This document discusses aerobic training as part of a pulmonary rehabilitation program for patients with chronic respiratory diseases such as COPD. It provides details on implementing continuous and interval aerobic training, including frequency, intensity, duration, and mode. Both training methods are shown to improve exercise capacity, health-related quality of life, and symptom control, with no significant differences found between moderate and high intensity programs. Ground walking is recommended over stationary cycling to better improve endurance walking capacity.

1. PULMONARY REHABILITATION: AEROBIC TRAINING
PHYSIOTHERAPY IN CARDIOPULMONARY CONDITIONS
(BPT402)
Submitted to- Dr. Jamal Moiz
Submitted by- Saiha Alina
BPT 4th YEAR
Roll no.-17BPT030
CPRS

2. Introduction
• The American Thoracic Society/ European Respiratory Society
(ATS/ERS) describes pulmonary rehabilitation as a
‘‘comprehensive intervention based on a thorough patient
assessment followed by patient-tailored therapies which
include, but are not limited to, exercise training, education and
behavior change, designed to improve the physical and
emotional condition of people with chronic respiratory disease
and to promote the long-term adherence to health-enhancing
behavior.’’

3. Implementing an Aerobic Training
Programme in Pulmonary
Rehabilitation
• Aerobic training is to improve endurance and exercise
capacity.
• It has been shown that endurance training also improves
peripheral muscle function in patients with COPD.
• Walking, running, cycling, stair climbing and swimming are
examples of endurance training exercise. Each of these forms
of training can be undertaken at high or low intensity; that is,
at high or low percentages of the patient’s individual maximal
work capacity for the given task

4. Continuous versus Interval Training
• The rationale for interval training included the ability to
impose high-power bursts of exercise on peripheral muscles
without overloading the cardio-respiratory system.
• Both exercise modalities led to comparable improvements in
exercise capacity and health-related quality of life.
• Nevertheless, in patients with very severe COPD there is
evidence that interval training is associated with fewer
symptoms of dyspnea during exercise and fewer unintended
breaks.

5. Table: 1 Practical recommendations for the implementation of
continuous and interval aerobic training programmes
Continuous endurance training Interval endurance training
Frequency 3–4 days/week 3-4 days/week
Mode Continuous Interval modes
30 s of exercise, 30 s of rest 20 s of
exercise, 40 s of rest
Intensity Initially 60–70% of PWR Increase
work load by 5–10% as tolerated
Progressively try to reach ,80–90%
of baseline PWR
Initially 80–100% of PWR for the
first three to four sessions .Increase
work load by 5–10% as tolerated
Progressively try to reach ,150% of
baseline PWR
Duration Initially 10–15 min for the first
three to four sessions Progressively
increase exercise duration to 30–40
min
Initially 15–20 min for the first
three to four sessions Progressively
increase exercise duration to 45–60
min (including resting time)
Perceived exertion Try to aim for a perceived exertion
on the 10-point Borg scale of 4 to 6
Try to aim for a perceived exertion
on the 10-point Borg scale of 4 to 6

6. Cycle-Based versus Walking-Based
Aerobic training
• Treadmill walking and stationary cycle training have
traditionally been the prominent exercise training modalities in
comprehensive PR.
• A study that compared ground walking with stationary cycle
training in patients with COPD showed that ground walking
improved endurance walking capacity to a greater degree, and
was as effective in improving peak walking capacity, peak and
endurance cycle capacity, and quality of life.
• The recommended ground walking intensity is 80% of the
average speed on the 6-minute walk test, or 75% of peak speed
attained with moderate dyspnea sensation (3 on the modified
Borg scale) during the incremental shuttle walking test.

7. Effect of Aerobic Training Intensity on
Symptom Control
• The results of this study show that aerobic intensity of at least
60% Wmax has a positive impact on symptom control
assessed by the transitional dyspnea index, without any
superior effect of higher intensities. These findings are in
accordance with the above-mentioned studies by Dourado et
al,37 Foglio et al,39 and Normandin et al40 with no
differences between groups.

8. Effect of Aerobic Training Intensity on
Exercise Tolerance
• International guidelines present evidence of physiological
benefits associated with higher aerobic training intensities, in
accordance with historical studies by Casaburi et al, Maltais et
al, Puente-Maestu et al, and Gimenez et al, but also more
recently by Lacasse et al, Laviolette et al, Bernard et al,
Montes de Oca et al, Dourado et al, Arnardo´ttir et al, Foglio et
al, Normandin et al, and Hsieh et al. Those studies reported
improvements in the 6MWT, incremental exercise test, and
constant-load exercise test with a pulmonary rehabilitation
program but without any evidence of significant differences in
these outcomes as an effect of the aerobic training intensities
applied.

9. Effect of Aerobic Training Intensity on
QOL
• There is evidence of a positive effect on HRQOL, as shown by
studies by Bernard et al, Pereira et al, Montes de Oca et al,
Dourado et al, Arnardo´ttir et al, and Foglio et al.
• The multi-center study by Laviolette et al with 168 subjects
with COPD also found improvement in the SGRQ after the
pulmonary rehabilitation program.
• There is equivalence impact of moderate and high aerobic
intensities on HRQOL but further refines moderate intensity as
60% Wmax and high intensity as 80% Wmax in a comparable
exercise prescription.

10. References
• Bernard S, Whittom F, LeBlanc P, Jobin J, Belleau R, Bérubé
C, Carrier G, Maltais F. Aerobic and strength training in
patients with chronic obstructive pulmonary disease.
• Rainer Gloeckl, Blagoi Marinov and Fabio Pitta. Practical
recommendations for exercise training in patients with COPD.
• Catarina Santos, Fa´tima Rodrigues, Joana Santos, Luísa
Morais, and Cristina Ba´rbara. Pulmonary Rehabilitation in
COPD: Effect of 2 Aerobic Exercise Intensities on Subject-
Centered Outcomes—A Randomized Controlled Trial