Exercise training in COPD patients: the basic questions

Pulmonary rehabilitation programmes aim at improving exercise capacity, activities of daily living, quality of life and perhaps survival in patients with chronic obstructive pulmonary disease (COPD). Recently, well-designed studies investigated and confirmed the efficacy of comprehensive pulmonary rehabilitation programmes, including exercise training, breathing exercises, optimal medical treatment, psychosocial support and health education. In the present overview, the contribution of exercise training in clinical practice to the demonstrated effects of pulmonary rehabilitation is discussed by means of six basic questions. These include: 1) the significance of exercise training; 2) the optimal intensity for exercise training; 3) prescribing training modalities; 4) the effects of exercise training combined with medication, nutrition or oxygen; 5) how training effects should be maintained; and 6) where the rehabilitation programme should be performed: in-patient, out-patient or homecare? First, exercise training has been proven to be an essential component of pulmonary rehabilitation. Training intensity is of key importance. High-intensity training (>70% maximal workload) is feasible even in patients with more advanced COPD. In addition, the effects on peripheral muscle function and ventilatory adaptations are superior to low-intensity training. There is, however, no consensus on the optimal training modalities. Both walking and cycling improved exercise performance. Since peripheral muscle function has been recognized as an important contributor to exercise performance, specific peripheral muscle training recently gained interest. Improved submaximal exercise performance and increased quality of life were found after muscle training. The optimal training regimen (strength or endurance) and the muscle groups to be trained, remain to be determined. Training of respiratory muscles is recommended in patients with ventilatory limitation during exercise. The additional effects of anabolic-androgenic drugs, oxygen and nutrition are not well-established in COPD patients and need further research. In order to maintain training effects, close attention of the rehabilitation team is required. The continuous training frequency necessary to maintain training effects remains to be defined. At this point in time, out-patient-based programmes show the best results and guarantee the best supervision and a multidisciplinary approach. Future research should focus on the role of homecare programmes to maintain improvements.     

Intensive vascular training in stage IIb of peripheral arterial occlusive disease. The additive effects of intravenous prostaglandin E1 or intravenous pentoxifylline during training

In a randomized open study, the combination of either prostaglandin E1 (PGE1) or pentoxifylline with controlled vascular training was compared with vascular training alone in patients with peripheral arterial occlusive disease in stage IIb. Forty-four patients were randomly assigned to treatment either of intensive vascular training alone (n = 15) or in combination with either i.v. pentoxifylline (200 mg over 2 hours BID, n = 15) or PGE1 (40 micrograms over 2 hours BID, n = 14). The basic therapy was a well-defined routine for vascular training, which was identical for all groups. The duration of therapy was 4 weeks. In all three test groups, there was a significant increase in the walking distance. There was a 119% increase in symptom-free walking distance in the exercise-only group. In comparison with exercise alone, the additional administration of pentoxifylline produced no greater effect; the increase was 105%. In contrast, administration of PGE1 combined with exercise achieved a remarkable improvement of 604%. Between-group comparison revealed the significant superiority of treatment with PGE1 (P < .05). During the 1-year follow-up, there was a reduction in the walking performance in all groups, albeit of variable extent. In the exercise-only and the pentoxifylline groups, the maintained increase in walking distance was only 30% compared with baseline values before the beginning of therapy. In the PGE1 group, on the other hand, the maintained improvement was 149%. Nine of 14 patients were still in stage IIa of peripheral arterial occlusive disease 1 year after PGE1 therapy.     

Effect of residential cardiac rehabilitation following bypass surgery. Observations in Switzerland

BACKGROUND: Cardiac rehabilitation in central Europe traditionally involves isolating patients in a residential idyllic setting where exercise is performed frequently but in a relatively unstructured fashion. Few studies have been performed on the effects of these programs among patients who have undergone bypass surgery. Recent data suggest that postbypass patients may enter these programs too soon after surgery or that exercise is not structured enough to distinguish the benefits of rehabilitation from those experienced by a control group. METHODS: Forty-two male patients (mean age, 58 +/- 7 years) were divided into exercise and control groups approximately 1 month after undergoing bypass surgery. Exercise training consisted of 1 h of group walking twice daily, with the intensity stratified into four levels based on initial exercise capacity. Using a crossover design, patients in the exercise group participated in rehabilitation for 1 month, followed by 1 month of usual care, while control patients underwent the opposite sequence. At 1, 2, and 3 months, patients in both groups underwent pulmonary function testing and maximal ramp exercise testing using lactate and gas exchange analysis. RESULTS: A main effect for maximal oxygen uptake was observed; significant improvements within each group occurred across each testing period (range, 5 to 13%; p < 0.05). However, there was no significant interaction between groups. Mean lactate levels throughout exercise were reduced within both groups (p < 0.01). A reduction in oxygen uptake for test 2 at the lactate threshold in the exercise group resulted in differences between groups in lactate, heart rate, and other gas exchange variables at this point. CONCLUSION: Similar changes occur in the functional status of postbypass surgery patients regardless of their participation in the short but concentrated programs common in central Europe. This suggests that a significant spontaneous effect of healing occurs in the recovery phase after surgery. These programs may have greater efficacy if they began later after surgery, lasted longer, or were more structured, and studies are needed to determine their effect on psychosocial factors and return to work.     

