You are on page 1of 8

Copyright #ERS Journals Ltd 2002

Eur Respir J 2002; 20: 12–19 European Respiratory Journal
DOI: 10.1183/09031936.02.01152001 ISSN 0903-1936
Printed in UK – all rights reserved

Interval training as an alternative modality to continuous exercise
in patients with COPD

I. Vogiatzis, S. Nanas, C. Roussos

Interval training as an alternative modality to continuous exercise in patients with National and Kapodistrian University
COPD. I. Vogiatzis, S. Nanas, C. Roussos. #ERS Journals Ltd 2002. of Athens, Medical School, Dept of
ABSTRACT: Understanding of what constitutes a training load adequate to induce Pulmonary and Critical Care Medi-
training effects in patients with chronic obstructive pulmonary disease (COPD) is still cine, Cardiopulmonary Rehabilitation
Centre, Eugenidion Hospital, Athens,
evolving. The present study investigated whether interval training (IT) is effective in Greece.
terms of inducing measurable improvements in physiological response and compared its
effects on exercise tolerance (ET) and quality of life to those of continuous training Correspondence: I. Vogiatzis, National
(CT). & Kapodistrian University of Athens,
Thirty-six COPD patients, with a forced expiratory volume in one second of 45¡4% Medical School, Dept of Pulmonary
of the predicted value (mean¡SEM), were randomly assigned to CT (exercise at 50% of and Critical Care Medicine, Eugeni-
baseline peak work-rate) or IT (work for 30 s at 100% of peak work-rate alternating dion Hospital, 2nd Floor, 20 Papan-
with 30-s rest intervals) groups that cycled 40 min?day-1 and 2 days?week-1 for 12 diamantopoulou Str. 115-28, Ilisia,
Athens, Greece.
weeks. Fax: 30 107242785
After training, both groups showed significantly improved ET (IT, 57¡6 to 71¡8 W; E-mail: vogiatzis@hotmail.com
CT, 57¡5 to 70¡6 W) and total quality-of-life score of the Chronic Respiratory
Disease Questionnaire (IT, 77¡3 to 88¡2; CT, 78¡3 to 93¡2). At identical levels Keywords: Chronic obstructive pul-
of exercise, minute ventilation was significantly reduced (IT, 35.8¡2.5 to monary disease, dyspnoea, exercise
31.7¡2.5 L?min-1; CT, 36.4¡2.7 to 32.5¡2.7 L?min-1). The magnitude of improvement tolerance, interval training
in these variables was not significantly different among groups.
The present data expand on the principles of exercise prescription for chronic Received: July 31 2001
obstructive pulmonary disease patients by demonstrating that interval training elicits Accepted after revision: December 26
2001
substantial training effects, which are similar in magnitude to those produced by
continuous training at half the exercise intensity but double the exercise time. This study was supported by a grant
Eur Respir J 2002; 20: 12–19. from the Greek General Secretariat for
Research and Development.

Dyspnoea associated with insufficient mechanical PWR) exercise for either the entire duration [5] or
ventilatory reserve [1] and skeletal muscle dysfunc- several weeks of the rehabilitation programme [6].
tion [2] are the principal factors that limit exercise A well-established alternative strategy that allows
tolerance in patients with chronic obstructive pulmo- high-intensity exercise to be performed for a relatively
nary disease (COPD). There is currently a compelling long period is interval training (IT), i.e. repeated
body of evidence that exercise training induces con- periods of maximal or high-intensity exercise alter-
siderable physiological effects and improves measures nating with corresponding short intervals of rest.
of exercise tolerance; as such it represents a corner- Early studies in healthy subjects showed that more
stone of the interdisciplinary management of COPD work can be performed before exhaustion sets in by
patients in pulmonary rehabilitation [3]. exercising with intervals than when the same total
High-intensity continuous exercise training (80% amount of work is performed continuously [7–9].
