1. BELLARMINE UNIVERSITY, LOUISVILLE, KY Improving Function of Patients with COPD Sarah Demarest, Rachel Flaherty, Ali Hafele, & Beth Niebuhr Bellarmine University

2. BELLARMINE UNIVERSITY, LOUISVILLE, KY PICO Question  Aerobic interval exercise compared to strength training http://thenutrifarm.com/can-you-stop-the-progression-of-copd/

3. BELLARMINE UNIVERSITY, LOUISVILLE, KY COPD & Exercise Characteristics  Limited ○ Exercise capacity ○ Ventilatory constraints (http://www.livingwellwithcopd.com/en/what-is-copd.html)

4. BELLARMINE UNIVERSITY, LOUISVILLE, KY COPD Training A) Dyspnea B) Leg Fatigue C) Lactate Concentration (Kortianou, 2013) Continuous Interval

5. BELLARMINE UNIVERSITY, LOUISVILLE, KY  Oxygen Uptake (VO2)  Minute Ventilation (VE) Continuous Interval COPD Training (Kortianou, 2013)

6. BELLARMINE UNIVERSITY, LOUISVILLE, KY Benefits of Interval Training Peripheral Muscle  Increases ms oxidative capacity  Increases cross sectional area of Type I and IIa fibers  Decreases Type IIb fibers  Limited increase of lactate Ventilatory Tolerate high intensity exercise Limited increase of lactate Prolonged tolerance to ventilation Lower perception of dyspnea (Information provided by: Vogiatzis, 2002; Kortianou, 2013)

7. BELLARMINE UNIVERSITY, LOUISVILLE, KY 12 Week Exercise Program for Patients with COPD Initial sessions Freq: 3-4x/wk Mode: 20-30s on/30-40s off Intensity: 80% max work load Duration: 15-20mins Increasing Intensity 5-10% of peak capacity Use 10-point Borg scale - Legs 5-6 - Dyspnea 3-4 Increasing Time - 30-90 mins (including rest) (Information provided by: Vogiatzis, 2002; Kortianou, 2013)

8. BELLARMINE UNIVERSITY, LOUISVILLE, KY Benefits of Interval Training (Information provided by: Vogiatzis, 2002; Kortianou, 2013)  Interval  ° Continuous 1 5 9 13 17 21 25 Training Session

9. BELLARMINE UNIVERSITY, LOUISVILLE, KY Clinical Implications: Interval vs. Continuous Indications: work related training improve domestic function less dyspnea with ADL’s (Vogiatzis, 2002) (Voiatzis, 2002)

10. BELLARMINE UNIVERSITY, LOUISVILLE, KY Strength Training For COPD Pts  Reasons to Strength Train  Muscle atrophy  Dyspnea  Low tolerance levels  De-conditioned  Resistance training is preferred if peripheral muscle atrophy is the main limiting factor over cardiovascular issues (Information provided by Ortega, 2002; Spruit, 2002)

11. BELLARMINE UNIVERSITY, LOUISVILLE, KY Strength Training Results  Increased:  FEV1  Power for cycle ergometry  QOL  Peripheral muscle force  Muscle endurance  Muscle strength (Clark, 2000) (Information provided by: Spruit, 2002; Wright, 2003)

12. BELLARMINE UNIVERSITY, LOUISVILLE, KY Benefits of Strength Training  Improved pulmonary function  Improved endurance capacity  Improved general well-being (Information provided by: Wright, 2003, Clark, 2000)

13. BELLARMINE UNIVERSITY, LOUISVILLE, KY Strength Training in Patients with Mild COPD 12 week Training Program:  Patients with mild COPD  2x/week  Cycling/walking warm-up and cool-down  3x10 reps of 8 individual weight exercises:  bench press (triceps)  body squat (quadriceps)  squat calf (medial and lateral gastroc; soleus)  latissimus (latissimus dorsi)  arm curls (biceps)  leg press (quadriceps, hamstrings, gluteals)  knee flexion (quadriceps)  hamstrings (Clark, 2000)

14. BELLARMINE UNIVERSITY, LOUISVILLE, KY Interval Training Strength Training 10%-20% increase in 6MWT Increased exercise tolerance - Aerobic and anaerobic challenges Increased QoL - Physical function - Health role limits - Emotion role limits - Social function - Mental Health - Energy Levels Increased functional capacity - ADLs Educational Opportunities - Maintenance of function - Current Health (Kaelin, 2001)

15. BELLARMINE UNIVERSITY, LOUISVILLE, KY Conclusion Patients with COPD have decreased strength and endurance capacity Resistance training can allow for strength and endurance gains Patients are better able to tolerate interval training compared to continuous The optimal exercise treatment program for patients with COPD is a combination of resistance training and interval training for improving function. Support for COPD Patients

16. BELLARMINE UNIVERSITY, LOUISVILLE, KY References Clark CJ, Cochrane LM, Mackay E, Paton B. Skeletal muscle strength and endurance in patients with mild COPD and the effects of weight training. Eur Respir J 2000;15:92-7. Kaelin M, Swank A, Barnard K, Adams K, Beach P, Newman J. Physical fitness and quality of life outcomes in a pulmonary rehabilitation program utilizing symptom limited interval training and resistance training. Journal Of Exercise Physiology Online [serial online]. August 2001;4(3)Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed November 12, 2013. Kortianou E, Nasis I, Spetsioti S, Daskalakis A, Vogiatzis I. Effectiveness of Interval Exercise Training in Patients with COPD. Cardiopulmonary Physical Therapy Journal [serial online]. September 2010;21(3):12-19. Available from: MEDLINE, Ipswich, MA. Accessed November 12, 2013. Ortega F, Toral J, Cejudo P, Villagomez R, Sánchez H, Castillo J, et al. Comparison of effects of strength and endurance training in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2002;166:669–74. Spruit M.A, Gosselink R, Troosters T, De Paepe K, Decramer M. Resistance versus endurance training in patients with COPD and peripheral muscle weakness. Eur Respir J 2002; 19: 1072–1078. Vogiatzis I, Nanas S, Roussos C. Interval training as an alternative modality to continuous exercise in patients with COPD. Eur Respir J [serial online]. July 2002; 20 (1): 12-19. Accessed September 24, 2013. Vonbank K, Strasser B, Haber P, et al. Strength training increases maximum working capacity in patients with COPD--randomized clinical trial comparing three training modalities. Respiratory Medicine [serial online]. April 2012;106(4):557-563. Available from: MEDLINE, Ipswich, MA. Accessed November 12, 2013. Wright P, Heck H, Langenkamp H. Effects of a Resistance Training on Pulmonary Function and Performance Measurements in Patients With Chronic Obstructive Pulmonary Disease. European Journal Of Sport Science[serial online]. June 2003;3(3):1-10. Available from: Academic Search Premier, Ipswich, MA. Accessed November 12, 2013.