Effects of cross-training on markers of insulin resistance/hyperinsulinemia

This study examined, through a randomized controlled trial, the effects of cross-training (combined resistance and endurance exercise) on markers of insulin resistance, (e.g., dyslipidemia, intra-abdominal obesity, hyperinsulinemia, and hypertension), body composition, and performance in hyperinsulinemic individuals. Sedentary adult males characterized as hyperinsulinemic (fasting insulin > 2 OuU.mL-1), randomly assigned to two groups (N = 8 each), completed 14 wk of training at 3 d.wk-1. An endurance-only (E) group performed both continuous cycle exercise and walking (30 min each at 60-70% heart rate reserve). A cross-training (C) group performed both endurance and resistance exercise (8 exercises, 4 sets/exercise, 8-12 repetitions/set) in a single session. Both E and C groups demonstrated similar increases in VO2max (25% and 27%) while only C demonstrated an increase in 1 RM bench press (19%) and leg press (25%). The changes induced by C training were significantly greater than those from E training alone in percent fat (6.9 +/- 1.3 vs 1.4 +/- 1.4), insulin concentration (8.5 +/- 2.7 vs 3.0 +/- 1.3 uU.mL-1), glucose levels (11.1 +/- 2.9 vs 5.9 +/- 2.6 mg.dL-1), HDL-C levels (5.1 +/- 1.3 vs 2.9 +/- 1.6 mg.dL-1), triglyceride concentration (43.8 +/- 13.6 mg.dL-1), and systolic blood pressure (14.6 +/- 5.5 vs 8.3 +/- 6.8 mm Hg). Results indicate that the addition of resistance training to an endurance training program will induce significantly greater differences in markers of insulin resistance and body composition in individuals with hyperinsulinemia than endurance training alone.     

Walking to meet health guidelines: The effect of prompting frequency and prompt structure.

This study assessed the effects of frequency of prompting (phone calls once a week versus once every 3 weeks) and structure of prompting (high versus low structure) in 135 participants (132 women and 3 men) in a walking program designed to meet the American College of Sports Medicine's cardiovascular exercise goals. Survival analysis using 6 months of data points and using the criteria of walking at least 20 min a day for at least 3 times per week indicated an effect for more frequent versus less frequent prompting (46% and 13%) but not for high- versus low-structure prompting (30% and 31%). The results suggested the efficacy of frequent prompting delivered in inexpensive ways as a means to increase exercise adherence and the further parametric study of other basic behavior change strategies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis

STUDY DESIGN: A randomized, controlled trial, test--retest design, with a 3-, 6-, and 30-month postal questionnaire follow-up. OBJECTIVE: To determine the efficacy of a specific exercise intervention in the treatment of patients with chronic low back pain and a radiologic diagnosis of spondylolysis or spondylolisthesis. SUMMARY OF BACKGROUND DATA: A recent focus in the physiotherapy management of patients with back pain has been the specific training of muscles surrounding the spine (deep abdominal muscles and lumbar multifidus), considered to provide dynamic stability and fine control to the lumbar spine. In no study have researchers evaluated the efficacy of this intervention in a population with chronic low back pain where the anatomic stability of the spine was compromised. METHODS: Forty-four patients with this condition were assigned randomly to two treatment groups. The first group underwent a 10-week specific exercise treatment program involving the specific training of the deep abdominal muscles, with co-activation of the lumbar multifidus proximal to the pars defects. The activation of these muscles was incorporated into previously aggravating static postures and functional tasks. The control group underwent treatment as directed by their treating practitioner. RESULTS: After intervention, the specific exercise group showed a statistically significant reduction in pain intensity and functional disability levels, which was maintained at a 30-month follow-up. The control group showed no significant change in these parameters after intervention or at follow-up. SUMMARY: A "specific exercise" treatment approach appears more effective than other commonly prescribed conservative treatment programs in patients with chronically symptomatic spondylolysis or spondylolisthesis.     

