Case:

Hr M. Ques-ons?
70 year
COPD
Presence of airow obstruc3on?
Recurrent infec3ons LOL (pseudomonas,
bronchiectasis)
No cardiovascular history Severity of airow obstruc3on?

40 pack years (stop since 1 year)

Limita3ons in ADL (walking on ground level at
own speed, shopping, gardening) Pulmonary func-on examina-on

Exercise training program?

Lung func-on Measured % pred

Ques-ons?
FEV1 2.21 L 70
FVC 4.01 L 97 Is this pa3ent a good candidate for an exercise training
FRC 5.17 L 140 program?
TLC 7.43 L 103
TLCO 4.07 mmol/min/kPa 51
Are there limita3ons to perform an exercise training
MVV 83 L program?

PaO2 76 mmHg
PaCO2 36 mmHg Are you able to prescribe a detailed exercise training
StcO2 95% program with the present informa3on?

Age 70yr BW 79Kg Height 178cm

 Ques-ons? What informa-on is further needed?
Is this pa3ent a good candidate for an exercise training Is the exercise capacity limited (compared to age-
program? matched healthy subjects)?
Are there limita3ons to perform an exercise training Which are the limi3ng factors?
program? Is maximal exer3on safe?
Are you able to prescribe a detailed exercise training What is the appropriate exercise intensity during
program with the present informa3on? training?

NO: you need addi-onal informa-on from a maximal Maximal exercise tes-ng!
exercise test!

EXERCISE TEST EXERCISE TEST

Wmax 85 W 52 %pred Wmax 85 W 52 %pred

VO2max 1.200 L/min 54 %pred VO2max 1.200 L/min 54 %pred
15,1 ml/kg 15,1 ml/kg
HR 122 min-1 HR 122 min-1 78 %pred
VE 72 L/min VE 72 L/min 87 %MVV
MVV 83 L/min MVV 83 L/min
Sat Rust/max 95/91 % Sat Rust/max 95/91 %
Borg Dys/Fat 5/6 Borg Dys/Fat 5/6
Is the exercise capacity impaired?
Muscle Strength Measured % pred
YES (Wmax ~ 50%pred, 15mL/min/kg, 6MWD 77%)


Which are the limi3ng factors? PImax -69 cm H2O 91
Cardio vascular: (HRmax /HRmaxpred: 122/150+/-10) NO PEmax 157 cm H2O 118
Ven3latory (VEmax/MVV: 72/83=87%) YES Quadr 108 Nm 70
Gas exhange limita3on (SaO2 rest/exerc 95/91%) YES
Hand 40 KgF 133
Muscle weakness (Fa3gue score 6 indica3ve)

6MWD 443 m 77
Other? (not from exercise test, history?)

Is maximal exer3on safe? (no ECG abnormali3es reported)

 Treatment

Which treatment modali3es?

Which modality of exercise training?
Strength training?
Other modali3es?
Which intensity?
Which frequency?
Dura3on of the program?

WEEK DURATION INTENSITY WEEK DURATION NUMBER of INTENSITY

per serie series
1 10 min. 60% Wmax 1 5x 60% Wmax
2 - 2 - 2 min.
2 12 min. 60% Wmax 2 2- 2 - 2 min. 6x 60% Wmax
3 12 min. 65% Wmax 3 2- 2 - 2 min. 6x 65% Wmax
4 14 min. 65% Wmax 4 2 - 2 - 2 min. 7x 65% Wmax
5 14 min. 70% Wmax 5 2 - 2 - 2 min. 7x 70% Wmax
6 14 min. 70% Wmax 6 2 - 2 - 2 min. 7x 70% Wmax
7 2 - 2 - 2 min. 7x 70% Wmax
7 14 min. 75% Wmax
8 2 - 2 - 2 min. 8x 75% Wmax
8 16 min. 75% Wmax
9 2 - 2 - 2 min. 8x 75% Wmax
9 16 min. 80% Wmax 10 8x 85% Wmax
2 - 2 - 2 min.
10 16 min. 80% Wmax 11 8x 85% Wmax
2 - 2 - 2 min.
11 16 min. 85% Wmax 12 2 - 2 - 2 min. 8x 85% Wmax
12 16 min. 85% Wmax

Example Endurance Cycling Program Example Interval Cycling Program

 Training schedule WEEK
1
DURATION
10 min.
INTENSITY
75% Speed MWD
2 12 min. 75% Speed MWD
3 12 min. 80% Speed MWD
Cycle ergometer (Wmax 85 Wae) 4 14 min. 80% Speed MWD
5 14 min. 85% Speed MWD
100 W1 16 W1 6 14 min. 85% Speed MWD
W12 W12
90 14 7 14 min. 90% Speed MWD
80
12 8 16 min. 90% Speed MWD
70
10
9 16 min. 95% Speed MWD
60
50 8
10 16 min. 100% Speed MWD
40
11 16 min. 100% Speed MWD
6
30 12 16 min. 110% Speed MWD
4
20
10 2
0 0
Watts Time Example Endurance Walking Program

Training schedule Training schedule

Treadmill (6MWD 445m) Resistance training 3 series 8 contrac3ons
6 180 W1
W1 16 W1
W12
W12 W12 160
5 14

12 140
4 120
10

8
100
3
80
6
2
60
4
1 40
2
20
0 0
Snelheid Time 0
Kg
 TRAINING EFFECTS
600 140

Training dura-on 500 120

100
400
80
300
Pre 60 Pre
200 Post Post
Week 1 Week 12 40
100 20
Cycle
Walk 0 0

Step 6 MWD QF
Arm
QF
120 30
TR
100 25
Pect
Rest 80 20

60 15
Pre Pre
40 Post 10 Post

Total dura-on: 90 minutes 20 5

0 0

Wmax Dyspnoe