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Interval versus continuous training in lung transplant candidates: A randomized trial

https://doi.org/10.1016/j.healun.2012.06.004Get rights and content

Background

Interval (IT) and continuous training (CT) represent well-established exercise modalities in patients with moderate to severe chronic obstructive pulmonary disease (COPD). However, their effects and feasibility in patients with end-stage COPD remain unclear.

Methods

Sixty patients (53 ± 6 years, 53% women) being evaluated for lung transplantation where randomly assigned either to IT (n = 30, cycling at 100% peak work rate for 30 seconds alternating with 30 seconds of rest) or CT (n = 30, cycling at 60% of peak work rate) during a 3-week inpatient rehabilitation program. Both exercise protocols yielded an equivalent amount of total work. Patients had a mean forced expiratory volume at 1 second (FEV1) of 25% ± 8% of predicted value.

Results

Patients in both groups achieved similar clinically relevant improvements in 6-minute walking distance of 35 ± 29 meters for IT and 36 ± 43 meters for CT, with a between-group difference of 0.3 meters (95% confidence interval, −18.2 to 18.8). Changes in lung function parameters were not significant. Perceived intensity of dyspnea was significantly (p < 0.05) lower in IT (Borg 6.2 ± 1.8) compared with CT (Borg 7.1 ± 1.7). Patients required a median of 5 unintended breaks (interquartile range, 2–28) during IT exercise and 29 (interquartile range, 6–68) during CT (p < 0.001).

Conclusions

IT is associated with a lower intensity of dyspnea during exercise and fewer unintended breaks but achieves similar improvements in exercise capacity compared with CT in pre-lung transplant COPD patients.

Section snippets

Methods and materials

This study was approved by the Bavarian Ethics Committee (identification number 08022) and registered on the Clinical Trials registry (identification number NCT00962078).

Baseline characteristics

Sixty of 71 patients completed the study (for drop-out reasons see Figure 1) and were considered for the final per-protocol analysis. Owing to the advanced stage of the disease, patients showed an extreme limitation of respiratory capacities (baseline values see Table 1). Mean forced expiratory volume at 1 second (FEV1) was 25% ± 8% of predicted value on admission. Furthermore a low Tiffeneau Index (FEV1/inspiratory vital capacity) of 35% ± 8% predicted, as well as a low diffusion capacity if

Discussion

Former trials investigating different endurance training protocols mostly included patients with COPD at GOLD stages II to III with FEV1 values between 33% and 55% predicted.14, 25, 26, 27, 28, 29 Our study extended these findings to the GOLD stage IV by revealing that exercise training is also effective in very disabled COPD patients before LTx.

IT and CT can both induce comparable effects in exercise capacity. These findings are in line with results of previous studies. Puhan et al26

Disclosure statement

The authors thank Dominica Holle, Andreas Zech, Inga Heinzelmann, Regina Dittmann-Ontivero, Ulrike Hornung, Jessica Wendl, Jens Boensch, Andreas Brandner, and Thomas Damisch, from the Department of Sports Therapy, and Wanda Tamerl, Monika Jell, and their staff, from the Department of Clinical Diagnostics, for assistance with data collection. The authors thank Dr Bernd Sczepanski and Dr Sandra Winterkamp for the medical care of the patients. Special thanks to Dr Tibor Schuster from the

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