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Varied Exercise Training Program Better in Advanced COPD – “You Gotta Move”

Posted Mar 16 2013 2:37pm

Whatever you do, you just can’t sit.  Even when you are “off” you must “go.”  The human body is designed to move, walk, run, and  climb.  We are “hunters and gatherers.”   Our primal roots demand that we keep moving to live,  I think.  What do you think?  Is daily movement part of your treatment?

Here is some research that indicates “interval” training,  is superior to traditional exercise, even in advanced COPD. Need to get that far first:  “Baby Steps”  Start with the walk.  Go “hunt, or gather”  Have a great weekend.

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By Will Boggs, MD

NEW YORK (Reuters Health) Mar 14 – Nonlinear periodized exercise training, a method commonly used for athletes, is superior to traditional endurance and progressive resistance training in patients with severe COPD, researchers from The Netherlands report.

“Exercise training is mandatory and essential during pulmonary rehabilitation,” Dr. Peter Klijn from Merem Asthma Center Heideheuvel in Hilversum told Reuters Health. “I think nonlinear periodization (NLPE) should become the guiding exercise paradigm.”

NLPE, he explained, “uses recovery of the energy systems and the neuromuscular system to attain overcompensation and to avoid the detrimental effects of overtraining.”

With NLPE, training intensity, duration, and repetition-volume (the number of sets and repetitions) are altered frequently, whereas standard training programs consist of linear progression from a low level of intensity to a higher level of intensity.

Dr. Klijn and colleagues compared the effects of NLPE training and traditional endurance and progressive resistance (EPR) training on cycle endurance in a 12-week randomized trial (with 10 weeks of exercise training).

The participants were 110 patients with severe COPD (GOLD stage III-IV).

EPR patients had significantly more training sessions and significantly higher cycle training volume than NLPE patients, although the increase in cycle duration and intensity progressed slowly in many EPR patients.

During resistance training, EPR patients had fewer repetitions and a lower total lifted weight than did NLPE patients, the authors reported February 28th online in the American Journal of Respiratory and Critical Care Medicine.

In both cycle and resistance training, EPR patients had significantly higher symptom scores than NLPE patients.

The cycle work rate goal was 75% of maximum for 20 minutes. By the end of training, 12 EPR patients and 30 NLPE patients had reached this goal (22% vs 55%). The researchers say these improvements were clinically important and the difference between the groups was statistically significant.

Fat-free mass increased significantly more in the NLPE group than in the EPR group, but the increase was only marginal, and there were no differences between the groups for peripheral muscle strength or body mass index.

Health-related quality of life improved significantly more with NLPE than with EPR in all domains.

“COPD is characterized by variable periods of greater symptom burden, and NLPE allows flexible protocols to be used during these periods with maintenance of physiological capacities,” Dr. Klijn said in an email to Reuters Health.

“We have been using the nonlinear principles during the last six years in our pulmonary patients (COPD, asthma, ILD, et cetera) with excellent results,” Dr. Klijn said. “Moreover, patients enjoy this type of training more than traditional EPR which they were used to, which may be an important factor in long-term exercise adherence.”

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