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Ventilatory support during training improves training benefit in severe chronic airway obstruction
Reuveny R, Ben-Dov I, Gaides M, Reichert N
Israel Medical Association Journal 2005 Mar;7(3):151-155
clinical trial
6/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: One mechanism that may limit training effect in chronic obstructive pulmonary disease is the ventilatory limitation and associated dyspnea. OBJECTIVES: To minimize ventilatory limitation during training of patients with severe COPD by applying bi-level positive pressure ventilation during training in order to augment training intensity (and effect). METHODS: The study group comprised 19 patients (18 males, 1 female) with a mean age of 64 9 years. Mean forced expiratory volume in 1 second was 32 4% of predicted, and all were ventilatory-limited (exercise breathing reserve 3 9 L/min, normal > 15 L/min). The patients were randomized: 9 were assigned to training with BiPAP and 10 to standard training. All were trained on a treadmill for 2 months, twice a week, 45 minutes each time, at maximal tolerated load. Incremental maximal unsupported exercise test was performed before and at the end of the training period. RESULTS: BiPAP resulted in an increment of 94 53% in training speed during these 2 months, as compared to 41 19% increment in the control group (p < 0.005). Training with BiPAP yielded an average increase in maximal oxygen uptake of 23 16% (p < 0.005), anaerobic threshold of 11 12% (p < 0.05) and peak O2 pulse of 20 19% (p < 0.05), while peak exercise lactate concentration was not higher after training. Interestingly, in the BiPAP group, peak exercise ventilation was also 17 20% higher after training (p < 0.05). Furthermore, contrary to our expectation, at any given work rate, ventilation (and tidal volume) in the BiPAP group was higher in the post-training test as compared to the pre-training test, and the end tidal partial pressure of CO2 at 55 watts was lower, 40 4 and 38 4 mmHg respectively (p < 0.05). No improvement in exercise capacity was observed after this short training period in the control group. CONCLUSION: Pressure-supported ventilation during training is feasible in patients with severe COPD and it augments the training effect. The improved exercise tolerance was associated with higher ventilatory response and therefore lower P-ET-CO2 at equal work rates after training.

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