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Interval versus Continuous High-Intensity Exercise in Chronic Obstructive Pulmonary Disease: A Randomized Trial

Milo A. Puhan, MD, PhD; Gilbert Büsching, PT; Holger J. Schünemann, MD, MSc, PhD; Evelien vanOort, PT; Christian Zaugg, PhD; and Martin Frey, MD
[+] Article and Author Information

From University of Zurich, Zurich, Switzerland; Klinik Barmelweid, Barmelweid, Switzerland; McMaster University, Hamilton, Ontario, Canada; University at Buffalo, Buffalo, New York; Italian National Cancer Institute Regina Elena, Rome, Italy; and University of Basel, Basel, Switzerland.


Acknowledgments: The authors thank the physiotherapists and physicians who participated in the study. They also thank Professor Patrick Bossuyt, PhD, University of Amsterdam, the Netherlands, for his valuable comments.

Grant Support: By AstraZeneca Switzerland (unrestricted grant), Boehringer Ingelheim Switzerland (unrestricted grant), and Klinik Barmelweid.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Milo A. Puhan, MD, PhD, Horten Centre, University Hospital of Zurich, Postfach Nord, CH-8091 Zurich, Switzerland; e-mail, milo.puhan@usz.ch.

Current Author Addresses: Dr. Puhan: Horten Centre, University Hospital of Zurich, Postfach Nord, CH-8091 Zurich, Switzerland.

Mr. Büsching, Ms. vanOort, and Dr. Frey: Klinik Barmelweid, CH-5017 Barmelweid, Switzerland.

Dr. Schünemann: Department of Epidemiology, Regina Elena Cancer Institute, Via Elio Chianesi 53, 00144 Roma, Italia.

Dr. Zaugg: Kantonsspital Basel, Department of Research, ZLF 319, Hebelstrasse 20, CH-4031 Basel, Switzerland.

Author Contributions: Conception and design: M.A. Puhan, G. Büsching, H.J. Schünemann, E. vanOort, M. Frey.

Analysis and interpretation of the data: M.A. Puhan, H.J. Schünemann, M. Frey.

Drafting of the article: M.A. Puhan, H.J. Schünemann.

Critical revision of the article for important intellectual content: G. Büsching, H.J. Schünemann, E. vanOort, C. Zaugg, M. Frey.

Final approval of the article: M.A. Puhan, G. Büsching, H.J. Schünemann, E. vanOort, M. Frey.

Provision of study materials or patients: G. Büsching, E. vanOort, M. Frey.

Statistical expertise: M.A. Puhan, H.J. Schünemann, C. Zaugg.

Obtaining of funding: M.A. Puhan, M. Frey.

Administrative, technical, or logistic support: M.A. Puhan, G. Büsching, E. vanOort, M. Frey.

Collection and assembly of data: G. Büsching, E. vanOort, M. Frey.


Ann Intern Med. 2006;145(11):816-825. doi:10.7326/0003-4819-145-11-200612050-00006
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Between May 2004 and November 2005, 100 of 103 eligible patients agreed to participate in this study (Figure 2). One patient in each group withdrew informed consent for unspecified reasons. Forty-three (89.6%) and 44 (88.0%) patients completed the inpatient rehabilitation in the interval and continuous exercise groups, respectively. Eleven patients did not complete the rehabilitation because of COPD exacerbations (3 patients in the interval and 2 patients in the continuous exercise group); musculoskeletal pain (2 patients in the interval and 1 patient in the continuous exercise group); and, in the continuous exercise group only, chest pain, an accident, and newly diagnosed lung cancer.

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Figures

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Figure 2.
Study flow diagram.

COPD = chronic obstructive pulmonary disease; GOLD = Global Initiative for Chronic Obstructive Lung Disease.

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Figure 3.
Main comparison of health-related quality of life.

Adjusted for sex, 6-minute walking distance, Hospital Anxiety Depression Scale depression score, long-term use of oxygen, recent exacerbation, and cardiovascular and endocrine comorbid conditions. CRQ = Chronic Respiratory Questionnaire.

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Figure 4.
Main comparison of exercise capacity.

Adjusted for sex, 6-minute walking distance, Hospital Anxiety Depression Scale depression score, long-term use of oxygen, recent exacerbation, and cardiovascular and endocrine comorbid conditions. The number of patients included in the per protocol analyses were 41 for the interval exercise group and 44 for the continuous exercise group for the 6-minute walking distance, 38 and 39, respectively, for short-term maximum exercise capacity, and 41 and 43, respectively, for maximum exercise capacity.

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Summary for Patients

Interval versus Continuous High-Intensity Exercise for Patients with Chronic Obstructive Pulmonary Disease

The summary below is from the full report titled “Interval versus Continuous High-Intensity Exercise in Chronic Obstructive Pulmonary Disease: A Randomized Trial.” It is in the 5 December 2006 issue of Annals of Internal Medicine (volume 145, pages 816-825). The authors are M.A. Puhan, G. Büsching, H.J. Schünemann, E. vanOort, C. Zaugg, and M. Frey.

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