Improving aerobic capacity in healthy older adults does not necessarily lead to improved cognitive performance.

The effects of aerobic exercise training in a sample of 85 older adults were investigated. Ss were assigned randomly to either an aerobic exercise group, a nonaerobic exercise (yoga) group, or a waiting-list control group. Following 16 weeks of the group-specific protocol, all of the older Ss received 16 weeks of aerobic exercise training. The older adults demonstrated a significant increase in aerobic capacity (cardiorespiratory fitness). Performance on reaction-time tests of attention and memory retrieval was slower for the older adults than for a comparison group of 24 young adults, and there was no improvement in the older adults' performance on these tests as a function of aerobic exercise training. Results suggest that exercise-related changes in older adults' cognitive performance are due either to extended periods of training or to cohort differences between physically active and sedentary individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An evaluation of modeling and experiential procedures for self-disclosure training.

Attempted (a) to adapt and implement an interpersonal-skills training paradigm for training married individuals to exhibit increased self-disclosive behavior in their marital relationships, and (b) to determine the efficacy of experiential and modeling procedures in such training. 27 university-affiliated married couples (mean age 24.5 yrs, mean length of marriage 3.1 yrs) were randomly assigned to 1 of 3 groups: a communication-skills training group, a modeling group, and a control group. Frequency, duration, and quality of self-disclosive behavior were analyzed for pre- to posttraining changes by means of the Hill Interaction Matrix and the Facilitative Self-Disclosure Scale. Results indicate that (a) the communication-skills training group demonstrated a significant increase on 4 of the 5 self-disclosure measures, (b) the modeling group demonstrated an increase on 3 of the self-disclosure variables, and (c) the controls did not change on any of the variables. Implications of integrating both modeling and experiential methods into interpersonal-skills training programs are discussed. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Computer-assisted attention retraining in head-injured individuals: A controlled efficacy study of an outpatient program.

The efficacy of a computer-assisted attention retraining program was evaluated with 29 outpatients suffering from moderate to severe traumatic brain injury. Ss who were at least 12 mo postinjury were randomly assigned either to the attention training program or a memory training program that served as a control condition. Training lasted 9 wks with 2 2-hr sessions per wk for both groups. The experimental design evaluated outcome by juxtaposing a multiple baseline procedure for a 1st set of measures of attention and memory with a pre- and postgroup comparison that relied on a 2nd set of neuropsychological tests. The experimental group improved significantly in comparison with the control group on measures of attention. The reversed pattern for the memory measures was not observed. None of the treatment effects generalized to the 2nd set of dependent variables. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The validity of swimming training for two-year-old thoroughbreds

To investigate the validity of swimming training, the following matters were considered: 1) changes in the performance capacity, 2) changes in the constitution and 3) frequency of locomotor diseases. These were evaluated during a training program including both conventional exercise on a track and swimming. In this study, 24 two-year-old thoroughbred horses were studied, and divided into the following three groups: Group A, trained by only running; Group B, trained by running plus a gradual increase in swimming; Group C, trained by running plus constant swimming. As a result of standardized exercise tests, only the intercepts of the 3 regression curves between the speed and the blood lactate concentration in Group B increased significantly as the training progressed. While the growth in height in Groups B and C were greater than in Group A, the increase in girth and weight in Groups B and C were smaller than in Group A. The percentages with locomotor diseases during this experiment in Groups A, B, and C were 62.5%, 12.5% and 25.0%, respectively, and there was a significant difference (p < 0.05) between Group A and Group B. As mentioned, it was suggested that a training program including swimming training is seen as being useful for improvement in performance capacity, since it can reduce locomotor diseases in young horses and allow for smooth progress in future training.     

