To determine the immediate effects of bilevel non-invasive ventilation plus oxygen (NIV+O2) during exercise compared to exercise with O2 alone in people recovering from acute on chronic hypercapnic respiratory failure (HRF), a randomised crossover study with repeated measures was performed. Eighteen participants performed six minute walk tests (6MWT) and 16 participants performed unsupported arm exercise (UAE) tests with NIV+O2 and with O2 alone in random order. Distance walked increased by a mean of 43.4m (95% CI 14.1 to 72.8, p = 0.006) with NIV+O2 compared to exercise with O2 alone. In addition, isotime oxygen saturation increased by a mean of 5% (95% CI 2 to 7, p = 0.001) and isotime dyspnoea was reduced (median 2 (interquartile range (IQR) 1 to 4) versus 4 (3 to 5), p = 0.028) with NIV+O2. A statistically significant increase was also observed in UAE endurance time with NIV+O2 (median 201s (IQR 93 to 414) versus 157 (90 to 342), p = 0.033), and isotime perceived exertion (arm muscle fatigue) was reduced by a mean of 1.0 on the Borg scale (95% CI -1.9 to -0.1, p = 0.037) compared with O2 alone. Non-invasive ventilation plus O2 during walking resulted in an immediate improvement in distance walked and oxygen saturation, and a reduction in dyspnoea compared to exercise with O2 alone in people recovering from acute on chronic HRF. The reduction of dyspnoea during walking and arm muscle fatigue during UAE observed with NIV+O2 may allow patients to better tolerate exercise early in the recovery period.

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