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Chronic obstructive pulmonary disease
Published in John M. Saxton, Exercise and Chronic Disease, 2011
The initial intensity of aerobic exercise should ideally be set at 70–80 per cent of the peak O2 (either measured or predicted from a walking test), with breathlessness scores being monitored during exercise training and used to inform adjustments to intensity (Mahler et al., 2003). However, a more thorough discussion of optimal exercise intensity is presented below. Peak power output (measured during an incremental exercise test) has been used as an alternative approach to determine aerobic exercise training intensity, with an intensity of 60–80 per cent of the peak power output frequently shown to evoke positive results. Another option is to express aerobic exercise training intensity as a percentage of the maximal heart rate (using the prediction formula: 220 minus age). Caution is necessary using this approach though, as there is significant variability in heart rate measurements in patients with COPD and in the corresponding relationships with lactate threshold (Zacarias et al., 2000). Furthermore heart rate is influenced by various medications commonly prescribed for COPD. Hence, individualised exercise prescription requires a flexible approach: for patients with mild COPD, not used to exercise, heart-rate based exercise prescription may result in significant cardiovascular benefits (Vallet et al., 1994), with intensities of 80–85 per cent predicted maximum heart rate needed to achieve lactate threshold intensities (Zacarias et al., 2000). Lower intensities can lead to less than expected change in functional outcomes (Pitta et al., 2004). Clinical judgment is always required to determine the most appropriate aerobic exercise training prescription, with respect to optimising the exercise stimulus and encouraging long-term behaviour change.
Low volume high intensity interval training leads to improved asthma control in adults
Published in Journal of Asthma, 2021
A one group pre (first HIIT session), post (last HIIT session) study design was used in which eligible participants (non-smoking, moderately active adults with a self-reported physician diagnosis of asthma, with a current prescription for a short-acting bronchodilator, aged 18–44 years) completed 6 weeks of HIIT, 3 times per week on a cycle ergometer (5 min warm-up at 25 Watts, followed by 10% peak power output for 1 min and 90% peak power output for 1 min, repeated 10 times). Participants completed a ramp incremental maximal exercise test (increase by 1 Watt every 2 s until volitional exhaustion) to determine peak power output at pre and post-intervention. Peak power output was reported as the last workload in which a RPM of 70–80 was maintained. All participants provided written informed consent prior to participation in the study. This study was approved by the Research Ethics Board at the University of Ontario Institute of Technology.
Feasibility of high-intensity training in asthma
Published in European Clinical Respiratory Journal, 2018
L. L. Toennesen, E. D. Soerensen, M. Hostrup, C. Porsbjerg, J. Bangsbo, V. Backer
Prior to exercise testing, patients refrained from severe physical activity for at least 24 h. The cardiopulmonary exercise test was performed in accordance with the American Thoracic Society’s guidelines [17] on a bike ergometer (Monark 839E, Stockholm, Sweden). The test started at an intensity of 50 W and increased by 2 W every 6 s until exhaustion. Oxygen uptake was simultaneously recorded breath-by-breath with a gas-analyser system (Master Screen JAEGER CPX, Viasys Healthcare, Hoechberg, Germany). Before testing, all patients were instructed to inhale two puffs of their regular SABA. VO2 max was measured as the highest oxygen consumption in a period of 30 s divided by the total body weight. The criteria used to end the bicycle tests were as follows: Either an elevated respiratory exchange ratio (RER) ≥1.1, achievement of at least 90 percentage of age-adjusted estimate of maximal heart rate (HRmax) and/or reaching a VO2 plateau within 2 and 2.2 ml·kg(−1)·min(−1). Peak power output (PPO) was defined as the highest load (watt) reached during the exercise test. HRmax was measured during the test.