of baseline peak work-rate (WR) (PWR)) has been GOSSELINK et al. [10] and COPPOOLSE et al. [11]
shown by CASABURI et al. [4] to be superior to low- examined the effects of IT on measures of exercise
intensity exercise (50% PWR) when the same total tolerance and compared its efficacy to that of
work is performed by two groups of patients char- continuous exercise in COPD patients. These studies
acterised by moderate airflow limitation (forced revealed no significant differences between the two
expiratory volume in one second (FEV1) 56% of the training modalities in terms of improvement in
predicted value). Further studies, by MALTAIS et al. [5] exercise tolerance. Interestingly, the study of
and CASABURI et al. [6], however, reported that the COPPOOLSE et al. [11] reported that IT did not induce
majority of patients characterised by severe airflow a reduction in ventilatory demand at a given exercise
limitation (FEV1 38 and 36% pred, respectively) were level. Furthermore, in the nonrandomised study of
not able to sustain prolonged high-intensity (80% GOSSELINK et al. [10], the most severe patients were
assigned to the interval group, whereas, in the
For editorial comments see page 4. randomised trial of COPPOOLSE et al. [11], patients

followed by Height cm 166¡2 167¡2 2 min unloaded pedalling. Germany) according to recommended and 3) no clinical evidence of exercise-limiting cardio. pulmonary function and (MVV) was estimated by multiplying the FEV1 by exercise capacities of patients at the outset of the study 40 [13]. tidal volume (VT). the patients met the selection criteria.CO % pred 58.4 55.3¡5. lessness and quality of life (QoL) in patients with patients were randomly assigned. Copenhagen.16¡0. parallel two-group study. Sensor Medics). pred) and PWR (f or w70 W) as assessed by ramp- and. in the modalities on exercise tolerance.41¡0. Jaeger.O2). to investigate whether a training programme or continuous.11 to the limit of tolerance on an electromagnetically % pred 64.06 7. Spirometry for the deter- FEV1 v60% pred and FEV1/forced vital capacity mination of FEV1 and FVC was performed in the (FVC) v65% without significant reversibility (v15% sitting position using a spirometer (Masterlab. % pred: breath every 2 min using the 0–10 Borg category ratio percentage of the predicted value. It is. In addition. (1 mmHg=0.17¡0. intensity of breath. INTERVAL VERSUS CONTINUOUS EXERCISE IN COPD 13 assigned to IT received a combination of high.133 kPa. fC: cardiac frequency. carbon dioxide tension. Radiometer.CO2 mmHg 40¡2 41¡1 frequency of o50 revolutions per minute for 30 s. LT: on-line electrocardiogram and Sa.78¡0. Subjects were also asked to rate shortness of oxygen saturation measured by pulse oximetry.24¡0.6¡3. the patients were clinically stable and met the following criteria: 1) postbronchodilator Pulmonary function tests. Within each stratum. Cardiac frequency (fC) was diffusion capacity of the lung for carbon monoxide. PWR was defined as the highest Pa. therefore.8 braked cycle ergometer (Ergoline 800. CA. Maximum voluntary ventilation Table 1. Pulmonary gas exchange and ventilatory Peak V9O2 L?min-1 1.43¡0.05 0.6 52.81¡0. minute ventilation (V9E).and Study design low-intensity sessions.06 1.).02 Patients breathed through a mouthpiece with a nose Peak work-rate W 57¡6 57¡5 clip in place.O2: arterial (Sp. FEV1: forced expiratory ratio. Stratified randomisation was used to that consisted of maximal-intensity interval exercise achieve approximate balance of the important char- sessions could be effective in terms of inducing acteristics (table 1). entering the study.1 Anaheim. Arterial blood was drawn by puncture of the radial artery at rest while breathing room air for Interval group Continuous group the analysis of arterial oxygen tension (Pa. were compared with those of JONES [15].5 mmHg. Sp.O2 mmHg 71¡2 71¡2 work level reached and maintained at a pedalling Pa.O2: determined using the R-R interval from a 12-lead arterial oxygen tension. beats?min-1 128¡4 122¡4 The following variables were recorded breath by Peak Sp. V9O2: oxygen uptake.13 2.4¡3.8¡2. scale [14]. Methods Outcome measurements Patient inclusion criteria Within 1 week before and after the end of the Thirty-six outpatients with COPD defined as training programme. DL. FVC: forced vital capacity.7¡3. probable that the effectiveness of IT in these two studies. Lung diffusion capacity for carbon vascular or neuromuscular diseases.O2 by pulse oximetry lactate threshold.CO2: arterial carbon dioxide tension. Arterial pH 7. monoxide (DL.4¡2. Peak fC. Age yrs 67¡2 69¡2 Weight kg 77¡3 76¡3 Cycle ergometer test. health and safety. change in initial FEV1).O2) and pH Males/females n 14/4 16/2 (ABL330. patients visited the laboratory moderate to severe using American Thoracic Society for a half-day session and performed pulmonary criteria were referred to the rehabilitation programme function and cardiopulmonary exercise tests on the by their attending chest physicians (table 1). The peak V9O2 of the ramp-incremental test 1 kPa=7. to compare the effects of the two incremental cycle ergometer test (see below).13¡0. All patients gave moderately severe COPD.8 65. both