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Effect of Respiratory Muscle Endurance Training in Patients With COPD Undergoing Pulmonary Rehabilitation^*

^* From the Veterans Affairs Western New York Healthcare System (Drs. Mador, Deniz, Aggarwal, Kufel, and Ms. Shaffer), Buffalo, NY; and Exercise Physiology (Dr. Spengler), Institute for Human Movement Sciences, Swiss Federal Institute of Technology, Zurich, Switzerland.

Correspondence to: M. Jeffery Mador, MD, Division of Pulmonary, Critical Care, and Sleep Medicine, Section 111S, State University of New York at Buffalo, Veterans Administration Medical Center, 3495 Bailey Ave, Buffalo, NY 14215; e-mail: mador{at}acsu.buffalo.edu

Background: Respiratory muscle endurance training (hyperpnea training) has been shown to have beneficial effects in patients with COPD.

Study objectives: The purpose of this study was to determine whether hyperpnea training, when added to an endurance exercise training program, would lead to additional benefits compared with endurance training alone in patients with COPD.

Setting and participants: Patients with COPD entering an 8-week outpatient pulmonary rehabilitation program. Fifteen patients (mean [± SE] FEV₁, 45 ± 6% predicted) were randomized to combined therapy, and 14 patients (mean FEV₁, 44 ± 4% predicted) were randomized to endurance training.

Methods: Peak exercise capacity, exercise endurance time during constant workload cycle exercise, 6-min walk distance, quality of life as measured by the chronic respiratory questionnaire, respiratory muscle strength and endurance, and quadriceps fatigability were measured before and after endurance or combined training.

Results: After rehabilitation, peak exercise capacity, exercise endurance time, 6-min walk distance, and quality of life all increased in both groups, but there was no significant difference in the extent of improvement between groups. Mean respiratory muscle endurance increased to a significantly greater extent in the combined therapy group (17.5 ± 2.7 vs 8.5 ± 2.5 min, respectively; p = 0.02). Respiratory muscle strength was significantly increased, and quadriceps fatigability was significantly reduced after rehabilitation in the combined therapy group but not in the endurance training group, but the difference between groups did not reach statistical significance.

Conclusion: The endurance of the respiratory muscles can be improved by specific training beyond that achieved by endurance training alone in patients with COPD. However, this improvement did not translate into additional improvement in quality of life or exercise performance.

Key Words: COPD • exercise • exercise therapy • muscles • pulmonary disease • rehabilitation • skeletal

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