Though pharmaceutical treatments are commonly used for the management of COPD, exercise is considered to be an addition to a prescribed plan. Medications can help in relieving the symptoms of COPD, such as shortness of breath (dyspnoea), but it cannot cure the disease.

Endurance training has been shown to improve the lung function and cardiovascular health of those who are not diseased (Yerg 2^nd et al., 1985; Randers et al., 2013; Matelot et al., 2016). It may, therefore, be possible that endurance exercise can be used as a treatment method to manage the symptoms of COPD with or without the addition of standard medications.

Improvements in lung function

 A research paper from Mehri et al. (2007) measured the effect of endurance training on VO2 peak (ml/kg/min). The treatment group (TET) ran 2 times a week for 8 weeks. The control group did not participate in any exercise. The results showed that there was a significant improvement in VO2 peak in the TET group following the 8-week programme. 80% of the participants within this study had severe COPD. However, there were no other measurements of lung functionality. It is also questionable whether these effects are sustained following the end of the intervention.

Ortega et al. (2002) compared the effects of either endurance, strength training or combining the two modalities. The training was performed 2 times a week for a course of 12 weeks. They indirectly confirmed the results of the previous study by showing a significant improvement in VO2 max and maximal ventilation (V_E max) after 12 weeks of endurance training. The results showed that there was a small but significant decrease in VO2 max 12 weeks post-training. Consequently, the training may need to be continued in order to sustain the effects achieved from aerobic training for the indefinite management of COPD.

 

 

The previous two papers have highlighted and shown the potential benefits endurance training has on improving VO2 max. It is also apparent, following a study by Puente-Maestu et al. (2000), that other pulmonary function measurements may be improved following an endurance training intervention. The study measured Forced Expiratory Volume (FEV), Total Lung Capacity (TLC) and Maximal Inspiratory Pressure (MIP). Both groups were either supervised or not-supervised and completed a walking intervention 4 times a week for 8 weeks. There was a very small but significant improvement in FEV1 (FEV in one second), TLC and MIP in both groups following the intervention.

Daily tasks such as walking to the shop, going upstairs or getting up from a chair may be made easier due to the improvement in lung function and capacity provided by endurance training. Patients would need to continue the programmes indefinitely which may prove difficult following exacerbations or during periods of decreased motivation.

Health-Related Quality of Life

Quality of life is paramount when suffering from COPD. A chronic condition which deteriorates your lung function over time will have physical and psychological effects. Therefore, it is essential to study the effects of endurance training on quality of life.

Daabis et al. (2017) studied the effects of endurance training on health-related quality of life (HRQL) following endurance, strength or combined training interventions. They used St Georges Respiratory Questionnaire for COPD patients (SGRQ-C) and the modified Medical Research Council dyspnoea scale (mMRC dyspnoea scale) for HRQL. These are commonly used in the assessment of physical and mental quality of life. The endurance intervention demonstrated a significant reduction in mMRC and SRGQ. Though Daabis et al. (2017) showed a significant improvement in HRQL, the endurance group performed treadmill exercise combined with free weights (high repetitions and low weight). This may have influenced the outcome of the results versus performing treadmill training alone. Additionally, though there was an improvement, there were no specifications on which aspects of HRQL was improved.

Ortega et al. (2002) also measured HRQL aspects of endurance training within the same paper. They used the Baseline Dyspnoea Index and Chronic Respiratory Questionnaire (CRQ). Following 12 weeks of endurance training, there was a significant improvement in Baseline Dyspnoea Index score; through the magnitude of the task, magnitude of effort and functional impairment. In addition, the fatigue, emotion and dyspnoea aspects of the CRQ were also shown to be significantly greater following the endurance intervention.

These two papers exhibit evidence that endurance training can improve certain aspects of HRQL. No other aspects of HRQL were measured, therefore it is not certain that all aspects of HRQL can be improved.

Exacerbations and recovery

Exacerbations of COPD decreases lung function (Donaldson et al., 2008; Halpin et al., 2012) and therefore an endurance programme may be impossible to prescribe. This type of intervention may aid in recovery and reduce the number of admissions due to exacerbations.

Kirsten et al. (1998) measured the effect of a short-term exercise intervention in patients with severe COPD following an acute exacerbation. The training group walked as far as possible in 6 minutes and performed five self-controlled walking sessions per day in the hospital corridor. This was performed for 11 days. The control group did not perform any exercise. Both groups received their usual medication through the intervention. Following the programme, there was a significant improvement in lung function measurements compared to the control. This includes Vital Capacity (VC), Residual Volume (RV) and Inspiratory Capacity (IC). Other parameters such as breathing frequency, minute ventilation (VE), heart rate (HR), Partial Pressure of Oxygen (PaO2) and Carbon dioxide (PaCO2) also improved following exercise versus the control.

This paper demonstrates the possible effectiveness of short-term endurance exercise interventions on recovery following an acute exacerbation. However, continual medical treatment without exercise, including physiotherapy and other hospital-based modalities may warrant a good recovery. The inclusion of endurance exercise to aid in recovery would need to be prescribed individually due to the different abilities of patients after an exacerbation.

 

 

This recent research presents evidence to suggest that both the functional deficit and decreased quality of life experienced when suffering from COPD can be improved. There are few papers measuring exacerbation admission and endurance training. Consequently, we could estimate that those who regularly perform endurance exercise may experience a smaller decrease in lung function or a decrease in hospital admissions due to COPD exacerbations. Individuals with COPD who are physically inactive may be predisposed to a greater amount of hospital admissions or a larger decrease in quality of life compared to those who are active.

 

Written by: Conor Goldsmith (17802824)

Reference list:

Daabis, R., Hassan, M., Zidan, M. (2017). Endurance and strength training in pulmonary rehabilitation for COPD patients. Egyptian Journal of Chest Diseases and Tuberculosis. 66 (2), p231-236. https://doi.org/10.1016/j.ejcdt.2016.07.003

Donaldson, GC., Seemungal, TA., Bhowmik, A., Wedzicha, JA. . (2002). Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax. 57 (10), p847-852. http://dx.doi.org/10.1136/thorax.57.10.847

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Mehri, S., Khoshnevis, S., Zarrehbinan, F., Hafezi, S., Ghasemi, A., Ebadi, A. (2007). Effect of Treadmill Exercise Training on VO2 Peak in Chronic Obstructive Pulmonary Disease. National Research Institute of Tuberculosis and Lung Disease, Iran. 6 (4), p18-24.

Ortega, F., Toral, J., Cejudo, P., Villagomez, R., Sanchez, H., Castillo, J., Montemayor, T. (2002). Comparison of Effects of Strength and Endurance Training in Patients with Chronic Obstructive Pulmonary Disease. American Journal of Respiratory and Critical Care Medicine, [e-journal] 166 (5), p669-674. https://doi.org/10.1164/rccm.2107081

Puente-Maestu, L., Sanz, ML., Sanz, P., Cubillo, JM., Mayol, J., Casaburi, R.. (2000). Comparison of effects of supervised versus self-monitored training programmes in patients with chronic obstructive pulmonary disease. European Respiratory Journal. 15 (3), p517-525.

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