Eccentric Exercise in COPD

FOR RELATED ARTICLE, SEE PAGE 564Eccentric training has been proposed as a therapeutic alternative to concentric in symptom-limited individuals with COPD who are unable tolerate conventional exercise, because up four times greater muscle forces can be generated lower ventilatory demands.1Ellis R. Shields N. Lim K. Dodd K.J. Eccentric exercise adults cardiorespiratory disease: systematic review.Clin Rehabil. 2015; 29: 1178-1197Crossref PubMed Scopus (9) Google Scholar Scientific evidence on eccentric emerged the past decade,2Camillo C.A. Burtin C. Hornikx M. et al.Physiological responses during downhill walking: new modality for subjects chronic obstructive pulmonary disease?.Chron Respir Dis. 12: 155-164Crossref (25) Scholar, 3Camillo Osadnik C.R. al.Effects of walking rehabilitation patients COPD: randomised controlled trial.Eur J. 2020; 56: 2000639Crossref (8) 4Mujaddadi A. Moiz J.A. Singla D. Naqvi I.H. Ali M.S. Talwar Effect markers damage disease.Physiother Theory Pract. 2019; ([published online ahead print July 25, 2019]): 1-7https://doi.org/10.1080/09593985.2019.1644690Crossref (2) 5Bourbeau De Sousa Sena Taivassalo T. al.Eccentric versus cycle improve strength advanced randomized clinical trial.Respir Physiol Neurobiol. 276: 103414Crossref (11) 6MacMillan N.J. Kapchinsky S. Konokhova Y. ergometer promotes locomotor but not mitochondrial adaptation severe disease.Front Physiol. 2017; 8: 1-14PubMed 7Rocha Vieira D.S. Baril Richard Perrault H. Bourbeau feasibility application.COPD. 2011; 270-274Crossref (38) and studies have shown that endurance use contractions is well-tolerated, safe feasible.7Rocha However, its ability elicit sufficient physiologic induce effect similar still under debate, it unclear whether comparable between healthy individuals. 564 In this issue CHEST, Ward al8Ward T.J.C. Lindley M.R. Ferguson R.A. al.Submaximal cycling people acute whole-body cardiopulmonary metabolic responses.Chest. 2021; 159: 564-574Abstract Full Text PDF (6) compare tests across range matched mechanical workloads stable age-matched control subjects. Participants cycled six 4-minute bouts starting at 15% peak workload achieved maximal incremental test, increments until reaching 90% or volitional exhaustion. Differences were For same workload, magnitude was than cycling, minimal increases oxygen uptake minute ventilation even higher workloads, perception fatigue dyspnea. separate visits, authors also performed biopsies determine before after 20-minute (or exhaustion) constant load 65% workload. Changes phosphocreatine, creatine, lactate concentrations observed concentric, eccentric, cycling. Findings suggest that, loads, does evokes exercise-induced symptoms. It should noted expected able achieve absolute loads Two recent trials evaluated effects (adaptations) vs COPD.5Bourbeau Scholar,6MacMillan Both conducted by research group included 10 weeks consisted three weekly 30-minute sessions These found elicited improvement isometric quadriceps relative thigh mass showed less compared The latter line low level al.8Ward Interestingly, literature suggests (both walking) enhance capacity, possibly extent training.3Camillo Scholar,5Bourbeau This matches strong relationship capacity COPD. Lower limb weakness common related intolerance, impaired postural control, poor quality life, premature death.9Spruit M.A. Singh S.J. Garvey al.An official American Thoracic Society/European Respiratory Society statement: key concepts advances rehabilitation.Am J Crit Care Med. 2013; 188: e13-e64Crossref (1991) Therefore, optimizing considered an important goal rehabilitation. tempting speculate could particularly interesting intervention profound leg markedly limited dyspnea moderate-to-high intensity aerobic exercise. equipment used may play role response subjective experience upright perform tests, which limit trunk stability reaction required force production.10Lipski Abbiss Nosaka Cardio-pulmonary task failure.Eur Appl 2018; 118: 947-957Crossref (16) supported participants reported challenging due concentration difficulty getting technique.8Ward Recumbent ergometers do demonstrate motor coordination difficulties except work rates (>176 W), although seem prevent progression power subsequent sessions.7Rocha Another walking, easier implement expensive function. COPD, (eccentric exercise) produced (concentric exercise), similarly findings while inducing low-frequency (a determinant optimal terms capacity).2Camillo Walking advantage being translated easily daily functional activity involving several muscles from limb, places stress muscle. choice consider patients’ tolerance levels, available resources, goals. Overall, function reduced costs. scarce. small samples heterogeneity grades previous preclude firm conclusions about benefit most type training. widely recognized highly variable compliance programs compromised severely patients, thus tailored interventions recommended optimize outcomes.11Spruit Wouters E.F.M. Organizational aspects respiratory diseases.Respirology. 24: 838-843Crossref (28) feasible option these early stages motivate them adhere improving preferred supports idea. Further needed standardize intensity, duration, modes best candidates timing within application ensure patient safety. Submaximal Cycling People With Acute Whole-Body Cardiopulmonary Muscle Metabolic ResponsesCHESTVol. 159Issue 2PreviewCardiopulmonary blood submaximal ECC CON equivalent confirmed patients. well tolerated allowed cost. based unlikely stimulate cardiovascular CON. Full-Text