Upper-limb interval versus constant-load exercise in patients with COPD: a physiological crossover study

Mara Paneroni; Ioannis Vogiatzis; Alessandro Cavicchia; Beatrice Salvi; Laura Bertacchini; Massimo Venturelli; Michele Vitacca

doi:10.1183/23120541.00779-2023

Upper-limb interval versus constant-load exercise in patients with COPD: a physiological crossover study

ERJ Open Res. 2024 Feb 26;10(1):00779-2023. doi: 10.1183/23120541.00779-2023. eCollection 2024 Jan.

Authors

Mara Paneroni¹, Ioannis Vogiatzis², Alessandro Cavicchia³, Beatrice Salvi¹, Laura Bertacchini¹, Massimo Venturelli³, Michele Vitacca¹

Affiliations

¹ Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy.
² Northumbria University, Faculty of Health and Life Sciences, Department of Sport, Exercise and Rehabilitation, Newcastle, UK.
³ University of Verona, Department of Neurosciences Biomedicine and Movement Sciences, Verona, Italy.

Abstract

Objective: Upper-limb exercise is recommended for patients with COPD, albeit there are limited data concerning the optimal modality to implement. We compared interval (INT-EX) to continuous (CONT-EX) upper-limb exercise in terms of exercise tolerance, ventilatory and metabolic responses when both conditions were sustained at an equivalent work rate.

Methods: 26 stable COPD patients undertook three upper-limb exercise sessions to initially establish peak work rate (PWR) via an incremental exercise test and subsequently two equivalent work rate tests to the limit tolerance in balanced order: 1) INT-EX consisting of 30-s work at 100% PWR interspersed with 30-s work at 40% of PWR; and 2) CONT-EX at 70% PWR.

Results: 20 patients (76.9%) had longer tolerance during INT-EX, while six out of 26 (23.1%) exhibited longer tolerance during CONT-EX. The average endurance time was 434.1±184.7 and 315.7±128.7 s for INT-EX and CONT-EX, respectively. During INT-EX at isotime (i.e. when work completed was the same between INT-EX and CONT-EX), the majority of patients manifested lower oxygen uptake, minute ventilation, pulmonary hyperinflation, heart rate, symptoms and higher CO₂ blood concentration. Patients with longer INT-EX had a lower comorbidity score (Cumulative Illness Rating Scale: 1.58±0.30 versus 1.88±0.29, p=0.0395) and better-preserved lung function (forced vital capacity 84.7±15.31% versus 67.67±20.56%, p=0.0367; forced expiratory volume in 1 s 57.15±14.59 versus 44.67±12.99% predicted, p=0.0725) compared to patients with longer CONT-EX.

Conclusion: INT-EX is more sustainable than CONT-EX for the majority of COPD patients with moderate obstruction, leading to lower dynamic hyperinflation and symptoms at isotime. Further studies need to define the benefits of its application during pulmonary rehabilitation.