BACKGROUND: High-intensity exercise is recommended for the pulmonary rehabilitation of patients with chronic obstructive pulmonary disease (COPD); however, it can cause an energy imbalance due to increased energy expenditure. Here, we aimed to explore the effect of reducing exercise intensity on energy balance in patients with COPD experiencing high-intensity training-induced weight loss. METHODS: All participants underwent high-intensity endurance and resistance training for a 2-week preliminary period. Those who lost more than 1% of their weight were then randomized to either continue high-intensity exercise (AA group) or switch to low-intensity exercise (AB group) for another 2 weeks (experimental period). RESULTS: The analysis included 30 participants (AA, n = 15; AB, n = 15). The AA group showed significant increases in body composition, dietary intake, nutritional status, muscle strength, and exercise capacity at week 4 than at week 2, with no significant changes in the AB group. After the experimental period, a greater proportion of the AA group had energy intake exceeding expenditure than did the AB group (80% versus 40%). CONCLUSIONS: In patients with COPD who lost body weight during pulmonary rehabilitation with high-intensity exercise, continuing this exercise had a more positive effect on body composition, nutritional status, physical function, and energy balance than did reducing exercise intensity. These results suggest the importance of continuing high-intensity exercise, while taking into consideration energy intake and nutritional therapy, even when body weight loss occurs during pulmonary rehabilitation in patients with COPD. TRIAL REGISTRATION: This study was retrospectively registered on the UMIN-CTR as UMIN000050976 on May 5, 2023.

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