in The study was designed as a randomised controlled absolute terms and relative to continuous exercise.2¡5. Wu¨rzburg. including FEV1 (f or w50% measurable improvements in physiological response. oxygen saturation (Sa. Pa. USA). Prior to cycle ergometer.04 and a mass flow sensor (Vmax 229. techniques [12].5 36.CO: respiratory frequency (fR). pulmonary carbon dioxide output (V9CO2). they were randomly present study was designed with a two-fold purpose: assigned to one of the two training modalities: interval first. each subject performed a FEV1 L 1.5 Peak V9E L?min-1 35. V9E: minute ventilation.4¡3.09¡0.7 signals derived from rapidly responding gas analysers LT L?min-1 0. respiratory exchange Data are presented as mean¡SEM. Once it was verified that the might have been underestimated. and volume in one second.9 44. . 2) optimised medical therapy. DL. Pa.09 1.09 % pred 45.CO) was determined via the single- breath method. informed consent and the protocol was approved by the Institutional Research Review Panel of Eugeni- dion Hospital on issues of ethics.8¡3. After a 2-min rest. Sensor Medics. Therefore.O2). continuous (CT) and IT groups.6 ramp-incremental (1-min increments of 5 or 10 W) test FVC L 2.7¡4.06 variable measurements were obtained from calibrated % pred 54. secondly.06¡0.O2 % 94¡1 92¡1 breath: pulmonary oxygen uptake (V9O2). Denmark). – Physical characteristics.

The percentage Quality of life. breathing control and relaxation techniques. In summary. Both groups of patients adhered to their exercise during the second and third months. Osaka. QoL was measured using the Chronic difference in physiological variables before and after Respiratory Disease Questionnaire (CRDQ) devel. The level of significance was set Rehabilitation programme at pv0. Ltd. Peak V9O2 designed to equate to the work that these patients averaged 54. relative to peak exercise capacity and should parallel the improvement in physical status throughout the exercise programme [19–21]. the total exercise time and amount of work test is also presented in table 1. EC1600. Exercise prescription Patient characteristics The exercise prescription was designed to present patients with the same overall training load. Supervision 88¡4% for the CT group. respectively. VOGIATZIS ET AL. weekly frequency and total duration as between the study groups (table 1).05. 36 completed the rehabilitation programme. lactate threshold (LT) occurred [16]. Examination of the groups9 during exercise sessions was conducted by physical mean training intensities for each week of the pro- therapists and involved measurements of fC. Therefore.4% pred in the IT group and 55. The V-slope the IT group and four in the CT group because of technique was used to detect the V9O2 at which the exercise-induced oxygen desaturation (Sp. airflow limitation (FEV1 y45% pred). Nine patients failed to complete psychological support on issues relating to chronic the programme because of intercurrent pulmonary disability (administered by a psychiatrist).4 kPa) without CO2 retention at to 50% of baseline PWR for 40 min?day-1 and rest and a moderately reduced DL. using the Borg scale. disease education and instruction A total of 45 patients were initially enrolled. interspersed with 30 s rest. logist). dietary advice (given by a dietician). moderate hypo- Japan) at an intensity which was initially equivalent xaemia (Pa. Between- the rehabilitation programme. 1). Identification of the LT was made blindly and independently by two observers on both pre.O2 9. exercise done per session by each member of the IT group was tolerance was substantially impaired. Furthermore.8¡3. Specific infection or noncompliance with the training schedule. Of in the use of medication (performed by a pneumo. respectively. no the CT group but at an intensity that was initially changes were observed in these characteristics after equivalent to 100% of baseline PWR with 30 s work training in any of the groups. methods Patient recruitment of clearance of pulmonary secretions (performed by physical therapists). The attendance rate at the 60 and 70% and 120 and 140% of the baseline PWR exercise sessions averaged 90¡4% for the IT group and in the CT and IT groups. One of the training principles [18] requires that 80¡7 and 82¡7% of the predicted MVV for the IT and exercise intensity should be optimally maintained CT groups. after checking for normal distribution. written instructions in the form of a booklet were Five of these had been assigned to the IT group and given to patients in order to enable them to practice four to the CT group. it was decided Training programme to increase the training intensity by an equal mag- nitude in both groups on a monthly basis so that. Patients The general characteristics of the two groups before assigned to the CT group were instructed to exer. the slope of V9O2/WR was calculated. The within- oped by GUYATT et al. significantly different from those of the remaining patients. Supplemental oxygen amount of work was performed in the two types of was used during training sessions for two patients in training (fig. Data are presented as mean¡SEM. The mean programme intensity of the .O2v90%). Patients assigned to the Resting pulmonary function characteristics after IT group were instructed to exercise for the same randomisation did not show significant differences period of time.5% pred in the CT group. Their characteristics were not upper body and breathing exercises at home. Therefore. The questionnaire was and between-group differences were analysed using administered within 1 week before and after the end of repeated measures analysis of variance. at the outset of The baseline response to the incremental exercise the study.. these. it represented regimens reasonably well.CO (y55% pred). Peak V9E amounted to group. and 18 in each group.O2 and gramme revealed that approximately the same total dyspnoea.7¡ would have done had they been assigned to the CT 3. Sp. Cat Eye Co. The rehabilitation programme was multidiscip- linary and included two different modalities of Results supervised exercise training (continuous or interval).and post-training exercise data Statistical analysis sets. the cise on electromagnetically braked cycle ergometers groups were characterised by moderately severe (Cateye Ergociser. training are presented in table 1. 2 days?week-1 for 12 weeks. group comparisons of baseline characteristics were carried out using an unpaired t-test.14 I. As expected. training interventions were calculated. [17].

the V9O2 at which 120 ll the LT occurred (detected before and after training l l lll in 14 out of 18 patients in both training groups) 100 l significantly increased in the IT and CT groups by l 0. V9O2 (IT. Discussion IT group (124¡3% PWR) was approximately double The present study demonstrates that a training that of the CT group (67¡1% PWR). 4).12 L?min-1 Dyspnoea Borg scale (13%)). respectively. 1. – a) Group training intensities sustained during the training not significantly different between the two groups sessions each week of the programme. fR. fR (IT. For each patient. fC programme consisting of maximal-intensity interval response was similar between the two groups. peak physiological measurements at the WR attained at the end of 40 tolerable exercise in the baseline ergometer test were compared to measurements at an identical WR during b) the outcome test. in the light of the shift in the V9O2/WR relationship. 60 and fC (fig. 80 These changes were accompanied by trends of improvement in the peak values of V9O2. PWR: peak work-rate. Significant mean reductions in V9E 6 (IT. CT.13 L?min-1 (12%)).and post-training CRDQ l l l l ll questionnaire scores are presented in figure 4. 2). both groups were well lessness.9 L?min-1 (11%)). 2). 1. there was a significant improve- 100 ment in the CRDQ overall score in both groups (IT. CT.7 (41%)) and fC (IT. The magni- tude of improvement in these parameters was not 2 ll l llll significantly different between the two groups. at pretraining V9O2. there were no significant changes in the recorded variables. the comparison of the effects of matched with respect to mean peak exercise responses maximal-intensity IT versus moderately intense CT on . respectively (fig. by 9 and 12 W (16 and 20%). l l l l lll l l lll ll 10 beats?min-1 (8%)) were found (fig. 11 (14%).12 L?min-1 (14 and 15%). including reductions in both ventilatory requirement and sense of breath- At the outset of the study. pre.9 (42%). 15 (19%)). 0. 3. CT. respectively. After training.11 and 0. dyspnoea score (IT. 3). l lll l respectively (fig. Training intensity % baseline PWR whereas the slope of V9O2/WR was significantly 140 l l llll l ll l reduced by 12 and 9% in the IT and CT groups. Furthermore. b) dyspnoea scores (Borg scale) and c) cardiac frequency (fC). fC beats·min-1 120 Quality of life l ll l l l Differences between pre. There 110 l ll ll l were no significant differences between the two groups l l ll l at the outset of the study. After the end of the training programme. The magnitude of improvement was Fig. Following completion of the programme. 1.5 and 2 points. Furthermore. CT. 5 breath- 4 ll l s?min-1 (15%)).and post-training measurements at the same metabolic (V9O2) level were compared in 0 both groups. 0. #: continuous training group). CT. respectively) [17]. a) PWR was significantly increased by 14 and 13 W 160 (25 and 23%) in the IT and CT groups. 5 breaths?min-1 (16%). 2.e. Furthermore. c) with the exception of WR. 4. 40-min training session ($: interval training group. 13 beats?min-1 (10%). CT. which was significantly 130 higher. 2). The improvements were accompanied by physiological and exertional changes Incremental exercise test at a given level of exercise. 0. exercise tolerance and QoL. Furthermore. V9E.01). V9CO2 (IT. over the last 5 min of each (fig. CT. Data are presented as mean¡SEM.12 L?min-1 (11%). whereas exercise sessions as part of pulmonary rehabilita- perception of dyspnoea was significantly lower during tion yields substantial improvements in measures of interval training (pv0. in the IT and CT groups. 0. Patients in both groups 1 5 9 13 17 21 25 showed clinically significantly improved scores for the Training session domains of dyspnoea and fatigue (i. INTERVAL VERSUS CONTINUOUS EXERCISE IN COPD 15 (table 1).1 L?min-1 (11%).10 L?min-1 (11%).

