One-Legged Cycle Training for Chronic Obstructive Pulmonary Disease. A Pragmatic Study of Implementation to Pulmonary Rehabilitation.
BACKGROUND
In patients with chronic obstructive pulmonary disease (COPD), partitioned exercise training using one-legged cycling leads to greater improvements in peak oxygen uptake than conventional two-legged cycling.


OBJECTIVE
We evaluated the feasibility of incorporating one-legged cycling as the principal aerobic training modality for pulmonary rehabilitation in COPD.


METHODS
Physiotherapists underwent four teaching sessions about the principles and practical implementation of one-legged cycling training. Patients enrolled in a pulmonary rehabilitation program underwent 6-8 weeks of training in which one-legged cycling three times per week was the principal aerobic exercise activity. Participants cycled for 15 minutes with each leg, in each session. An incremental cardiopulmonary exercise test was completed before and after pulmonary rehabilitation along with standard pulmonary rehabilitation outcome measures. Participants and physiotherapists completed a satisfaction survey at the end of the program.


RESULTS
A total of 22 out of 32 participants (14 male; mean [SD] age, 66 [7] years; FEV1% predicted, 32 [17]%; median [interquartile range] Medical Research Council dyspnea scale, 3.5 [3.0-4.3]) completed pulmonary rehabilitation. Peak oxygen uptake increased 1.1 (0.4-1.7) ml·min(-1)·kg(-1) (8%) from baseline (P<0.01). The mean (95% confidence interval) 6-minute-walk test distance improved by 72 (45-98) m (P=0.001). The change in the Chronic Respiratory Questionnaire total score of 1.6 (1.1-2.1; P<0.001) was achieved by improvement in all four domains above the clinically important difference. All the physiotherapists considered one-legged cycling safe and would continue to prescribe it; 75% of participants would recommend it to other patients.


CONCLUSIONS
One-legged cycling was successfully implemented into a "real-life" pulmonary rehabilitation program, demonstrating improvements in cardiorespiratory fitness with associated improvement in function for patients with moderate/severe COPD. One-legged cycling should be recommended in professional pulmonary rehabilitation guidelines as an option for exercise training and be available in other pulmonary rehabilitation programs. Clinical trial registered with www.clinicaltrials.gov (NCT01930526).
Departments of 1 Respiratory Medicine and.|2 Department of Infection, Immunity, and Inflammation, University of Leicester, Leicester, United Kingdom; and.|Departments of 3 Medicine and.
Rachael A
RA
Evans
Departments of 1 Respiratory Medicine and.|4 Respiratory Diagnostic and Evaluation Services, West Park Healthcare Centre, Toronto, Ontario, Canada.
Thomas E
TE
Dolmage
Departments of 1 Respiratory Medicine and.
Suzanna
S
Mangovski-Alzamora
Departments of 1 Respiratory Medicine and.
Julia
J
Romano
Departments of 1 Respiratory Medicine and.|Departments of 3 Medicine and.
Lauren
L
O'Brien
Departments of 1 Respiratory Medicine and.|5 Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
Dina
D
Brooks
Departments of 1 Respiratory Medicine and.|4 Respiratory Diagnostic and Evaluation Services, West Park Healthcare Centre, Toronto, Ontario, Canada.|Departments of 3 Medicine and.|5 Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
Roger S
RS
Goldstein
D000368:Aged; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
human; lung diseases; muscle; obstructive; oxygen consumption; physical conditioning; pulmonary; rehabilitation; skeletal