Exercise training in COPD: how to distinguish responders from nonresponders

Pulmonary rehabilitation programs consistently have improved exercise capacity, quality of life, and symptoms over the past decade. Although training has been shown to be an essential component of the rehabilitation program, individual patients do not always benefit to the same extent. The present study was designed to investigate which patients were achieving significant benefit of exercise training.

Forty-nine stable outpatients with moderate to severe COPD (FEV1 37 (15)%pred) were evaluated before and after 12 weeks of exercise training (3 times per week). Responders in exercise capacity were defined as having 15% increase in maximal workload and/or 25% increase in walking distance, while responders in quality of life showed an improvement of at least 10 points on the chronic respiratory disease questionnaire. With multivariate discriminant analysis, responders were distinguished from nonresponders based upon their initial characteristics.

Thirty-two patients were responders in terms of improved exercise capacity. Ventilatory reserve (VE/MVV), inspiratory muscle strength (Plmax), and peripheral muscle strength (handgrip force and quadriceps force) were significant predictors of the training response (P < 0.05) (accuracy 80% P < 0.001). Although the explained variance was modest, patients that were clearly ventilatory limited and had normal skeletal muscle strength were not likely to benefit from exercise training in terms of exercise capacity. No physiologic variables predicted whether a patient would increase quality of life after exercise training.

Patients with reduced exercise capacity who experience less ventilatory limitation to exercise and more reduced respiratory and peripheral muscle strength are more likely to improve with exercise training. Improvements in quality of life after exercise training were significant but remained unpredictable with variables included in the present trial.