a) 45 b) * * 30 * * * ∆ response % 15 * 0 -15 * * * * * * * * * * * * -30 -45 * * PWR V'O2 V'CO2 V'E fR fC dysp.: end-exercise dyspnoea score. exercise tolerance. LT V'O2/ WR WR Parameter Parameter Fig.05 mastery and emotional function) scores produced by interval within group. 0 Fig. [11]. – Change from baseline (D) of Chronic Respiratory Disease dioxide output. The significant training-induced increase in LT is probably 25 * * 20 18 * 15 ∆ response % 10 * ∆CRDQ score 12 5 * 0 * -5 6 * * -10 WR V'CO2 V'E VT fR dysp. *: pv0. VT: tidal volume. The magnitude of improvement in PWR in the IT The necessity to investigate the efficacy of IT group (25%) is comparable to that described by derives from the fact that ventilatory response dyna. V9E: minute ventilation. [10] and COPPOOLSE et al. WR: work-rate.: end-exercise dyspnoea score.05 within group. training (u) and continuous training (h). suggesting that the relief latory requirement is multifactorial and relates to intervals between bouts of hard work in IT bear improved oxidative capacity [4. from 12 reported randomised controlled trials [3] is Studies in healthy people have shown that repeated the lack of significant improvement in recorded peak maximal-intensity exercise bouts. 2. can be the present results differ importantly from those of tolerated for an extensive period [7] and yield similar COPPOOLSE et al. altered breathing pattern [6] and/or improved work efficiency [26]. V9E: minute ventilation. 2). [11] in that patients assigned to the physiological benefits to extended high-intensity con. fatigue. 3. Questionnaire (CRDQ) total score and domain (dyspnoea. . cardiovascular and respiratory responses. *: pv0. interval group demonstrated a reduction in ventila- tinuous exercise [22. 23]. V9CO2: carbon Fig. consistent with their and previous results patients with moderately severe and severe COPD [1]. In mics constrain tolerance to high-intensity exercise in addition. GOSSELINK et al. 25].05 within group. LT V'O2/ PWR V'O2 V'CO2 V'E fR fC dysp. sponding short rest intervals between bouts. h) and at an identical work-rate (WR. dysp. V9O2/WR: slope of V9O2/WR. of a very similar magnitude. However. piratory frequency. *:pv0. VOGIATZIS ET AL. sense of breathlessness and QoL special importance with regard to the successful revealed that both modalities induced improvements application of maximal-intensity training. as shown in tory requirement and dyspnoea scores in response to healthy individuals [24]. 4. V9O2: oxygen uptake. fR: respiratory frequency. the metabolic response to identical levels of exercise in the incremental exercise interval exercise is very similar to that to continuous tests (fig.16 I. fR: res. LT: lactate threshold. – Difference (D) in recorded responses before and after Total Dyspnoea Fatigue Mastery Emotional training at pretraining oxygen uptake (V9O2) level during the function incremental cycle ergometer test produced by interval training (u) and continuous training (h). u) from initial PWR exercise during the incremental cycle ergometer test produced by a) interval training and b) continuous training. allowing corre. – Difference (D) in physiological responses at baseline peak work-rate (PWR. V9CO2: carbon dioxide output. dysp. Furthermore. fC: cardiac frequency. It is likely that the reduction in venti- exercise at half the WR.

