EXERCISE, EXERCISE TESTING and EXERCISE TRAINING
SEE ALSO Pulmonary rehabilitation
GUIDELINE on EXERCISE TESTING:
ATS/ACCP Statement on cardiopulmonary exercise testing (2003). Am J Respir Crit Care Med, 167, 211277.
ajrccm.atsjournals.org/cgi/reprint/167/2/211
ATS STATEMENT: Guidelines for the six-minute walk test (2002) Am J Respir Crit Care Med, 166: 111-117
ajrccm.atsjournals.org/cgi/content/full/166/1/111
indications, practicalities, safety factors, interpretation of results
Aboussouan LS (2009) Mechanisms of exercise limitation and pulmonary rehabilitation for patients with neuromuscular disease. Chr Respir Dis, 6, 4, 231-49
crd.sagepub.com/cgi/content/abstract/6/4/231
benefits of carefully-managed exercise training for neurological patients, including support from noninvasive ventilation, neuromuscular electrical stimulation, or diaphragm pacing
Aliverti A (2001) How and why exercise is impaired in COPD. Respiration, 68, 229-39
high expiratory pressures may reduce venous return and limit exercise in COPD
Bandolier (2004) Physical activity reduces risk of cognitive decline, vol.130
www.jr2.ox.ac.uk/bandolier/booth/hliving/physcog.html
exercise reduces the risk of cognitive decline
Bandolier (2004) Bone mass and exercise in women, vol.130
www.jr2.ox.ac.uk/bandolier/band68/b68-2.html
exercise training programmes prevent or reverse bone loss of almost 1% per year
Bauldoff GS (1996) Home-based upper-arm exercise training for COPD. Heart Lung, 25, 288-94.
upper arm training can reduce SOB
Behnke M, Wewel AR, Kirsten D et al (2005) Exercise training raises daily activity stronger than predicted from exercise capacity in patients with COPD. Respir Med, 99, 711-17
www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WWS-4F8TK5D-1&_user=10&_handle=V-WA-A-W-AD-MsSAYVA-UUW-U-AAVEVEBYUW-AAVDUDVZUW-YCUVBEWVU-AD-U&_fmt=summary&_coverDate=06%2F30%2F2005&_rdoc=7&_orig=browse&_srch=%23toc%237138%232005%23999009993%23594642!&_cdi=7138&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=eb0f836c06049c4496fc44a8c8246982
exercise training increased activity significantly more than predicted from the gain in exercise capacity, implicating the importance of patient-centred factors
Billaut F (2010) Cerebral oxygenation decreases but does not impair performance during self-paced, strenuous exercise. Act Physiol, 198, 477-86
Bjψrnshave B, Korsgaard J (2005) Comparison of two different levels of physical training in patients with moderate to severe COPD. Lung, 183, 101-108
www.springerlink.com/(ign225bp0skgvhar5wfhp4z0)/app/home/contribution.asp?referrer=parent&backto=issue,3,6;journal,3,52;browsepublicationsresults,1643,2517
minimum training necessary to improve physical performance is 23 hours a week of middle intensity homebased training,
Bjφrnstad H et al (2001) Recommendations for exercise training in chronic heart failure patients. Eur Heart J, 22, 2, 125-135
eurheartj.oxfordjournals.org/content/22/2/125.full.pdf+html
Brooks D, Solway S (2006) Should the endurance shuttle walk test replace the six-minute walk test in individuals with COPD? Chron Respir Dis, 3, 1-2
endurance test is very responsive but requires four tests which may cause excessive fatigue and be too time-consuming in practice.
Carrieri-Kohlman V et al (2001) Dyspnea and the affective response during exercise training in obstructive pulmonary disease. Nurs Res, 50, 136
exercise reduces anxiety related to breathlessness
Cesari M (2004) Antioxidants and physical performance in elderly persons. Am J Clin Nutr, 79, 289-94
higher dietary intakes of most antioxidants, especially vitamin C, is associated with higher skeletal muscular strength in elderly persons
Clark CJ (1996) Low intensity peripheral muscle conditioning improves exercise tolerance and breathlessness in COPD. Eur Resp J, 9, 2590-6.