Association between homeobox-containing gene MSX1 and the occurrence of limb deficiency

Impaired exercise capacity is a common finding in chronic obstructive pulmonary disease (COPD) patients. This reduction is not a simple consequence of airflow limitation. Peripheral muscle weakness, deconditioning and impaired gas exchange, were recognized as important contributors to exercise intolerance. In this overview, the contribution of peripheral muscle function and muscle training to exercise performance is discussed by means of three questions: 1) Is peripheral muscle dysfunction contributing to exercise limitation in COPD? 2) How do we measure peripheral muscle function? 3) Are peripheral muscle training modalities effective? At present, there is substantial evidence for peripheral muscle dysfunction. Both reduced force generating capacity as well as impaired muscle metabolism were observed and these findings contributed substantially to the reduced exercise capacity in COPD. Peripheral muscle strength measurements are feasible with mechanical or electronic devices and revealed muscle weakness in COPD patients. However, this weakness is not uniform for all muscle groups. Upper arm and leg muscles were more affected than hand muscles. This may, at least in part, be related to differences in the levels of inactivity between leg and hand muscles. In addition, muscle weakness is associated with impaired exercise capacity and symptoms of increased exertion during exercise. Endurance exercise training, i.e. cycling and treadmill walking, improved exercise capacity and was associated with alterations in muscle metabolism. Strength training of peripheral muscles showed increases in submaximal exercise performance and quality of life measures. These improvements were observed independently of the degree of airflow obstruction. The optimal training regimen (strength or endurance), and the muscle groups to be trained, remain to be determined.     

Growth trajectories of exercise self-efficacy in older adults: Influence of measures and initial status.

Objective: This study examined differential trajectories of exercise-related self-efficacy beliefs across a 12-month randomized controlled exercise trial. Method: Previously inactive older adults (N = 144; M age = 66.5) were randomly assigned to one of two exercise conditions (walking, flexibility-toning-balance) and completed measures of barriers self-efficacy (BARSE), exercise self-efficacy (EXSE), and self-efficacy for walking (SEW) across a 12-month period. Changes in efficacy were examined according to efficacy type and interindividual differences. Latent growth curve modeling was employed to (a) examine average levels and change in each type of efficacy for the collapsed sample and by intervention condition and (b) explore subpopulations (i.e., latent classes) within the sample that differ in their baseline efficacy and trajectory. Results: Analyses revealed two negative trends in BARSE and EXSE at predicted transition points, in addition to a positive linear trend in SEW. Two subgroups with unique baseline efficacy and trajectory profiles were also identified. Conclusion: These results shed new light on the relationship between exercise and self-efficacy in older adults. They also highlight the need for strategies for increasing and maintaining efficacy within interventions, namely targeting participants who start with a disadvantage (lower efficacy) and integrating efficacy-boosting strategies for all participants prior to program end. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assertion training and trainer effects on unassertive and aggressive adolescents.

Examined the effects of assertion training and trainers on 90 adolescents selected for their unassertive or aggressive behavior with teachers. Structured learning training (SLT) was compared with instruction conditions and no-treatment conditions on self-report and in vivo measures of assertive behavior. For SLT groups, trainers were varied for their situational similarity to teachers. The result yielded a 2?×?5 factorial design, varying type of participant (unassertive vs aggressive) and type of training (SLT with teachers, parents, or students as trainers vs verbal instructions and no-treatment conditions). SLT improved assertive behavior in teacher situations. Effects generalized to novel teacher, parent, and student situations and to the in vivo test as a 1 wk follow-up. The SLT with teacher trainers produced more assertive behavior in teacher situations than did all other groups. Test performance was differentially affected by type of participant. Results suggest person and situation specificity of behavior. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maternal-fetal disease information as a source of exercise motivation during pregnancy.

Objective: A Protection Motivation Theory (PMT) framework was used to examine whether information about the role of exercise in preventing maternal-fetal disease served as a meaningful source of exercise motivation. Design: Pregnant women (n = 208) were randomly assigned into one of three conditions: PMT, attention control, and noncontact control. Women in the PMT group read a brochure about the benefits of exercise during pregnancy incorporating the major components of PMT; perceived vulnerability (PV), perceived severity (PS), response efficacy (RE), and self-efficacy (SE). Participants in the attention-control condition read a brochure about diet. Following treatment, all participants completed measures of their beliefs toward maternal-fetal disease and exercise, goal intention (GI), and implementation intention (IMI). One week later, a measure of self-reported exercise behavior was collected. Main Outcome Measures: Main outcome measures were PMT variables (PV, PS, RE, and SE), GI, IMI, and follow-up physical activity. Results: Participants assigned to the PMT-present group reported significantly higher PS, RE, SE, GI, and increased exercise behavior. PS, RE, and SE predicted GI, GI predicted IMI, and IMI predicted exercise behavior. Conclusion: Information grounded in PMT is effective in influencing pregnant women’s beliefs and intentions as well as changing their initial behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Training with supplemental oxygen in patients with COPD and hypoxaemia at peak exercise

