Nonlinear exercise training in advanced chronic obstructive pulmonary disease is superior to traditional exercise training: A randomized trial

Rationale: The optimal exercise training intensity and strategy for individualized exercise training in chronic obstructive pulmonary disease (COPD) is not clear. Objectives: This study compares the effects of nonlinear periodized exercise (NLPE) training used in athletes to traditional endurance andprogressive resistance (EPR) training inpatientswith severeCOPD. Methods: A total of 110 patients with severe COPD (FEV1 32% predicted) were randomized to EPR or NLPE. Exercise training was performed three times perweek for 10 weeks.Theprimary outcomeswere cycling endurance time and health-related quality of life using the Chronic Respiratory Questionnaire.Thedifference in changebetween EPR and NLPE was assessed using linearmixed-effectsmodeling. Measurements andMain Results:NLPE resulted in significantly greater improvements in cycling endurance time compared with EPR. The difference in change was +300.6 seconds (95% confidence interval [CI]= 197.2-404.2 s; P < 0.001). NLPE also resulted in significantly greater improvements in all domains of the Chronic RespiratoryQuestionnaire compared with EPR, ranging from +0.48 (95%CI = 0.19-0.78) for the domain, emotions, to +0.96 (95% CI = 0.57-1.35) for dyspnea. Conclusions: NLPE results in greater improvements in cycle endurance and health-related quality of life in patients with severe COPD than traditional training methods. Copyright © 2013 by the American Thoracic Society.