details of exercises,
outcomes: increased fitness, reduced SOB, on-going self-management
Collins E (2004) Effects of exercise training on aerobic capacity and quality of life in individuals with heart failure. Heart Lung, 33, 3, 154-61
exercise training in adults with heart failure increases exercise tolerance and perceived physical function
Collins EG (2001) Breathing pattern retraining & exercise in COPD. AACN Clin Issues, vol.12
literature review
Cooper CB (2006) Exercise testing does not have to be complicated. Chronic Respir Dis, 3, 2, 107-108
Dainese R (2004) Effects of physical activity on intestinal gas transit and evacuation in healthy subjects. Am J Med, 116, 536-9
flatulence may be relieved by gentle bed exercises
Davis AHT (2007) Reliability and validity of the Exercise Self-regulatory Efficacy Scale for individuals with COPD. Heart Lung, 36, 3, 205-16
Dimeo F, Schwartz S, Wesel N et al (2008) Effects of an endurance and resistance exercise program on persistent cancer-related fatigue after treatment. Ann Oncol, 19, 8, 1495-9
annonc.oxfordjournals.org/content/19/8/1495.full.pdf+html
a 3-week exercise program leads to a substantial improvement of physical performance and reduction of mental and physical fatigue in cancer patients
Drukker M et al (2001) The effects of exercise training in institutionalized elderly people. Phys Ther Rev, 6, 273-85
Eberhardt RT (2002) Exercise for intermittent claudication. J Cardiopulm Rehabi, 22, 199-200
long-term exercise may reduce ischaemic-related cardiovascular complications
Ernst E (1996) Exercise training and heart failure. Eur J Phys Med Rehabil, 6,161.
exercise is beneficial in compensated heart failure
Fiatarone MA (1994) Exercise training and nutritional supplementation for physical frailty in very elderly people. New Eng J Med, 330, 1769-75.
exercise training is effective in very elderly people
Fowler SJ, Singh SJ, Revill S (2004) Reproducibility and validity of the incremental shuttle walking test in patients following coronary artery bypass surgery. Physiotherapy, 91, 22-7
incremental shuttle walking test relates to cardiorespiratory fitness and correlates with VO2 max
Gigliotti F (2003) Exercise training improves exertional dyspnea in patients with COPD. Chest, 123, 17941802
www.chestjournal.org/cgi/content/full/123/6/1794?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=123&firstpage=1794&resourcetype=HWCIT
Glass JM (2004) The effect of brief exercise cessation on pain, fatigue, and mood symptom development in healthy, fit individuals. J Psychosom Res, 57, 391-398
www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T8V-4DN233P-G&_coverDate=10%2F31%2F2004&_alid=327963240&_rdoc=1&_fmt=&_orig=search&_qd=1&_cdi=5096&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=f801d3e0377a2ab17fe68fd5ed5e6d03
some healthy people who have hypoactive function of their stress response unknowingly exercise to augment this response and suppress symptoms; they may be at risk for developing chronic multisymptom illnesses e.g. chronic fatigue syndrome
Griffiths TL (1996) Effects of a structured domiciliary exercise training programme on quality of life and walking tolerance in patients with severe COPD. Eur Resp J, 9(23), 144s
rehab for severely-impaired patients leads to ¬ exercise tolerance and quality of life
Hamdorf PA (1999) Walking with its training effects on the fitness and activity patterns of 79-91 year old females. Aust NZ J Med, 29, 22-8
exercise programme increases exercise tolerance in healthy very elderly women
Hautala A et al (2006) Individual differences in the responses to endurance and resistance training. Euro J App Physiol, 96, 5, 535-42, springerlink.metapress.com/(d4yvil45e1gquz45jk0pgjrb)/app/home/contribution.asp?referrer=parent&backto=issue,8,20;journal,4,443;linkingpublicationresults,1:100513,1
healthy people whose training response is low after endurance training show a marked improvement in cardiorespiratory fitness by resistance training.
Holland AE, Hill C (2008) Physical training for interstitial lung disease. Cochrane Database of Systematic Reviews, 4. Art. No.: CD006322. DOI: 10.1002/14651858.CD006322.pub2
onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD006322/frame.html
exercise training improves exercise tolerance, breathlessness and QoL for people with interstitial lung disease
Holland AE, Hill CJ, Rasekaba T (2010) Updating the minimal important difference for six-minute walk distance in patients with chronic obstructive pulmonary disease. Arch Phys Med Rehab, 91, 1, 221-25
a clinically-significantly change in 6MD is 25 meters
Horner D (2001) Chronic heart failure: the challenge for physiotherapists. NZ J Physiother, 29, 15-23
exercise training is safe for people with CHF
Howe TE, Shea B, Dawson LJ, Downie F, Murray A, Ross C, Harbour RT, Caldwell LM, Creed G. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD000333. DOI: 10.1002/14651858.CD000333.pub2
www2.cochrane.org/reviews/en/ab000333.html
exercise slightly improves bone mineral density and reduces the chance of fracture.