This concept compare to training at 80% of maximum rather than has at least two important implications with regard . 22]. which fall within the range of a rehabilitation programme. A significant ensure high rates of attendance. fR. [10] and COPPOOLSE et al. 3). [1] showed that the highest level of reduce thoracic gas entrapment and the rate of continuous exercise that could be sustained for a expiratory muscle recruitment and result in decreased relatively long period of time (20 min) was equivalent work of breathing and exertional breathlessness [26]. the possibility have shown that the physiological responses to CT at of a more efficient breathing pattern and decreased either 70% [22] or 80% [21] of peak exercise capacity hyperinflation following IT cannot be excluded. Therefore. and intensity remained unchanged. improvement in overall CRDQ score was comparable patients who were assigned to the interval group in both groups is important. as fitness training load of each group was gradually increased level improved and WR increased.e. similar degree of reduction in breathlessness. The magnitude of reduction in the chronic obstructive pulmonary disease patients above variables confirms the results of the studies of MALTAIS et al. 27]. Further. total work output during the training period The most interesting feature of the present investi- was kept constant without being regularly adjusted gation was the almost exact replication of results to parallel the improvement in physical fitness and following two different training methods in patients thus to maintain relative training intensity constant with moderately severe COPD. [11] regarding the efficacy of IT less dyspnoea. 3) the training load (i. since the CRDQ Nevertheless. 3). Early studies in healthy subjects oxygen extraction [4. fC did not increase significantly during the and disease severity were equated. as well as the total duration of the GOSSELINK et al. As can be seen in figure 2. Furthermore. 2). In addition. [6] who applied Interval exercise allows work of maximal intensity either moderate (50–60%) [5] or high-intensity (80%) to be performed with a relatively low perception of [6] continuous exercise training. In the present study. The finding that the the prescription of interval exercise. Both training study [29] and in view of the cost. 1). when the total workload was at an identical WR during the incremental ramp test equated per training session. based on the results of a previous between the two training groups. were extrapolated to improved QoL. Most notably. as evidenced by the significant change in inducing physiological changes is possibly due to in score for this domain. 28] and confirmed by the IT and CT modalities would be found. would be expected to NEDER et al. patient compliance issues involved when conducting ment in PWR. shown by the reduction in the differences in the magnitude of improvements between slope of V9O2/WR (fig. the absence of significant changes in physiological The improvements in measures of exercise tolerance variables at a given metabolic (V9O2) level (fig. mean were not significantly different to those of IT at 100% fR was significantly lower and VT marginally higher of peak work capacity. fC and dyspnoea scores decreased by a significant amount and to a Potential implications for training prescription in comparable degree. dyspnoea (fig. [11] in programme. INTERVAL VERSUS CONTINUOUS EXERCISE IN COPD 17 indicative of improved efficiency of peripheral muscle 50% of maximum. demonstrated objective improvements in domestic The discrepancy between the present study and that function. at a given metabolic (V9O2) rate. that CT and IT produce nearly identical responses. 1) by the introduction of properly It might be wondered how the 100% IT would spaced short exercise and rest periods. it would be expected that no significant mechanical efficiency. However. It is highly likely that increase in LT occurred as a result of training in both a higher weekly training frequency would have been groups. The investigators [19. especially when it is received only nine blocks of 1-min high-intensity (90% considered that both groups experienced very similar PWR) exercise which were alternated with nine blocks physiological training effects accompanied by a of 2-min low-intensity (45% PWR) exercise. to perform after rehabilitation (fig 4). 28]. the relative exercise but remained fairly comparable for both groups. resource effort and modalities resulted in similar percentages of improve. in patients (fig. patients in both groups questionnaire overall score increased in both groups were able. during the trial: 1) the initial level of exercise capacity ing. 22] is the lack of significant differences [3–6. and CT groups. [5] and CASABURI et al. 11. The results at identical WRs during the response to identical levels of exercise as shown above incremental WR tests corroborate the PWR tests in but also at a given metabolic (V9O2) level. number of researchers in order to secure adequacy tions [21. 2) [26. respectively. was within the range advocated by a patients with COPD and others on healthy popula. The reduction in fR by 16 and 15% in the IT with moderate airflow obstruction (FEV1 46% pred). it was decided to limit improvement normally reported (15–30%) for CT [3] training frequency to twice weekly in an attempt to and IT programmes [10. In their study. to 82% of PWR. patients external work at a higher rate (fig. 2) the exercise training period (fig. 20]. more. being able to perform daily activities with of COPPOOLSE et al. Notwithstand. 21. providing that patients It is also likely that the reduction in ventilatory assigned to the CT group in the present study were requirement following IT is associated with a reduced able to sustain high-intensity (80% of baseline PWR) metabolic requirement and recruitment of active exercise for 40 min from the beginning of the pro- muscle mass [20] and hence an improvement in gramme. V9E. after training. suggesting that muscle oxidative capacity was more effective in terms of inducing measurable enhanced regardless of the type of training that was improvements in physiological responses not only in applied. suggesting that. intensity and duration of Consistent with the results of the studies of training sessions). the training intensity attribute this to the following variables controlled progressively increased in each patient.

