Effects of exercise training in patients with chronic obstructive pulmonary disease--a narrative review for FYSS (Swedish Physical Activity Exercise Prescription Book).

The aims of this review were to determine the level of evidence for exercise training in the management of patients with chronic obstructive pulmonary disease (COPD) and provide evidence-based recommendations on exercise training. This review was performed in PubMed and Cochrane Library. Included studies investigated patients with COPD who had been randomised to exercise training or no training. Six systematic reviews were included. The methodological quality was scored using a grading system (GRADE). The analysis showed that aerobic and resistance training in patients in a stable state of COPD results in improved health-related quality of life and decreased dyspnoea, anxiety and depression (moderately strong scientific evidence, grade +++), and increased physical capacity and decreased dyspnoea in daily activities (limited scientific evidence, grade ++). In patients with an acute exacerbation, aerobic and resistance training, performed directly after the exacerbation, results in improved health-related quality of life (moderately strong scientific evidence, grade +++), improved exercise capacity and decreased mortality and hospitalisation (limited scientific evidence, grade ++). Thus, patients with COPD should be recommended to take part in exercise training.

Hospital-based pulmonary rehabilitation in patients with COPD in Sweden--a national survey.

Pulmonary rehabilitation (PR) is an evidence-based, multidisciplinary and cost-effective intervention that leads to improved health in patients with chronic obstructive pulmonary disease, COPD. However, the availability of PR programs varies between and within different countries. The aim of this study was to investigate the availability and content of hospital-based PR programs in patients with COPD in Sweden. A cross-sectional descriptive design was applied using a web-based questionnaire which was sent out to all hospitals in Sweden. The questionnaire consisted of 32 questions that concerned availability and content of PR in patients with COPD during 2011. Seventy out of 71 hospitals responded the electronic survey. Forty-six (66%) hospitals offered PR for patients with COPD. Around 75% of the hospitals in southern and middle parts of Sweden and 33% of the hospitals in the northern part offered PR. Thirty-four percent of the patients declined participation. A total number of 1355 patients participated in PR which represents 0.2% of the COPD population in Sweden. All hospitals had exercise training as major component and 76% offered an educational program. Not even half a percent of the patients with COPD in Sweden took part in a hospital-based PR program during 2011. There was a considerable geographic discrepancy in availability over the country. To enable a greater part of the increasing number of patients with COPD to take part in this evidence-based treatment, there is a need of evaluating other settings of PR programs; in primary care, at home and/or over the internet.

Validation of the MetaMax II portable metabolic measurement system.

The purpose of this study was to investigate the validity of the MetaMax II portable metabolic measurement system against the Douglas Bag technique. Nine recreationally active male subjects were included in a validation at 100 W, 10 well-trained male subjects at 200 W and 10 well-trained males at 250 W and at maximal exercise (volitional fatigue at a mean workload of 325 W). All testing was performed on an electronically braked bicycle at 60 rpm. At 100 W, the influence on MetaMax II measurements of adding a Douglas Bag breathing valve in series to the MetaMax II was investigated. The oxygen uptake was, for the MetaMax II, at 100 W mean 0.03 l x min (-1) higher (p < 0.01), at 200 W mean 0.02 l x min (-1) (n. s.) lower, at 250 W mean 0.04 l x min (-1) (n. s.) higher, and at 325 W mean 0.11 l x min (-1) (p < 0.05) higher. The carbon dioxide excretion was, for the MetaMax II, at 100 W mean 0.06 l x min (-1) (p < 0.01) lower, at 200 W mean 0.11 l x min (-1) (p < 0.05) lower, at 250 W mean 0.03 l x min (-1) (n. s.) lower, and at 325 W mean 0.16 l x min (-1) (p < 0.05) lower. The addition of a breathing valve in series to the MetaMax II resulted in lower breathing frequency, a higher ventilated tidal volume, and an affected gas measurement validation. In conclusion, the MetaMax II was found to be valid for metabolic gas measurements between 100 and at least 250 W.

Physical training with and without oxygen in patients with chronic obstructive pulmonary disease and exercise-induced hypoxaemia.

A randomized, controlled, single-blind study was performed on 20 patients with chronic obstructive pulmonary disease and exercise-induced hypoxaemia. Ten patients each were randomly assigned to one of two groups, one training with air and the other training with oxygen. There were no significant differences between the groups regarding values measured prior to the study. The patients trained 3 times per week for 30 minutes each time for a duration of 8 weeks. The training consisted of interval walking on a treadmill (intensity set according to Borg ratings) with either air or oxygen administered through a nasal cannula at a rate of 5 l/min. Training significantly improved the 6-minute walking distance by 20% and 14% in the air and oxygen group, respectively, when the patients were tested on air. In the same test the air group significantly decreased Borg ratings for perceived exertion. Borg ratings for dyspnoea and perceived exertion significantly decreased in the oxygen group when they were tested on oxygen. It was concluded that oxygen supplementation did not further improve the training effect, compared with training with air, in patients with chronic obstructive pulmonary disease and exercise-induced hypoxaemia.