Page 42 - JCTR-11-4

Journal of Clinical and
Translational Research Physical exercise on COPD

Table 3. Parameters used in each study included in this review
Study (year) Frequency Intensity Duration Type
Zwerink et al. 16 In the first period, Intensity of the program was tailored to the A compulsory 6-month Training sessions consisted of
patients trained 3 individual patient’s performance level by the period, followed by an cycling, walking, climbing stairs,
times/week, and in physiotherapist optional but recommended and lifting weights
the second period, 5-month training period
twice per week
Breyer et al. 14 3 times/week 75% of the initial maximum heart rate 3 months Nordic walking
Wootton et al. 17 3 times/week Ground-based walking training 8 weeks Walking training was performed
commenced at 30 min duration, speed set on a flat indoor track within the
at 80% of the average speed achieved during participating hospitals
the 6-min walk test
Behnke et al. 15 Not informed Not informed 10 days Supervised walks on aisle, separated
by at least an hour and spread over
the whole day
Wootton et al. 18 2 or 3 times/week Walking training commenced at 30 min; 8 – 10 weeks Supervised, ground-based walking
pace adjusted to elicit a dyspnea score of training
3 – 4 on a modified 0 – 10 point
category-ratio dyspnea scale

training, but stagnation in progress between months Borg scale scores may not show significant changes due
3 and 9. These results are consistent with those of to several factors, such as the type of exercise performed,
Jehn et al., who suggested that the training response the intensity applied, the short duration of interventions,
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may be greater in the early stages of a program, with the patients’ physiological adaptation to the effort, or
a “learning” effect initially, followed by a plateau in individual characteristics like an altered effort perception
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further gains. Bourbeau et al. explained that while threshold in people with COPD.
adaptation to exercise may occur quickly, psychosocial The analysis of the studies reinforces the idea that, in
factors, such as adherence to the exercise program and order to maximize the benefits of exercise in COPD, the
patient behavior, can influence the maintenance of approach must be individualized, taking into account the
long-term benefits. severity of the disease, the patient’s physical condition,
The stagnation in progress observed by Zwerink motivation, and the presence of comorbidities. Exercise
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et al. between 7 and 12 months into the intervention is should be adjusted in terms of intensity, duration, and
another important consideration. The authors suggested type to ensure that patients not only improve their
that this may be related to a lack of patient adherence and functional capacity but also maintain these gains over
motivation over time. Sullivan et al. also pointed out that time.
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after pulmonary rehabilitation programs end, many COPD With such a small number of studies, the ability to
patients return to previous levels of inactivity, which detect true and consistent effects across them is reduced,
contributes to the loss of gains achieved. increasing the risk of type II errors (false negatives).
Furthermore, the variability among studies may have a
Puhan et al. noted that a combination of aerobic disproportionate influence on the overall results, making
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and resistance exercise may be more effective than it difficult to assess heterogeneity and generalize the
aerobic exercise alone in improving functional capacity findings. The wide CI observed in the distance walked
and quality of life in COPD patients. This is consistent during the 6-min walk test may be attributed to factors
with the findings of Breyer et al., who used Nordic such as small sample sizes, high variability among
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walking training, and Zwerink et al., who incorporated participants, and inconsistencies in test protocols, all
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a community physiotherapy program focused on of which hinder the accuracy of clinical interpretation.
walking. Lange et al. also emphasized that combining Heterogeneity among the studies was assessed using the
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aerobic training with muscle-strengthening exercises I index, which revealed moderate to high variability.
2
aimed at improving the endurance of type I and type II Furthermore, differences in exercise protocols across
muscle fibers can result in more lasting benefits, as the included studies contributed to this variability,
these modalities address the peripheral muscle deficits highlighting the importance of considering these aspects
observed in COPD. when interpreting the results.

Volume 11 Issue 4 (2025) 36 doi: 10.36922/jctr.25.00004