title: The effects of high intensity exercise during pulmonary rehabilitation on ventilatory parameters in people with moderate to severe stable COPD: a systematic review.
abstract: OBJECTIVE
  The objective of this systematic review was to determine whether people with moderate to severe COPD who are participating in pulmonary rehabilitation and exercising at high intensity demonstrate the changes in ventilatory parameters that are associated with decreased dyspnea.
  
  
  METHODS
  The authors searched EMBASE, The Cochrane Library, and CINAHL databases up to December 2013 for relevant randomized control trials, systematic reviews, and observational studies. References of identified studies were also screened.
  
  
  METHODS
  Studies conducted in a pulmonary rehabilitation setting that included education and exercise were included. Symptom-limited, graded exercise testing that measured tidal volume, respiratory rate, minute ventilation, and inspiratory capacity was required. The studies that contained these keywords in the title or the abstract were selected for further evaluation of the text. Disagreements between reviewers were resolved by consensus. Four studies met these inclusion criteria.
  
  
  METHODS
  Quality assessment and data extraction were performed independently by two reviewers. Risk of bias and quality was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions.
  
  
  RESULTS
  Participants in three studies trained at high intensity (70%-80% maximum workload), demonstrating statistically significant changes in tidal volume and respiratory rate. One study did not demonstrate positive ventilatory benefits; however, participants may not have met the desired training intensity. Two studies reported improvement in dyspnea at submaximal exercise intensities. One study noted an increased maximum workload with no significant change in dyspnea at peak exercise.
  
  
  CONCLUSIONS
  People with moderate to severe, stable COPD were able to perform high intensity exercise, which was associated with positive changes in ventilatory parameters and dyspnea. A number of factors limit the generalizability of these results to people participating in pulmonary rehabilitation.
authors.affiliation: School of Physiotherapy, Dalhousie University, Halifax, NS, Canada.
authors.forename: Kristin
authors.initials: K
authors.lastname: Osterling
authors.affiliation: School of Physiotherapy, Dalhousie University, Halifax, NS, Canada.
authors.forename: Kimbly
authors.initials: K
authors.lastname: MacFadyen
authors.affiliation: School of Health Sciences, Dalhousie University, Halifax, NS, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Gilbert
authors.affiliation: School of Physiotherapy, Dalhousie University, Halifax, NS, Canada.
authors.forename: Gail
authors.initials: G
authors.lastname: Dechman
mesh_terms: D004417:Dyspnea / Q000209:etiology / Q000503:physiopathology; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D012123:Pulmonary Ventilation; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: chronic obstructive lung disease; chronic obstructive pulmonary disease; exercise; respiratory rate; tidal volume