Hunter J, Singh SJ, Morgan MDL (2006) Objective monitoring of adherence with home exercise training. Physiother, 92, 1, 50-54
Iriberri M, Galdiz JB (2002) Comparison of the distances covered during 3 and 6 min walking test. Resp Med, 96, 812-16
good correlation between 3 and 6 min walking tests
Janaudis-Ferreira T (2009) Differences in training effects following training with and without supplemental oxygen in patients with COPD. Adv Physiother, 11 (4): 186-92
Keteyian SJ, Piρa IL, Hibner BA (2010) Clinical role of exercise training in the management of patients with chronic heart failure. J Cardiopulm Rehab Prev, 30, 2, 67-76
Kortianou EA (2010) Effectiveness of interval exercise training in patients with COPD. Cardiopulm Phys Ther J, 21, 3, 1219
www.ncbi.nlm.nih.gov/pmc/articles/PMC2941353/
Lareau SC (2006) Functional status: have we found the gold standard? Chronic Respir Dis, 3, 61-2
Shuttle test and 6MD are useful to measure walking distance, but not to measure general activities nor upper limb activities
Lazo MG, Filipinas SG, Valdez JE (2003) Compliance with home exercise programs. Arch Phys Med Rehab, 84, E29
symptom relief and time constraints are the primary factors affecting compliance
Manali ED (2010) MRC chronic dyspnea scale: Relationships with cardiopulmonary exercise testing and 6-minute walk test in idiopathic pulmonary fibrosis patients. BMC Pulm Med, 10, 32. doi:10.1186/1471-2466-10-32
www.biomedcentral.com/1471-2466/10/32/abstract
in pulmonary fibrosis patients, theres good correlation between the MRC chronic dyspnoea score and physiological parameters obtained during exercise testing
Mattia ED, Barbarito N, Cirio S et al (2004) Six minute walk test with and without encouragement in severe chronic lung disease patients. Eur Respir J, 24: Suppl. 48, 515s
www.ersnet.org/ers/lr/browse/media.aspx?id_dossier=17643&id_fiche=122823
patients with severe disease should walk as fast as they like rather than their maximum,
maximum effort can cause excessive fatigue, dyspnea, tachycardia, and oxygen desaturation without increasing distance walked.
Mejia R (1999) Target dyspnea ratings predict expected oxygen consumption as well as target heart rate values. Am J Respir Crit Care Med, 159, 1485-9
respiratory patients are often too breathless to reach true maximal HR or VO2max
Mutrie N (2007) Benefits of supervised group exercise programme for women being treated for early stage breast cancer. BMJ, 334, 7592, 517
Nieman DC, Henson DA, Austin MD (2010) Upper respiratory tract infection is reduced in physically fit and active adults. Br J Sports Med, 44, 14
O'Donnell DE et al (1995) The impact of exercise reconditioning on breathlessness in severe chronic airflow limitation. Am J Respir Crit Care Med, 152, 2005-13.
exercise training reduces acute and chronic breathlessness, and increases exercise tolerance
Olivier FL (1998) Suggested guidelines for the use of exercise with adults in acute care settings. Physiother Can, Spring, 127-36
Peel C, Mossberg KA (1995) Effects of cardiovascular medications on exercise responses. Phys.Ther, 75, 387-96
Pellegrino R (1999) Breathing during exercise in subjects with mild-to-moderate airflow obstruction. J Appl Phys, 87, 1697-1704
Pepera G, McAllister J, Sandercock G (2010) Long-term reliability of the incremental shuttle walking test in clinically stable cardiovascular disease patients. Physiotherapy, 96, 3, 222-7
practice test not required
Probst VS et al (2004) Mechanisms of improvement in exercise capacity using a rollator in patients with COPD. Chest, 126, 1102-7
www.chestjournal.org/cgi/content/full/126/4/1102?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=probst&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=126&firstpage=1102&resourcetype=HWCIT
a rollator improves walking distance of patients with COPD through improved ventilatory capacity and/or walking efficiency
Rampulla C (1992) Dyspnea on exercise. Chest, 101, 248S-252S
fatigue is the main limitation to exercise in COPD, not SOB
Revill SM, Williams J, Sewell L, Collier R, Singh SJ (2009) Within-day repeatability of the endurance shuttle walk test. Physiotherapy, 95, 2, 140-43
