Comparison of effects of supervised versus self-monitored training programmes in patients with chronic obstructive pulmonary disease

The effects of two 8 week programmes of reconditioning in chronic obstructi ve pulmonary disease (COPD) patients were studied. Forty one subjects (mean+/-SD) 644.5) yrs; forced expiratory volume in one second (FEV1) 1.09+/-0.16 L; 40.6+/-6.2% predicted were randomly assigned e ither to supervised training on a treadmill, 4 days-week(-1) (group S; n=21 ) or walking 3 or 4 km in 1 h 4 days.week(-1), selfmonitored with a pedomet er, with weekly visits to encourage adherence (group SM; n=20), Patients we re evaluated with the chronic respiratory diseases questionnaire (CRQ) and two exercise tests on a treadmill: incremental (IT) and constant (CT), abov e lactic threshold or 70% of maximal oxygen uptake (V'O-2, max) with arteri al blood lactate determinations. Estimated mean work rate of training was 69+/-27 W and 25+/-5 W respectivel y for groups S and SM, Both types of training produced similar changes in t he four dimensions of the CRQ, In group S reconditioning yielded significan t (p<0.05) increases in V'O-2, max and increases in duration, with decrease d lactate accumulation, venti-lation, CO2 output (V'CO2), heart rate (HR) a nd diastolic blood pressure (DBP) at the end of CT. They also adopted a dee per slower pattern of breathing during exercise. The SM group showed signif icant (p<0.05) increases in duration, lower HR and DBP at the end of CT. Si gnificantly (p<0.05) different effects between S and SM pro-grammes were ch anges in V'O-2, max100+/-101 mL.min(-1) versus 5+/-101 mL.min(-1)), duratio n of the CT (8.1+/-4.4 min versus 3.9+/-4.7 min), V'CO2 (-94+/-153 mL.min(- 1) versus 48+/-252 mL.min(-1)), lactate accumulation (-1.3+/-2.2 mmol.L ver sus 0+/-1.2 mmol.L-1 and respiratory rate at the end of CT (-4.3+/-3.,4 min (-1) versus -1+/-4.2 min(-1)). Supervised, intense training yields physiological improvements in severe ch ronic obstructive pulmonary disease patients not induced by self-monitored training, The self-monitored, less intense training, increases submaximal e xercise endurance, although to a lesser degree.