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Are the Effects of High-Intensity Exercise Training Different in Patients with COPD Versus COPD+Asthma Overlap?

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Abstract

Purpose

This study aimed to investigate whether patients with chronic obstructive pulmonary disease (COPD) presenting asthma overlap (ACO) benefit similarly in comparison to patients with only COPD after a 12-week high-intensity exercise training (ET) program.

Methods

Subjects with a diagnosis of COPD alone or ACO were evaluated and compared before and after a high-intensity ET program composed of walking and cycling plus strengthening exercises of the upper and lower limbs (3 days/week, 3 months, 36 sessions). Assessments included spirometry, bioelectrical impedance, 6-min walk test (6MWT), London Chest Activity of Daily Living Scale (LCADL), Hospital anxiety and depression Scale, modified Medical Research Council Scale (mMRC), Saint George Respiratory Questionnaire (SGRQ), and respiratory and peripheral muscle strength [manovacuometry and 1-repetition maximum test (quadriceps femoris, biceps and triceps brachialis), respectively]. ACO was defined according to Sin et al. (Eur Respir J 48(3):664-673, 2016).

Results

The sample was composed of 74 subjects (57% male, age 67 ± 8 years, BMI 26 (21–32) kg/m2, FEV1 47 ± 17%predicted), and 12 (16%) of them were classified as presenting ACO. Both groups improved pulmonary function, 6MWT, peripheral and inspiratory muscle strength, LCADL, and SGRQ after ET (p < 0.005 for all). There were no significant interactions between ACO and COPD on ET effects (p > 0.05 for all). Likewise, there was no difference in the proportion of patients achieving the minimum clinical important difference for 6MWT and mMRC.

Conclusion

High-intensity exercise training generates similar benefits in patients with COPD regardless of whether presenting asthma overlap or not.

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Abbreviations

1RM:

One-repetition maximum test

6MWT:

6-Min walk test

ACO:

Asthma-chronic obstructive pulmonary disease overlap

BDR:

Bronchodilator response

COPD:

Chronic obstructive pulmonary disease

ET:

Exercise training

FEV1/FVC:

Forced expiratory volume in the first second per forced vital capacity

FEV1 :

Forced expiratory volume in the first second

FVC:

Forced vital capacity

GINA:

Global Initiative for Asthma Management and Prevention

GOLD:

Global Initiative for Chronic Obstructive Pulmonary Disease

HADS:

Hospital Anxiety and Depression Scale

IQR:

25–75 Interquartile range

Kg:

Kilogram

LCADL:

London Chest Activity of Daily Living Scale

MCID:

Minimal clinical important difference

MEP:

Maximum expiratory pressure

MIP:

Maximum inspiratory pressure

mMRC:

Modified Medical Research Council Scale

PR:

Pulmonary rehabilitation

SD:

Standard deviation

SGRQ:

St. George’s Respiratory Questionnaire

UEL:

Londrina State University

UNOPAR:

University of Northern Parana

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Acknowledgements

Coordination for the Improvement of Higher Education Personnel (CAPES), Brazil. National Council of Technological and Scientific Development (CNPq), Brazil.

Funding

Antenor Rodrigues, Joice Mara de Oliveira, Felipe Vilaça Cavallari Machado, Letícia Fernandes Belo, Lorena Paltanin Schneider, Andrea Akemi Morita, Ana Carolina Andrelo, Jéssica Fonseca, Igor Lopes Brito, and Thaís Paes were supported by the Coordination for the improvement of Higher Education Personnel (CAPES), Brazil. Karina Couto Furlanetto is supported by Fundação Nacional do Desenvolvimento do Ensino Superior Particular (FUNADESP), Grant Number 5301164. Fabio Pitta is supported by the National Council of Technological and Scientific Development (CNPq), Brazil.

Author information

Author notes

  1. Antenor Rodrigues and Joice Mara de Oliveira have contributed equally to the study and share first authorship.

Authors and Affiliations

  1. Laboratory of Research in Respiratory Physiotherapy - LFIP, Department of Physiotherapy, Londrina State University, Londrina, Brazil

    Antenor Rodrigues, Felipe Vilaça Cavallari Machado, Letícia Fernandes Belo, Lorena Paltanin Schneider, Andrea Akemi Morita, Ana Carolina Andrelo, Jéssica Fonseca, Igor Lopes Brito, Thaís Paes, Vanessa Suziane Probst, Nidia Aparecida Hernandes & Fabio Pitta

  2. Center for Research in Biological and Health Sciences, University of Northern Parana, Londrina, Brazil

    Joice Mara de Oliveira, Karina Couto Furlanetto & Josiane Marques Felcar

  3. Laboratório de Pesquisa em Fisioterapia Pulmonar (LFIP), Departamento de Fisioterapia, Universidade Estadual de Londrina (UEL), Avenida Robert Koch, 60 - Vila Operária, Londrina,, Paraná, 86038-350, Brazil

    Fabio Pitta

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  1. Antenor Rodrigues
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Corresponding author

Correspondence to Fabio Pitta.

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Conflict of interest

All authors declare that they have no conflict of interest in relation to this work.

Ethical Approval

This study was approved by the institutional ethics committee (Number: UEL n. 123/09 and UNOPAR n. 0377/10), and all subjects gave informed consent.

Informed Consent

Informed consent was obtained from all subjects included in the study.

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Rodrigues, A., de Oliveira, J.M., Furlanetto, K.C. et al. Are the Effects of High-Intensity Exercise Training Different in Patients with COPD Versus COPD+Asthma Overlap?. Lung 198, 135–141 (2020). https://doi.org/10.1007/s00408-019-00311-7

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