In: Exercise Physiology. Int Z Angew American Thoracic Society and European Respiratory Physiol 1971. standardization of spirometry – 1987 update. 1988. The authors wish to 12. Eur J Appl Physiol 1979. Cunningham DA. A statement of the on maximum aerobic power output. Townsend M. Hedman R. pp. N. Filathidaki. Epler GR. M. Am J Respir rehabilitation programmes. 37: 83–92. Society. The training stimulus: the 2. Juthong S. Sparks KL. Patessio A. Burns MR. Whipp. physiologically based principles of exercise prescrip. Chest1997. Eur Respir J 1998. Jones PW. Physiologic benefits of the acute load on respiration may not exceed the limits exercise training in rehabilitation of patients with of their reduced capacity. Am the COPD patient. Casaburi R. Donner continuous and interval training in women and men. Rovina. 12: research is required to evaluate the efficacy and Suppl. it may explain why patients Rev Respir Dis 1991. Sakelariou. choose the optimal length of exercise and rest periods. 42: 773–778. 22. Company. Schols AMWJ. 2s. Cooper CB. In: Clinical thank S. 27: 174–178. 96: AACVRR evidence-based guidelines. Katch FI. Ch. As understanding of what 10. Saltin B. 136: 1285–1298. Med 2000. K. 159: S1– 20. The nature of the S40. Baarends EM. American Thoracic Society Kastanakis. Beaver WL.A. Stringer WW. Determi. 155: 555–561. References Chambers LW. M. the present investigation provides and continuous running. Coppoolse R. further endurance training (abstract). Troosters T. Am J Respir Crit Care Med 2001. thank doctors (V. used training strategies. with chronic obstructive pulmonary disease. Mablekou) Respir Dis 1987.18 I. Lea and Febiger. Eur Respir J 1999. Psychophysical bases of perceived exer- tive pulmonary disease patients inspired the tion. and staff of the physiotherapy and dietetics 13. Pulmonary rehabilitation: joint ACCP/ to one-legged exercise. present investigation. departments (D. As long as they are free to Crit Care Med 1997. K. Knibbs AV. Lam WK. 50: not only an additional perspective of the conventional 269–287. A new method for detecting anaerobic threshold by gas exchange. Med Sci Sports Exerc 1982. ACCP/AACVPR 289–305. J Appl disease but also endorses the benefit of commonly Pysiol 1969. O. Robinson S. et al. Nazar K. Acta Physiol Scand 1960. 1. Jones NJ. Casaburi R. Clausen JL. Astrand PO. both muscle strength and oxygen-transporting organs Intermittent muscular work. 6. Ward. 243–247. 17.J. Fox EL. Davies CTM. The 3rd Edn. American Association vascular response to interval and continuous exercise of Cardiovascular and Pulmonary Rehabilitation. Pentaraki. peripheral and central adaptations 3. First. it is possible to severe chronic obstructive pulmonary disease. benefits of interval training in chronic obstruc. severe COPD: a randomized clinical trial. Porszasz J. Chuaychoo B. Am J Respir Crit Care 393–416. D. Eddy DO. Anonymous. University of Glasgow. CF. Guyatt GH. 18. 19. Maltais F. Anonymous. in spite of a reduced 5. training in COPD patients: interval training vs. Costill DL. Am select the proper load and exercise and rest periods in J Respir Crit Care Med 1997. McArdle WD. Acta Physiol Scand 1960. 16. Skeletal muscle dysfunction in chronic effects of intensity duration and frequency of efforts obstructive pulmonary disease. Neder JA. Malvern. training response. in women. Decramer M. 112: 1363–1396. (typically exercise bouts of f30 s) [30]. Hedman R. Jobin J. Acknowledgements. Philadelphia. Intensity of capacity for work. Fox EL Cohen K. Wiegman DL. Specificity of . to how pulmonary rehabilitation might be given to in patients with chronic obstructive lung disease. the applicability of different interval-based exercise 11. Johnson RO Jr. pp. Wasserman K. Gosselink R. Normal standards. The effects of 4. for Exercise Testing. Intermittent In conclusion. Training nants of the exercise endurance capacity in patients anaerobic and aerobic power. 