeletal muscle by attenuating inflammation; however, the mechanisms of estrogen action in skeletal muscle are less well characterized than those of testosterone. Age- and/or disease-induced alterations in sex hormones are major contributors to muscle wasting. Hence, men and women may respond differently to catabolic conditions because of their hormonal profiles. Here we review the similarities and differences between men and women with common wasting conditions including sarcopenia and cachexia due to cancer, end-stage renal disease/chronic kidney disease, liver disease, chronic heart failure, and chronic obstructive pulmonary disease based on the literature in clinical studies. In addition, the responses in men and women to the commonly used therapeutic agents and their efficacy to improve muscle mass and function are also reviewed.

Effects of combined training vs aerobic training on cognitive functions in COPD: a randomized controlled trial

Aim

The aim of this study was to investigate the effects of high-intensity aerobic training (AT) and high-intensity aerobic training combined with resistance training (ie, combined training [CT]) on cognitive function in patients with COPD.

Methods

Twenty-eight Caucasian male patients (68.35±9.64 years; mean ± SD) with COPD were recruited and randomized into two groups, AT and CT. Both groups performed physical reconditioning for 4 weeks, with a frequency of five training sessions per week. The CT group completed two daily sessions of 30 minutes: one aerobic session and one strength session, respectively; The AT group performed two 30-minute aerobic endurance exercise sessions on treadmill. Physical and cognitive function tests were performed before and after the training intervention performances.

Results

Exercise training improved the following cognitive functions: long-term memory, verbal fluency, attentional capacity, apraxia, and reasoning skills (P<0.01). Moreover, the improvements in the CT group were significantly greater than those in the AT group in long-term memory, apraxia, and reasoning skills (P<0.05).

Conclusion

CT may be a possible strategy to prevent cognitive decline and associated comorbidities in male patients with COPD.