Chest
Volume 129, Issue 2, February 2006, Pages 325-332
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Original Research
Response to One-Legged Cycling in Patients With COPD

https://doi.org/10.1378/chest.129.2.325Get rights and content

Background

In patients with COPD, exercise intensity is often limited by the ventilatory system. We hypothesized that by exercising with a smaller muscle mass, ventilatory-limited patients would perform more high-intensity, muscle-specific work. The study objectives were as follows: (1) to determine the limitations of exercising with a smaller muscle mass, compared with conventional two-legged exercise; and (2) to determine the endurance time, using the same muscle-specific intensity, during one-legged vs two-legged exercise.

Methods

Nine patients (mean ± SD FEV1, 36 ± 13% of predicted) completed incremental exercise, and nine other patients (mean FEV1, 42 ± 16% of predicted) completed constant-power exercise. Nine healthy subjects (FEV1, 104 ± 14% of predicted) completed both tests. All subjects completed tests using two-legged and one-legged pedaling.

Results

Peak oxygen uptake ( V˙o2peak) was similar during one-legged and two-legged incremental exercise among patients (difference, 0.03 L/min; 95% confidence interval [CI], − 0.10 to 0.16 L/min; p = 0.60), as were ventilation and dyspnea scores. V˙o2peak was lower during one-legged vs two-legged exercise (− 0.57 mL/min; 95% CI, − 0.81 to − 0.32 mL/min; p < 0.001) among healthy subjects with substantial ventilatory and heart rate reserve. Patients endured one-legged pedaling at a constant power longer than two-legged pedaling (16.97 min; 95% CI, 9.98 to 23.96 min; p < 0.001), resulting in greater work (12.48 kilojoules [kJ]; 95% CI, 2.58 to 22.39 kJ; p = 0.02). Healthy subjects completed similar work (− 4.02 kJ; 95% CI, − 18.59 to 10.55 kJ; p = 0.54) with one-legged vs two-legged pedaling.

Conclusion

These observations demonstrate the effectiveness of using one-legged exercise at the same muscle-specific intensity in extending the duration of exercise among patients with COPD. This has important implications for training approaches designed to enhance exercise function among ventilatory-limited patients.

Section snippets

Subjects

Nonsmoking, clinically stable patients with COPD12 were enrolled. Patients were excluded if they were hypoxemic at rest (Pao2 < 55 mm Hg), had comorbidities that limited exercise tolerance, or were unable to provide informed consent. Healthy nonsmoking volunteers were recruited from among the health center staff. The study was approved by West Park Healthcare Centre Research Ethics Committee.

Exercise Testing

All of the 27 subjects were easily able to complete the required exercise tests, including both

Enrollment

A description of the patients completing the incremental and constant-power exercise tests is provided in Table l. All patients had a clear diagnosis of COPD,12 and all had stopped smoking at least 2 months before participation in the study. Hypothesis one was tested among nine COPD patients (group 1) who completed the incremental protocol. Hypothesis two was tested in nine other COPD patients (group 2) who completed the constant-power protocol. Nine healthy individuals completed both the

Discussion

In this report, we have studied patients with COPD with ventilatory limitation to exercise of sufficient severity for it to limit incremental exercise even when cycling with only one leg. By applying the same muscle-specific workload, with less total ventilatory load these patients tolerated constant-power exercise longer. Therefore, their total work was markedly increased. These findings have the potential to be applied to enhance the effectiveness of exercise training in patients with COPD.7

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    This study was supported in part by West Park Healthcare Centre Foundation.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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