www.sciencedirect.com/science?_ob=PublicationURL&_tockey=%23TOC%2318081%232009%23999049997%231024721%23FLA%23&_cdi=18081&_pubType=J&_auth=y&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=6104c9cba5be3f1d9d9b27b93cce6a5d
practice test not required
Ringbaek TJ (2000) Rehabilitation of patients with COPD. Exercise twice a week is not sufficient! Respir Med, 94, 150-4
twice-a-week exercise not enough to improve exercise tolerance
Ross RM, Murthy JN, Wollak ID (2010) The six minute walk test accurately estimates mean peak oxygen uptake. BMC Pulm Med, 10, 31. doi:10.1186/1471-2466-10-31
www.biomedcentral.com/1471-2466/10/31/abstract
Rydwik E (2004) Effects of physical training on physical performance in institutionalised elderly patients (70+) with multiple diagnoses. Age Ageing, 33, 13-23
institutionalised elderly people show improved strength and mobility with exercise training
Sato S (2001) Relationship between exercise tolerance and respiratory pattern and muscular strength of legs in patients with chronic heart failure. J Phys Ther Sci, 14, 47-50
exercise intolerance is related to respiratory pattern and leg strength in chronic heart failure patients
Selvadurai HC et al (2002) Randomized controlled study of in-hospital exercise training programs in children with cystic fibrosis. Pediatr Pulmonol, 33, 194-200
both aerobic and resistance training benefit people with CF
Schlader ZJ, Mundel T, Barnes MJ (2010) Peak cardiac output in trained males. Br J Sports Med, 44, 14, i21
training doubles peak cardiac output in males
Smart N (2004) Exercise training for patients with heart failure: a systematic review of factors that improve mortality and morbidity. Am J Med, 116, 693-706
Solway S, Brooks D, Lacasse Y et al (2001) A qualitative systematic overview of the measurement properties of functional walk tests used in the cardiorespiratory domain. Chest, 119, 25670
comparison of 2-min walk test, 6-min walk test, 12-min walk test, self-paced walk test, and shuttle test: 6-min test preferred
Stamatakis E, Weiler R (2010) Prevention of cardiovascular disease: why do we neglect the most potent intervention? Heart, 96, 4, 261-262
heart.bmj.com/content/96/4/261.abstract
the benefits of physical activity support its use in preventive health care and it should be a serious prescription option for the primary prevention of cardiovascular disease
Stulbarg MS, Carrieri-Kohlman V (2002) Exercise training improves outcomes of a dyspnea self-management program. J Cardiopulm Rehab, 22, 109-21
exercise helps reduce breathlessness
Tomkinson JL, Bruton A (2009) The 6-minute walk test for patients with bronchiectasis. ACPRC Journal, 41, 16-21
people with bronchiectasis show same reduction in exercise tolerance as COPD
Ussher MH, Taylor AH, West R, McEwen A (2000) Does exercise aid smoking cessation? Addiction, 95, 199-208
exercise may aid smoking cessation
Wadell K (2005) Muscle performance in patients with COPD effects of a physical training programme. Adv Physiother, 7, 51-9
normal body mass index predicts improvement in muscle performance on exercise training
Wall JC, Bell C, Campbell S (2000) The Timed Get-up-and-Go test revisited: measurement of the component tasks. J Rehabil Res Dev, 37, 109-13
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10847578&dopt=Abstract
Wolf SL, Coogler C, Xu T (1997) Exploring the basis for Tai Chi Chuan as a therapeutic exercise approach. Arch Phys Med Rehab, 78, 886-92
Woodard CM, Berry MJ (2001) Enhancing adherence to prescribed exercise. J Cardiopulm Rehab, 21, 201-9
review article
Zagol BW, Krasuski RA (2010) Effect of motorized scooters on quality of life and cardiovascular risk. Am J Cardiol, 105, 5, 672-676
www.sciencedirect.com/science?_ob=PublicationURL&_tockey=%23TOC%234876%232010%23998949994%231746096%23FLA%23&_cdi=4876&_pubType=J&_auth=y&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=804c5791ab0ec479ceb347a83d97f9a7
interventions such as motorised scooters which reduce activity can increase cardiovascular risk, particularly insulin resistance.
6MD = six-minute distance
ACCP = American College of Chest Physicians
ATS = American Thoracic Society
CF = cystic fibrosis
CHF = chronic heart failure
HR = heart rate
MRC = Medical Research Council
QoL = quality of life
SOB = shortness of breath
VO2max = maximum oxygen consumption