60: 2020–2027. Kassiotis. without significantly mobilising anaerobic processes 48: 448–453. Crapo RO. LeBlanc P. acidosis and ventilation as a result of exercise training 23. American 21. J Appl Physiol 1986. Secondly. Carithers ER. siological training effects is still evolving. Whipp BJ. Exercise constitutes a training load adequate to induce phy. 162: 497–504. Sideri. Acta Physiol Scand 1976. Ioli F. Hankinson JL. Astrand I. Am J Respir Crit Care Med 1999. Whipp BJ. The authors also wish to 15. McCrimmon D. power-duration relationship. The authors obstruction on exercise capacity and breathing reserve wish to acknowledge B. Berman LB. such a manner that the main demand is centred on 7. Christensen EH. Vlach LF. 8. Saltin B. 155: 1541–1551. Reductions in exercise lactic Eur J Appl Physiol 1977. University in COPD. Karmaniolas and P. Hanen JE. Borg GAV. Pugsley SO. Am Rev Papazahou. Nery LE. can remain in jobs involving heavy training and physiologic adaptation in patients with manual labour or successfully participate in exercise chronic obstructive pulmonary disease. W. 9. A measure of quality of life for clinical trials in chronic lung disease. Interval versus continuous training in patients with protocols. Saunders helpful suggestions regarding the manuscript. 29: 299–305.B. et al. 28. Gardner RM. Cardio- College of Chest Physicians. McKenzie DC. whose views about the potential A266. 14. Chang RSY. Katch VL. Koumoutsou) for their valu- able contribution to the study. The effect of airflow Komboti and F. VOGIATZIS ET AL. 14: 258–263. Thorax 1987. Wasserman K. with severe airflow obstruction. 41: 187–197. 14: 377–381. Metabolic energy tion for patients with chronic obstructive pulmonary sources during continuous and interval running. 143: 9–18. et al. Appendix D. Christensen EH. 1991. Zanaboni S. Wasserman K. Pulmonary Rehabilitation Guidelines Panel. Adelizi DA. 163: of London. PA. 3rd Edn.

. Physical Training. LeBlanc P. endurance training on skeletal muscle bioenergetics 412–476. Rodahl K. McGuire M. INTERVAL VERSUS CONTINUOUS EXERCISE IN COPD 19 metabolic and circulatory responses to arm or leg in chronic obstructive pulmonary disease. eds. Textbook of Work 27. 152: 2005–2013. In: Care Med 1995. Simard C. 25. Miles J. Webb KA. peripheral muscle strength and endurance in chronic NY. Astrand PO. Am J Respir Crit 30. Effects of Physiology. Marrades M. Saltin B. Essen B. and 28. 1971. Skeletal muscle 157: 1489–1497. Webb KA. Williamson AF. adaptation to endurance training in patients with 29. O9Donnell DE. pp. Chest impact of exercise reconditioning on breathlessness in 1999. Muscle Metabolism During Exercise. Sala E. Eur J Appl Physiol 1977. et al. Roca J. General exercise training improves ventilatory and eds. airflow limitation. Samis L. McGraw-Hill. O9Donnell DE. Rodahl K. Taylor IK. 159: 1726–1734. The patients with chronic airflow obstruction. 1986. Am J Respir interval training. severe chronic airflow limitation. Vogiatzis I. ATP. 39: 241–248 Crit Care Med 1999. chronic pulmonary disease. Saltin B. et al. lactate. Plenum Press. CP in intermittent exercise. McGuire M. Muscle glycogen. Maltais F. Am J Respir Crit Care Physiological responses to moderate exercise work- Med 1996. 116: 1200–1207. pp. Samis L. 419–424. 154: 442–447. NY. Astrand PO. loads in a pulmonary rehabilitation program in 26. 24. In: Pernow B. Am J Respir Crit Care Med 1998. New York. New York.