title: Nonlinear exercise training in advanced chronic obstructive pulmonary disease is superior to traditional exercise training. A randomized trial.
abstract: BACKGROUND
  The optimal exercise training intensity and strategy for individualized exercise training in chronic obstructive pulmonary disease (COPD) is not clear.
  
  
  OBJECTIVE
  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.
  
  
  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] = 197.2-404.2 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 = 0.19-0.78) for the domain, emotions, to +0.96 (95% CI = 0.57-1.35) 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).
authors: Department of Pulmonology, Merem Asthma Center Heideheuvel, Hilversum, The Netherlands. pklijn@heideheuvel.merem.nl
authors: Peter
authors: P
authors: Klijn
authors: Anton
authors: A
authors: van Keimpema
authors: Monique
authors: M
authors: Legemaat
authors: Rik
authors: R
authors: Gosselink
authors: Henk
authors: H
authors: van Stel
mesh_terms: D000222:Adaptation, Physiological / Q000502:physiology; D000368:Aged; D015444:Exercise; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D010807:Physical Endurance; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000534:rehabilitation*; D011788:Quality of Life; D016896:Treatment Outcome