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Inspanningstraining bij ernstige COPD: minder hard trainen geeft meer effect (Nonlinear exercise training in advanced COPD is superior to traditional exercise training: a randomized trial) [Dutch]
Klijn P, Legemaat M, van Keimpema ARJ, Gosselink R, van Stel HF
Nederlands Tijdschrift voor Geneeskunde 2013 Aug 27;157(35):A6629
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

RATIONALE: The optimal exercise training intensity and strategy for individualized exercise training in chronic obstructive pulmonary disease (COPD) is not clear. OBJECTIVES: This study compares the effects of nonlinear periodized exercise (NLPE) training used in athletes to traditional endurance and progressive resistance (EPR) training in patients with severe COPD. METHODS: A total of 110 patients with severe COPD (FEV1 32% predicted) were randomized to EPR or NLPE. Exercise training was performed three times per week for 10 weeks. The primary outcomes were cycling endurance time and health-related quality of life using the Chronic Respiratory Questionnaire. The difference in change between EPR and NLPE was assessed using linear mixed-effects modeling. MEASUREMENTS AND MAIN RESULTS: NLPE resulted in significantly greater improvements in cycling endurance time compared with EPR. The difference in change was +300.6 seconds (95% confidence interval (CI) 197.2 to 404.2 s; p < 0.001). NLPE also resulted in significantly greater improvements in all domains of the Chronic Respiratory Questionnaire compared with EPR, ranging from +0.48 (95% CI 0.19 to 0.78) for the domain, emotions, to +0.96 (95% CI 0.57 to 1.35) for dyspnea. CONCLUSIONS: NLPE results in greater improvements in cycle endurance and health-related quality of life in patients with severe COPD than traditional training methods. Clinical trial registered with www.trialregister.nl (The Netherlands Trial Register; NTR 1045).

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