title: Effect of endurance training on expiratory flow limitation and dynamic hyperinflation in patients with stable chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Expiratory flow limitation (EFL) is the primary pathophysiological hallmark of chronic obstructive pulmonary disease (COPD). However, the effect of lower-extremity endurance training alone on EFL in patients with COPD remains largely unknown.
  
  
  OBJECTIVE
  This study aims to determine the effects of endurance training on EFL and dynamic hyperinflation in patients with stable COPD.
  
  
  METHODS
  This was a prospective, single-blinded, non-randomised controlled 12-week study recruiting Chinese patients with stable COPD in an endurance training group (n = 15) or a control group (n = 13). Before and at the end of the study, we measured the EFL, pulmonary function, peak inspiratory flow (PIF) and maximum inspiratory pressure (MIP); moreover, the patients underwent a constant work rate exercise test in which Borg dyspnoea scale, tidal breathing flow volume curves and inspiratory capacity (IC) were determined every other minute.
  
  
  RESULTS
  Exercise training significantly improved the exercise endurance time (7.00 ± 3.05 vs 18.13 ± 6.44 min, P < 0.001), MIP (69.49 ± 16.03 vs 80.18 ± 15.97 cmH2 O, P < 0.001) and PIF (3.96 ± 1.01 vs 4.51 ± 1.13 L/s, P = 0.014), but not EFL (3.33 ± 0.49 vs 3.40 ± 0.51, P = 0.334). Subjects on training had decreased breathing frequency (26.26 ± 7.13 vs 23.15 ± 5.34 breaths/min, P = 0.002), minute ventilation (30.28 ± 7.52 vs 26.85 ± 4.17 L, P = 0.013), tidal peak expiratory flow (1.53 ± 0.22 vs 1.32 ± 0.20 L/s, P = 0.006), mean expiratory flow (0.87 ± 0.19 vs 0.68 ± 0.15 L/s, P = 0.011) and Borg dyspnoea score (7.20 ± 1.15 vs 3.93 ± 1.39, P < 0.001), as well as increased IC (1.50 ± 0.34 vs 1.67 ± 0.45 L, P = 0.002), expiratory time (1.47 ± 0.62 vs 1.72 ± 0.62 s, P = 0.004) and inspiratory flow reserve (2.05 ± 1.10 vs 2.95 ± 1.19 L/s, P = 0.002) at isotime. These changes were not observed in the control group.
  
  
  CONCLUSIONS
  Endurance training may benefit stable COPD patients in improving exercise endurance, inspiratory muscle strength, ventilatory requirements, exercise-induced hyperinflation and exertional dyspnoea.
authors.affiliation: Department of Respiratory diseases, SUN Yat-sen Memorial Hospital, SUN Yat-sen University, Guangzhou, China.
authors.forename: R
authors.initials: R
authors.lastname: Chen
authors.forename: R
authors.initials: R
authors.lastname: Chen
authors.forename: X
authors.initials: X
authors.lastname: Chen
authors.forename: L
authors.initials: L
authors.lastname: Chen
mesh_terms: D000368:Aged; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D010807:Physical Endurance / Q000502:physiology*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000534:rehabilitation*; D016037:Single-Blind Method; D014797:Vital Capacity / Q000502:physiology*
keywords: COPD; dynamic hyperinflation; exercise endurance; exercise training; expiratory flow limitation