Supplemental oxygen has acute beneficial effects on exercise performance in patients with chronic obstructive pulmonary disease (COPD). The purpose of this study was to investigate whether oxygen-supplemented training enhances the effects of training while breathing room air in patients with severe COPD. A randomized controlled trial was performed in 24 patients with severe COPD who developed hypoxaemia during incremental cycle exercise (arterial oxygen saturation (Sa,O2) <90% at peak exercise). All patients participated in an in-patient pulmonary rehabilitation programme of 10 weeks duration. They were assigned either to general exercise training while breathing room air (GET/RA group: forced expiratory volume in one second (FEV1) 38% of predicted; arterial oxygen tension (Pa,O2) 10.5 kPa at rest; Pa,O2 7.3 kPa at peak exercise), or to GET while breathing supplemental oxygen (GET/O2 group: FEV1 29% pred; Pa,O2 10.2 kPa at rest; Pa,O2 7.2 kPa at peak exercise). Sa,O2 was not allowed to fall below 90% during the training. The effects on exercise performance while breathing air and oxygen, and on quality of life were compared. Maximum workload (Wmax) significantly increased in the GET/RA group (mean (SD) 17 (15) W, p<0.01), but not in the GET/O2 group (7 (25) W). Six minute walking distance (6MWD), stair-climbing, weight-lifting exercise (all while breathing room air) and quality of life significantly increased in both groups. Acute administration of oxygen improved exercise performance before and after training. Training significantly increased Wmax, peak carbon dioxide production (V'CO2) and 6MWD while breathing oxygen in both groups. Differences between groups were not significant. Pulmonary rehabilitation improved exercise performance and quality of life in both groups. Supplementation of oxygen during the training did not add to the effects of training on room air.     

The effect of antiemetics and reduced radiation fields on acute gastrointestinal morbidity of adjuvant radiotherapy in stage I seminoma of the testis: a randomized pilot study

OBJECTIVE: To assess the long term effects of weight loss with and without additional aerobic and weight training exercises on exercise tolerance and cardiorespiratory fitness in obese women. EXPERIMENTAL DESIGN: Randomized prospective study for an approximately one-year community setting. PATIENTS: 31 healthy obese women volunteers (age 42.8 yrs +/- 6 SD) recruited by community advertisement. INTERVENTION: All subjects underwent a weight loss program consisting of low calorie diet and behavior therapy for a minimum of 46 weeks. They were randomly assigned to one of the four groups. Group A: diet alone, Group B: diet plus aerobic exercise program in a supervised group setting, Group C: Diet plus weight training and Group D: diet plus weight training plus aerobic exercise program. MEASURES: Exercise time (Tex) peak sustained workload (Wp), peak oxygen consumption (VO2), oxygen pulse and the rate of change of VO2 on recovery (VO2rec) were measured at the beginning and after 47.5 weeks +/- 1.5 SD, of the program. RESULTS: All subjects lost weight and achieved increased Tex and lowered resting VO2. VO2 peak and VO2 peak kg-1 increase in Groups B and D only. O2 pulse and VO2rec improved in group D. Improvements in exercise time correlated significantly with initial exercise time and weight loss. CONCLUSIONS: Weight loss increase Tex irrespective of participation in an exercise program. However, evidence of improved aerobic fitness occurred only in groups performing aerobic exercise.     

Application of social learning theory to employee self-management of attendance.

Training in self-management was given to 20 unionized state government employees to increase their attendance at the work site. Analyses of variance revealed that compared to a control condition (n?=?20), training in self-regulatory skills taught employees how to manage personal and social obstacles to job attendance, and it raised their perceived self-efficacy that they could exercise influence over their behavior. Consequently, employee attendance was significantly higher in the training than in the control group. The higher the perceived self-efficacy, the better the subsequent job attendance. These data were significant at the .05 level. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The emerging discipline of environmental psychology.

Examines developments in the study of the relationships between the physical environment and behavior, and their significance for the psychological profession. 3 types of problems are distinguished: behavioral ecology, generalized effects of the physical environment on behavior, and effects of environmental stimulation on affective and motivational variables. The latter are given particular attention, and relationships to psychological principles from the study of arousal, exploratory behavior, and adaptation processes are pointed out. The question of the type of institutional structures best suited to promote training and research in this new discipline is examined. (44 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)